PRESS RELEASE: Inconsistent Hospital Policies Put Patients at Greater Risk of Medical Debt

Analysis of 2,500 charity care policies finds significant variation in New York, Dallas, and many other U.S. cities

Boston, Mass.— A new report from the Lown Institute, an independent healthcare think tank, examines the policies of 2,500 U.S. hospitals and reveals a chaotic patchwork of practices that leaves patients vulnerable to confusion and medical debt. Patients with identical income and medical needs could receive free care at one hospital, yet face collections or lawsuits at another.

Hospitals are expected to provide free or discounted care to patients and have a written policy outlining eligibility requirements. But in the absence of clear federal standards, hospitals set their own rules for who qualifies and how aggressively they pursue unpaid bills. These decisions have major consequences on patients.

“This isn’t a case of red states versus blue states, or rural areas versus cities,” said Vikas Saini, MD, president of the Lown Institute. “We’re seeing massive disparities in charity care policies between hospitals that are practically around the corner from each other. Unfortunately, low- and middle-income patients are the ones who deal with the consequences.”

In New York City, a family of three earning $100,000 qualifies for free care at Tisch Hospital, but would be ineligible at NewYork-Presbyterian, where the threshold is $53,000. In Boston, the same family could get free care at Beth Israel Deaconess Medical Center, but not at Brigham and Women’s Hospital.

Similar disparities exist in cities like Dallas, Tucson, Los Angeles, and Pittsburgh.

Other findings from the report include:

• Most hospitals (87%) offer free care, but many impose restrictions based on location, insurance status, or types of services.
• Free care thresholds vary from below 100% of the federal poverty level ($25,000 for a family of three) up to 600% ($150,000).
• Most hospitals (59%) allow at least one extraordinary collection action, like wage garnishment, selling debt to a third party, or denying non-emergency care. 
• Only 10–15% of hospitals explicitly state they will not take these actions, leaving the vast majority of patients unsure of what to expect.

“When hospitals fail to make access to assistance easy and predictable, it drives people away from care and erodes trust in our entire system,” said Dr. Saini. “Right now, the burden is on patients to navigate a broken system. That has to change.”

To improve access to financial assistance and reduce harm from medical debt, researchers say that state and federal policymakers could set minimum eligibility standards, require patient screening for financial assistance, create a uniform application, and restrict allowed collection actions. 

A searchable list of all 2,500 hospitals is available and the full dataset can be downloaded from the report website. A companion white paper, written in collaboration with patient advocates and researchers, addresses the scope, drivers, and solutions for medical debt.

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About the Lown Institute

The Lown Institute is an independent think tank advocating bold ideas for a just and caring system for health. We envision a healthcare system focused on what’s best for people, like hospitals caring for those most in need, patients living without fear of financial distress, and health professionals finding joy in their roles. The Lown Hospitals Index, a signature project of the Institute, is the first ranking to assess the social responsibility of U.S. hospitals by applying measures never used before like community investment, medical overuse, and CEO pay. 

Contact

Aaron Toleos, Lown Institute, (978) 821-4620, atoleos@lowninstitute.org