How rural hospitals can tackle cost-driven health care delays without reducing prices

By: Angela Lutz | 4/14/23

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Gallup's annual health and health care poll revealed that in 2022, more Americans than ever delayed medical care due to cost, coinciding with the highest U.S. inflation rate in more than 40 years. Lower-income households, women, and young adults are disproportionately affected, and this trend presents serious public health risks. Untreated medical conditions can lead to more severe health complications, further straining rural hospitals that already grapple with unique challenges such as limited resources, workforce shortages, and accessibility issues. To mitigate these concerns, rural hospitals must adapt and find innovative solutions to ensure their communities receive timely and affordable care.
 
Historically, rural hospitals have been particularly susceptible to health care cost barriers. With more financial responsibility placed on patients through increased deductibles, copays, and coinsurance, it’s not surprising more patients in rural America are putting off care to avoid costly bills. Add in record-high inflation and we have a perfect (or not-so-perfect) storm preventing access to affordable care.
 
Here’s why that’s harmful:
 
1. It’s bad for public health and productivity 
According to the Centers for Medicare and Medicaid Services, more than 18 percent of the U.S. gross domestic product is allocated to health care, amounting to more than $12,914 per individual. The indirect expenses linked to preventable chronic diseases such as impacts on worker productivity and the subsequent burden on national economic performance could soon surpass $1 trillion annually. 
 
Let’s look at some of the numbers: 

• Heart disease in America costs our health care system $216 billion per year and causes $147 billion in lost productivity.
• The aggregate cost of U.S. cancer care is expected to reach more than $240 billion by 2030. 
• Obesity, which is more prevalent in rural America, costs the U.S. health  care system nearly $173 billion a year. 

*Source: Centers for Disease Control and Prevention 
 
Effective preventative care can reduce costs later— but affordability concerns disrupt this logic. When the cost of care is too high, people are less likely to seek preventive care and early intervention, which are crucial to maintaining good health and preventing more severe and costly health issues later.  
 
2. The high cost of health care is creating an even wider gap in health outcomes 
The CDC identifies health disparities as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” High-cost health care disproportionately affects low-income and historically marginalized populations who may struggle to afford necessary medical care, resulting in a higher risk of poor health outcomes due to limited access to necessary care. 
 
3. Avoiding care now creates problems for nonprofit hospitals later  
When left untreated, benign health problems often lead to chronic, costly diseases. For instance, an undiagnosed and prolonged case of high blood pressure increases the risk of heart failure. When diagnosed early, preventive screenings, lifestyle changes, and medication are extremely effective. However, 20.1 million U.S. adults have heart failure. The cost of caring for a patient with heart failure amounts to $10,737 to $17,830 per patient per hospitalization². That’s why it’s critical for rural hospitals to take the necessary steps to make care — and especially early intervention — more accessible.  
 
While nonprofit hospitals in rural America aim to provide accessible health care to their communities and patients, sometimes they don’t have the right tools to decipher which patients can pay and which patients can’t afford to pay — and they need help, because this is becoming a major problem.  
 
Here’s why: 

• Studies show that up to 75 percent of accounts that hospitals send to collection agencies could have qualified for financial assistance.  
• Millions of Americans face the potential loss of Medicaid coverage this year. The medical field, already grappling with dwindling federal pandemic relief funding and substantial labor costs and shortages, must now address the challenges of losing millions of insured patients, despite the lower rates paid by Medicaid. 
• When considering the fact that patients have increasingly been avoiding care, it leads to many challenges ahead for hospitals, which will likely see bad debt soar in the years to come. 

 
So how do we fix this?
Rural hospitals should consider updating their financial assistance policies and redesigning the patient experience with financial assistance programs that are tailored to the unique needs of their communities. Removing cost as a barrier to care for lower-income, underinsured individuals is proven to increase patient volume and insurance revenue.
 
The rising trend of patients delaying medical care due to cost is alarming, and hospitals have a role to play in addressing this issue. By adapting to the unique challenges they face, rural hospitals can help ensure every patient receives the care they need without access being blocked by financial concerns. When a hospital financial assistance program is well promoted and works as intended, both patient and hospital benefit, leading to less bad debt, more revenue, and greater access to care. By promoting financial assistance, redesigning financial assistance programs, and implementing tools that streamline the process, rural hospitals can rise to the challenge and provide essential care to their communities.


NRHA adapted the above piece for publication within the Association’s Rural Health Voices blog from Breez Health, a trusted NRHA partner empowering hospitals to drive organizational growth and affordability of care to vulnerable members of their communities.