Doctors Feel Helpless When It Comes to Patient Medical Debt
/By Crystal Lindell
A new study looked at medical debt from the point of view of doctors and other medical professionals. What researchers found offers insights into how burdensome medical debt has become on the healthcare system as a whole in the United States – and how helpless doctors feel in the face of it.
According to the Census Bureau, about 14 million Americans owe over $1,000 in medical debt and about 3 million owe more than $10,000.
The new report – released by Undue Medical Debt, a nonprofit funded by the Robert Wood Johnson Foundation – found that medical debt is a serious problem for clinicians and their patients, and that it’s impacting how, when and if patients receive care.
In short, doctors feel they are forced to weigh bad financial health versus bad physical health in their treatment decisions.
For the study, Undue Medical Debt, held four focus groups in early 2024. Each group consisted of a diverse group of participants, including family doctors, internists, hospitalists, nurse practitioners and community health workers, who shared their experiences with patients struggling with medical debt.
They found that cost-of-care conversations with patients were relatively common and that patients were less afraid to talk about their medical debt than anticipated. However, clinicians feel they have very limited training and few resources to offer patients
Most focus group participants reported having regular conversations with patients about medical debt and that patients were concerned about paying for their care. But the healthcare system is so replete with confusing and often disparate policies that it is difficult to be a fully informed consumer.
One clinician said that when patients take on medical debt, they end up deferring their healthcare, which is bad for them, their families and for the healthcare system as a whole.
“Because you have someone that, if they could have come in a year and a half before, you’re treating elevated cholesterol and blood pressure, but they push off their care and a year and a half after that, they’re showing up in your emergency room with a stroke,” the clinician said.
“That costs them more money, that costs the system more money, and so it’s a very negative perpetuation of bad value; when you put debt upon debt people stay away from healthcare.”
Clinicians said that they hope the importance of physical health will win out, but those decisions are often out of their control. They worry about the patient who disappears from care, particularly those who show up months, years or even decades later with advanced disease that could have been successfully treated earlier.
Several clinicians thought the healthcare system as a whole was on the verge of collapse.
“I’m not sure how much power I have. I’m sure there’s something that I can do more of, maybe from a top level. I guess sit on a board, talk to some of our administrators,” one clinician lamented. “But in general, healthcare has just unfortunately become such a machine. You know, it’s just such a machine.”
They added that they’re trying to give people the best care they can, but time constraints hold them back. Many felt helpless.
“We’re trying to address unbelievable amounts of problems, five and six different comorbid problems that are really, really serious and trying to prioritize, and we do that for probably, some of us, myself, 14 to 19 people a day, in some cases sometimes more,” one provider said.
Undue Medical Debt said that the business of medicine has pulled clinicians away from practicing medicine, forcing them to become financial counselors on top of their other duties. While many note this is outside their purview, they also understand they have “no choice” but to play this role.
Doctors and nurses in the focus groups blamed multiple actors for the state of the healthcare industry, such as insurers, pharmaceutical companies and health system bureaucracy.
When testing policy fixes with clinicians, the most popular ones included: presumptive financial aid screening; hiring people to help patients access resources and financial aid in multiple languages; capping interest rates, and making home foreclosures due to medical debt illegal.
The Consumer Financial Protection Bureau recently adopted a rule that bans all medical debt from credit reports and prohibits lenders from using medical information in their lending decisions. That will remove an estimated $49 billion in medical bills from the credit reports of about 15 million Americans.
Veterinarians Know. Why Can’t Doctors?
As a patient, I have long bemoaned the fact that the cost of medical services is so far removed from providers. There aren’t many other businesses that operate in such a way. Usually the person selling a service has to be aware of the cost of that service. And make no mistake, in a for-profit healthcare system, doctors are selling you healthcare.
There’s one example that highlights how absurd the situation has gotten – veterinarians. When I take my cat to the vet – a medical office where most customers pay out of pocket – the veterinarians and their staff are always acutely aware of the cost of each procedure, and they always provide an estimate up front.
It’s a system that makes me believe such care is possible for human patients, too. However, anytime I’ve seen a doctor and brought up pricing before agreeing to a test or procedure, the doctor has looked at me like I was speaking in an alien language. They can’t fathom that they would ever be asked to provide a cost estimate for their own services, much less factor it into treatment options.
I don’t currently have health insurance, so cost is an enormous factor for me now. However, even when I did have what people would consider “good” health insurance, co-pays and out of pocket expenses ruined my credit.
Yet anytime I tried to get cost estimates in advance of treatments or procedures, they would imply that I must not value my body if I am concerned with such petty things as money.
To be honest, even that was somewhat understandable a few years ago. But recently, many hospitals and doctors have resorted to what Undue Medical Debt calls “Extreme Collection Actions.” That’s when hospitals and doctors used collection methods such as suing people, taking their homes, or garnishing wages.
For many patients in the United States, the system is set up so that when you see a doctor, they order tests and treatments without telling you any sort of price range at all. Then they send you an opaque bill that lacks any sort of price breakdown. And then they’ll report you to a credit collector if you don’t pay them.
The fact that any of this is legal shows how broken healthcare has gotten.
While many doctors quoted in the Undue Medical Debt study said they don't want to be bothered with talk about money, that’s a luxury their patients don’t have.
Undue Medical Debt has a free downloadable toolkit designed to help healthcare workers have conversations about cost and medical debt with their patients.
“Our toolkit lays the groundwork to not only help clinicians assist their patients in avoiding the unjust burden of medical debt, but it also encourages clinicians to leverage their expertise and lived experience to champion upstream solutions to stymie the creation of unpayable medical debts to begin with,” said Eva Stahl, Undue Medical Debt’s Vice President of Public Policy and Program Management.
Here’s hoping doctors actually use it.
