Businessweek: I'm quoted on hospital collection practices

Bloomberg Businessweek has a story on how hospitals are asking for payment from patients upfront. I’m quoted:

“It used to be taboo to look like you were looking for money at a time when you were supposed to be focused on patient care,” David Williams, president of Boston-based consulting firm Health Business Group, said. “It’s not taboo anymore.”

I can’t really fault hospitals for trying to get paid (see Hospitals asking for payment upfront: generally ok with me). Their policy actually reveals some problems with the system:

  • Complexity and delays in the payment system mean a hospital often doesn’t really know how much a patient owes toward their out-of-pocket maximum
  • The growth of high-deductible health plans is good in theory because it gives patients an incentive to avoid unneeded services and seek care at cost-effective facilities. In practice it can act more like a poll tax by erecting high barriers to care for people with low incomes –even if they have insurance– while being inconsequential to those with higher incomes

The poll tax analogy isn’t entirely fair: many lower income people qualify for Medicaid, employers often fund HRAs and HSAs, and the plans’ intent is not to exclude certain classes of people. Nevertheless the impact is analogous in some cases.


By David E. Williams of the Health Business Group,

October 14, 2013

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