Medical debt in the United States has become a pressing issue – it affects up to 41% of Americans and severely diminishes both patients’ trust in the health care system and their ability to access care. Many patients face financial burdens due to the increasing costs of care, inadequate insurance coverage, and unexpected medical emergencies.
A wide variety of attributes of our health care system contribute to the problem of debt, from the prices of health care products and services to changes in insurance policies to the billing practices of health systems and hospitals. While no single individual or organization can solve this complex problem, hospitals and clinicians have an important role to play in protecting patients’ interests, reducing financial harm, and strengthening trust.
Addressing Medical Debt: A Playbook for Hospitals and Clinicians
Developed by AcademyHealth with support from the ABIM Foundation, Addressing Medical Debt: A Playbook for Hospitals and Clinicians offers practical recommendations, tools, and real-world examples to help hospitals and clinicians address the financial challenges patients face.
The playbook focuses on three areas for action: aligning hospital financial policies with organizational values, improving the patient financial experience, and partnering with community organizations to support patients. It includes three practical “plays,” four case examples, and resources that can be adapted to different settings.
Not sure where to start? The accompanying one-page resources for hospitals and clinicians highlight practical actions you can take. Start with the resource most relevant to your role, then explore the full playbook for additional guidance, tools, and examples.
For Hospital Leaders
Explore practical steps to align financial policies with organizational values, improve financial assistance and billing processes, and build partnerships that support patients.
For Clinicians
Explore ways to discuss costs with patients, connect them with financial assistance and other resources, and share insights that can help improve organizational processes.
Explore the full Playbook
Addressing Medical Debt: A Playbook for Hospitals and Clinicians provides additional recommendations, questions for consideration, implementation tools, and case examples to help hospitals and clinicians identify opportunities for meaningful change.
How We Got Here
The playbook builds on earlier work by the ABIM Foundation and AcademyHealth to better understand the causes and consequences of medical debt, identify promising approaches to reducing financial harm, and explore opportunities for hospitals and their partners to take action.
2024 Medical Debt Convening: Strategies, Gaps, and Opportunities
In June 2024, more than 60 health care leaders and advocates met to discuss best practices and promising approaches to address medical debt. The discussion highlighted several areas for action:
- Establish and expand financial assistance programs: Simplify applications, expand eligibility, and strengthen financial counseling and patient navigation.
- Improve billing and collections practices: Make bills clearer and more accurate, address billing errors, and avoid extraordinary collection actions that can cause additional financial harm.
- Address system-level challenges: Improve price transparency, examine the financial experiences of hospital employees, and use data to identify and address the causes of medical debt.
- Strengthen coordination and accountability: Encourage collaboration across hospital departments and with external partners, and measure the impact of medical debt.
- Advance research: Better understand the effectiveness of financial assistance programs, the costs and benefits of debt collection, and the effects of medical debt on patients’ health and care-seeking behavior.
These discussions informed the Foundation’s continued work to identify practical opportunities for hospitals, clinicians, and community organizations to reduce the burden of medical debt.
Download the Convening Summary
2026 Report: Hospitals and Medical Debt
Building on this work, a 2026 report from AcademyHealth – supported by the ABIM Foundation – examines how hospitals are addressing medical debt and where gaps remain.
Based on a literature review and interviews with hospital leaders and experts, the report explores:
- 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
- Systemlevel drivers, including financial pressures, payer dynamics, private equity involvement, and the high cost of care.
