Hospital Billing and Financial Practices: “First Do No Harm”

Hospitals Should Make Certain Their Policies Do Not Burden Community Residents or Employees  

The doctrine, First Do No Harm, is a fundamental health care principle. It guides providers as they consider the possible harm that might result from their actions or interventions. At this time when millions of people across the country are struggling with financial challenges, it is imperative that hospitals examine their practices for providing financial assistance, collecting outstanding medical bills and compensating employees with this principle in mind. Given the racial and ethnic disparities laid bare by the COVID-19 pandemic, examination of all these practices should be done through a racial equity lens. 

As Dr. Antony Fauci, the nation’s top infectious disease expert recently said, the COVID-19 pandemic exposed “the undeniable effects of racism” that have led to unacceptable disparities that hurt Black, brown and Indigenous people. The effects of racism play out in health care and far beyond. People of color are more likely to be uninsured compared to white people. As Black people comprise a great percentage of the population in states that have not expanded Medicaid, they are more likely than whites to fall within the coverage gap, having incomes above the Medicaid eligibility threshold but below the poverty rate and therefore ineligible for coverage under the Marketplace. Racial and ethnic minority groups are disproportionately represented in essential work settings like health care facilities, grocery stores, public transportation, production, and food processing, putting them at heightened risk of being exposed to COVID-19. Yet the vast majority of these jobs do not offer sufficient paid sick time or health benefits. In addition, certain racial and ethnic groups have lower incomes, less wealth and greater levels of debt.   

Hospitals, as valued community institutions, should be on the leading edge of interrogating their policies to ensure they are not a burden on the communities they serve. Communities would be well served if hospitals would follow the lead of the federal government, as directed by President Biden through his Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, assessing whether, and to what extent, programs and policies perpetuate systemic barriers to opportunities and benefits for people of color and other underserved groups. [1] As with federal agencies, hospitals must work with groups that have been historically subject to discrimination in policies and programs and engage with community-based organizations and civil rights organizations to advance racial justice. 

We urge all hospitals in the U.S. to begin by conducting a thorough examination of their financial assistance, billing and collection policies to make certain they provide equal opportunity for all people. Though the economy may be improving, millions of Americans are still out of work and are not feeling financially secure. Health care costs are an ongoing concern. A recent poll found that two-thirds of people worried they will not be able to afford health care this year. Another survey found that one in five people – more than 46 million adults – did not seek treatment for a health problem during the pandemic. Though Americans of all races skipped treatments in nearly equal numbers last year, about one-third of Black adults – almost double the number for white adults – and more than one-fifth of Hispanic adults, said they could not afford health care if they needed it today. This problem is made even worse as reports of hospitals suing their patients and garnishing wages strikes fear into the hearts of those who need medical care.