We have all had some visibility to the effects of the high-deductible health plans (HDHP); however, I'm not sure how many people predicted the behavior that many medical providers are seeing from their patients. In an article published in The New York Times, the study described numerous interviews with patients that indicated they had to make difficult decisions to put off care because of the cost for which they were now responsible. Here is one of the more shocking examples:

It's no secret that use of high deductible healthcare is on the rise, the amount of each deductible is on the rise and most patients are not prepared to pay their deductibles. Insurance companies want the patient to have some skin in the game when it comes to their cost of care. So much so that most contracts between providers and insurance companies specifically prevent the hospital or physician from discounting patient deductibles.

The Story Simply having insurance does not solve the challenge related to medical bills that many Americans face. It is unlikely that this statement is shocking or even surprising to most. What could be construed as shocking, however, is how far reaching the problem is and the drastic measures people go to in order to pay for medical care.

This McKinsey study did a fantastic job of explaining what we have seen in the patient account financing industry for the last five years.

Half of all debt on consumer credit reports is due to medical debt. Medical debt, more often than not, comes from an unexpected event or illness. Let's walk through an extreme, but not unlikely, example. One day a person has a decent job, health insurance, and a savings account. They make all their credit payments on time and have a decent credit rating. The next day, this person is in a severe car accident. The person is transported to the emergency room via ambulance. The person's condition is evaluated and determined that surgery is necessary. Surgery goes well, but the person has a long path to recovery. They stay in the hospital for a while and then the doctor determines they are well enough to continue recovery from home. All necessary medical equipment is sent to their home. After a period of time, the person is well enough to start physical therapy. Physical therapy sessions are more frequent in the beginning, but the doctor recommends they continue the therapy for several months.

athenahealth’s More Disruption Please (MDP) Network has the stated goal of “disrupting the status quo in healthcare” through partnerships in their Marketplace. athenahealth’s MDP process ensures seamless integration and implementation with each customer.

Consumers spent $824 billion for healthcare services in 2014, and out-of-pocket expenses are projected to rise more than $400 billion by 2016. According to the National Association of Healthcare Access Management (NAHAM), self pay has become the third largest payer to medical providers, only behind Medicare and Medicaid. On average, it costs the medical provider twice as much to collect from the patient. Medical providers are implementing drastic changes to account for the shift in payers and attempting to improve their collecting of patient responsibility; however, NAHAM states that 55% of patient responsibility is never collected.

Every month Becker's Hospital Review publishes their list of hospitals that have received credit downgrades. The list can be excruciating to look at because of the mighty repercussions that come from a downgrade. This is especially true if the hospital was about to launch a new construction project or look to expand through acquisition. Even a slight downgrade can deliver a mighty blow to a hospital's ability to obtain and/or service debt.

The Centers for Medicare & Medicaid Services (CMS) published a report outlining the projected national health expenditures through 2025. “From 2015 to 2025, health spending is expected to grow an average of 5.8 percent a year — 1.3 percentage points faster than the economy, measured by the gross domestic product,” according to Robert Pear in a NY Times article. The Obama Administration said, “National health spending will average more than $10,000 a person this year for the first time.”

The Consumer Financial Protection Bureau (CFPB) continues to encourage financial institutions to help those with limited or no credit histories. This group, referred to as credit invisible, represents one in every ten adults in the United States. These individuals have not had the opportunity or ability to build enough credit to generate a score with any of the nationwide credit reporting companies. In a CFPB article, the bureau recommends ways for individuals to begin building their credit in order to gain access to the numerous opportunities in life that have a credit requirement for participation.