Hospital billing and collection practices, a national data set

A two-year project examining the extent to which hospitals send bills to collections, deny care, and sue patients.

The United States faces a significant and persistent issue with medical debt that continues to intensify. Millions of Americans are affected. Even those with relatively good health insurance plans may find themselves grappling with substantial medical bills and accumulation of debt.

One factor contributing to this phenomenon is the varied billing and collection practices of hospitals. Some hospitals file lawsuits against patients or deny care to those with outstanding bills. Hospitals also engage third-party debt collection agencies to recoup outstanding payments, which can lead to damaged credit scores and a cycle of financial hardship for patients already in a vulnerable position due to their health conditions.

Advocates argue for addressing the root causes of high healthcare costs, improving transparency in pricing, and making changes to help patients navigate and negotiate their medical bills. But more data is needed to help inform these and other efforts aimed at reducing the medical debt problem.

Lown’s project involves a systematic review of financial assistance policies and billing and collection practices across 2,500 hospitals in the United States. Initial data are expected to be available in mid-2024 with a full report being issued in 2025. This work builds upon existing research conducted by Noam Levey, senior correspondent, at KFF Health News.

This project is supported  through funding from Arnold Ventures.

State of Medical Debt in the US

This two-hour webinar featured multiple panel discussions addressing the growing problem of medical debt in the United States. This was a must attend event for policymakers, journalists, thought leaders, and anyone else interested in getting up to speed on the scope of the problem, drivers, and possible solutions–by hearing directly from those most active in this space.

Watch the event recording

VIDEO: The state of medical debt in U.S. webinar, featuring Elisabeth Benjamin, Community Service Society of NY; Ruth Landé, Undue Medical Debt; Lisa Edmonds, patient advocate; Berneta Haynes, National Consumer Law Center; Noam Levey, KFF Health News; Sara Rosenbaum, Milken School of Public Health, GWU; Christopher Goodman, Internal Medicine; School of Medicine Columbia; Paula Smith, Lown Institute; and Alexandra Spratt, Arnold Ventures.

Download Project Data

DOWNLOAD: Hospital financial assistance, billing and collections data

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Project Team

Vikas Saini, MD, president; Kelsey Chalmers, PhD, director of research; Paula Smith, MPH, senior data scientist; Carissa Fu, chief of staff; Anna Back, MPH, healthcare data research assistant; Vivien Talon, healthcare data research assistant; Kassandra Jean-Marie, healthcare data research assistant; Stephanie Serrato, MPH, healthcare data research assistant.


If you have questions about the project, contact Carissa Fu, chief of staff, at

Media inquiries should be directed to Aaron Toleos, vp of communications, at

Related Blog Posts

Should hospitals be judged by their billing practices?

Which hospitals are suing patients? Investigation reveals hospital billing practices

Medical debt is a crisis. Is debt forgiveness the answer?

Surprise billing — another potential risk of overuse

Are Hospitals Driving Medical Debt?

How to stop hospitals suing patients

Is there an “equitable” way to sue patients for medical bills?

Related News

They Were Entitled to Free Care. Hospitals Hounded Them to Pay. NY Times

In This Oklahoma Town, Most Everyone Knows Someone Who’s Been Sued by the Hospital. KFF Health News

After Washington state lawsuit, Providence health system erases or refunds $158M in medical bills The Associated Press

Medical Debt—An Iatrogenic Epidemic With Mortal Consequences JAMA Network