Patient Repayment of US Hospital Bills From 2018 to 2024

How has patient repayment of owed cost sharing changed over recent years, and how does it vary with patient, clinician, and service characteristics?This cross-sectional study of patient accounts at 217 US hospitals from 2018 to 2024 found that prior to the COVID-19 pandemic (January 2018-February 2020) mean repayment rates were approximately 54% and declined in recent years. Repayment rates varied by bill size with lower repayment rates on the smallest and largest bills, and higher repayment rates on midsized bills.These findings suggest that changes to insurance design and consumer protections removing medical debt from credit reporting may contribute to recent trends of incomplete and decreasing repayment rates, which contribute to medical debts and hospital collection shortfalls.

Corresponding Author: Benedic Ippolito, PhD, American Enterprise Institute, 1789 Massachusetts Ave NW, Washington, DC 20036 (benedic.ippolito@aei.org).

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