This environmental scan highlights how hospitals are addressing medical debt, identifies key gaps in evidence and reporting, and outlines strategies and opportunities for a more just and patient‑centered financial landscape.
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. Eva Stahl, Vice President of Policy, Engagement, and Research at Undue is a co-author on this report.
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