Hospitals and Medical Debt: A Report on Policies and Practices
AcademyHealth, with support from the ABIM Foundation, explores hospital policies and practices focused on reducing medical debt, highlighting evidence gaps and promising approaches for hospitals and health systems to address this growing problem.
Medical debt affects up to 41 percent of Americans and contributes to delayed care, worse health outcomes, and declining trust in the health system. Hospitals sit at the center of this challenge, with influence over whether medical debt is incurred, mitigated, or prevented through financial assistance, billing practices, and community partnerships.
With support from the ABIM Foundation, AcademyHealth conducted a two‑part environmental scan, including a literature review and 18 key informant interviews, to better understand how hospitals are approaching medical debt mitigation and collection.
The report examines:
• The federal and state policy context shaping hospital obligations and patient protections;
• Evidence on effective strategies, including financial assistance, presumptive eligibility for Medicaid, financial navigation, and medication‑focused support;
• Billing and collections practices, including trends in extraordinary collection actions; and
• System‑level drivers, including financial pressures, payer dynamics, private equity involvement, and the high cost of care.
Findings reveal wide variations in hospital policies and practices, misalignment between financial performance and financial assistance, and gaps in standardized reporting and transparency.
By prioritizing patient-centered financial assistance and ethical billing, and engaging with community-focused partners, hospitals and health systems can play an instrumental role in reducing medical debt and rebuilding trust.
Supplementary Materials
In addition to the full report, companion resources are available for a range of different audiences, summarizing key insights and actionable strategies:
- Executive Summary
- One-pager: 5 Ways Health Systems and Partners Can Reduce Medical Debt
- Issue Briefs: Hospitals and Medical Debt: Insights and Actions for