Ippolito Benedic, Trish Erin, Duffy Erin L, Vabson Boris
American Enterprise Institute, Washington, DC.
Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles.
JAMA Health Forum. 2025 Aug 1;6(8):e252284. doi: 10.1001/jamahealthforum.2025.2284.
Patient cost sharing liability has risen in recent years, increasing the costs associated with care for patient households and imposing collections challenges for hospitals and clinicians.
To measure patient repayment of cost sharing over recent years, and how that varies across patient, hospital, and service characteristics.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of billing and payment data from a revenue cycle management company examined patient accounts at 217 US hospitals from 2018 to 2024. Participants included 24.5 million and 6.2 million patient episodes of care with positive patient out-of-pocket liability for individuals with private insurance and Medicare Advantage, respectively.
Percentage of owed patient cost sharing actually paid among patients with private insurance and Medicare Advantage measured over time, for inpatient and outpatient care and by bill size.
Across the full sample of 217 US hospitals (30.7 million patient episodes), mean (SD) patient liability per person, including those with no liability, was higher for individuals with private insurance ($375.41 [$51.55]) than those with Medicare Advantage ($172.50 [$14.84]). Consistent with high-deductible plan design with annual resetting, mean patient liability was higher for visits in January than December, particularly among the privately insured (eg, mean [SD] patient liability for visits among the privately insured in January: $479.44 [$29.21] vs December: $321.63 [$14.29]). Prior to the COVID-19 pandemic (January 2018-February 2020), mean repayment rates were 53.9% and 54.0% for patients with private or Medicare Advantage insurance, respectively, and repayment rates declined in more recent years. Across the entire sample, patients with private or Medicare Advantage insurance paid either 0% or 100% of their owed cost sharing in 92.2% and 94.1% of cases, respectively. Repayment rates varied by bill size with lower repayment rates on the largest bills and the smallest bills, and higher repayment rates on midsized bills.
This cross-sectional study found that patient cost sharing repayments were incomplete and have fallen in more recent years, which result in both medical debts for patients and collections shortfalls for hospitals and clinicians. These findings suggest that changes to insurance plan design or the treatment of medical debt are among several factors that may contribute to observed results; if declines in cost sharing repayment continue, hospitals and clinicians may increasingly seek payment of cost sharing ahead of service, when allowable.
近年来患者的费用分担责任有所增加，这增加了患者家庭的护理成本，并给医院和临床医生带来了收款挑战。
衡量近年来患者费用分担的偿还情况，以及其如何因患者、医院和服务特征而异。
设计、设置和参与者：这项对一家收入周期管理公司的计费和支付数据进行的横断面研究，考察了2018年至2024年美国217家医院的患者账户。参与者分别包括2450万和620万例有私人保险和医疗保险优势计划的患者自费责任为正的护理事件。
按时间、住院和门诊护理以及账单规模衡量，有私人保险和医疗保险优势计划的患者实际支付的应承担费用分担的百分比。
在217家美国医院的整个样本（3070万例患者护理事件）中，包括无责任患者在内，私人保险患者的人均责任（标准差）（375.41美元[51.55美元]）高于医疗保险优势计划患者（172.50美元[14.84美元]）。与每年重置的高免赔额计划设计一致，1月份就诊的患者平均责任高于12月份，尤其是在私人保险患者中（例如，1月份私人保险患者就诊的平均[标准差]患者责任：479.44美元[29.21美元]，而12月份为321.63美元[14.29美元]）。在2019冠状病毒病大流行之前（2018年1月至2020年2月），私人保险或医疗保险优势计划患者的平均偿还率分别为53.9%和54.0%，近年来偿还率有所下降。在整个样本中，私人保险或医疗保险优势计划患者分别在92.2%和94.1%的情况下支付了0%或100%的应承担费用分担。偿还率因账单规模而异，最大账单和最小账单的偿还率较低，中等规模账单的偿还率较高。
这项横断面研究发现，患者费用分担偿还不完整且近年来有所下降，这既导致患者产生医疗债务，也导致医院和临床医生出现收款短缺。这些发现表明，保险计划设计的变化或医疗债务的处理是可能导致观察结果的几个因素之一；如果费用分担偿还率继续下降，医院和临床医生可能会在允许的情况下，越来越多地在服务前寻求收取费用分担。
