Trends In Patient Cost Sharing For Hospital Care And Implications For Urban And Rural Hospital Revenue

Understanding the evolving composition of cost sharing and its interaction with shifts in inpatient and outpatient care delivery is essential for anticipating financial pressures on both patients and health care providers. This study leveraged eleven years of commercial insurance claims from the Health Care Cost Institute to investigate changes in the distribution of magnitudes of cost sharing owed and the share of allowed amounts anticipated as cost-sharing collections by hospitals. We found that despite declining or stable utilization rates during the period 2012-22, mean per enrollee spending and patient cost-sharing burdens grew substantially in more recent years. Cost sharing has notably shifted in composition toward both high-cost and zero-cost encounters, consistent with the adoption of high-deductible health plans on the one hand and out-of-pocket maximums and preventive or other services covered in full on the other. These trends may disproportionately affect rural hospitals, which face a higher share of patient-responsible revenue and likely greater challenges in collection.