Healthcare Blame Game: How news outlets mishandled a medical debt study

Brad Dennison is a 25-year veteran of the newspaper industry. He served 15 years as the top news executive for multiple national organizations and led thousands of journalists across the U.S., including investigative teams. He’s also a past board member of the Associated Press Media Editors, where he was elected national chair. Dennison joined HFMA as chief content executive in 2019.

Headline: Americans are knee-deep in medical debt. Most owe hospitals.
Sources: The Washington Post (syndicated to various media outlets)
Reporter: Freelancer
Published: March 18, 2023

This recent article about medical debt from The Washington Post is based on an Urban Institute survey of 9,494 adults ages 18 to 64 with some fairly common sense results:

• Low-income people are disproportionately affected by overdue medical debt.
• The more money you have, the lower your overdue medical bills.
• Most people with overdue bills have been contacted about the amount due.
• A major culprit of debt is emergency department visits.

The institute’s report is based on its June 2022 “Health Reform Monitoring Survey” and reinforces a lot of intuitive points, like those above, but the report is a bit loose with data, relying heavily on percentages with few hard numbers and several moving parts that forced me to do extra math. The report itself acknowledges some of its own issues in its “Limitations” section. Here are a few worth noting:

• “Because the survey only asks adults with past-due medical debt about actions taken by providers to make bills easier to pay, receipt of charity care by adults without past-due medical debt, which may have prohibited them from incurring such debt, was not observed.”
• “There may be measurement error in self-reported past-due medical debt …”
• “Some respondents may have misreported having past-due hospital debt if they received services from providers who were not employed by the hospital.”

Citing the study, the original article made a statement that “nearly three-quarters of those surveyed owed some or all of that debt to hospitals … Owing a hospital also meant higher amounts of debt across the board.” However, this is incorrect based on the source material. While 9,494 people were surveyed, only 15.4% – or about 1,462 respondents – reported having medical debt. More accurately, 72.9% of 1,462 respondents – or about 1,065 people – specifically had past-due balances with a hospital. That’s 11.2% of the original respondent base so the reporter overstated this metric by 61.7 percentage points.

I wrote the reporter with this information, and to her credit, received a prompt response acknowledging she had received it. Within minutes, I had word the Washington Post – also to its credit – would issue a correction and did the next day. The editors involved were very conscientious about resolving this. The paragraph in question was rewritten to read, “Nearly three-quarters of the survey respondents who reported having past-due medical debt owed some or all of it to hospitals.” There’s also a “correction” box atop the article noting the earlier version of the story was mistaken.

But the headline remains. Does the Urban Institute’s findings of 15.4% of respondents reporting some type of medical debt warrant the headline, “Americans are knee-deep in medical debt?”

Others follow

WaPo isn’t alone. News outlets across the country, including Healthcare Dive and Becker’s Hospital Review, along with United Press International and a host of local outlets, wrote essentially the same story, taking the narrative straight from the Urban institute’s commentary. In fact, if you read the institute’s full report, you’ll see reporters took the narrative straight from the opening two-page overview.

And in Becker’s case, it’s a rewrite of the WaPo story, following the same basic script and repeating the WaPo’s initial “three-quarters” error (rewritten as, “almost 75% of those surveyed … owed their debts to hospitals.”

Omitted details

Neither WaPo, Healthcare Dive nor Becker’s articles name sources of medical debt other than hospitals even though the institute’s report does. It says 72.9% of respondents who reported medical debt owed some or all of that debt to hospitals. Further broken down, 27.9% of them only owed a hospital, and 45.1% owed a hospital and a doctor or dentist. Another 21.1% reported owing just a doctor or dentist, with an additional 6% owing “other types of medical providers or suppliers or did not report the source of their debt.”

The WaPo writer also makes this statement: “The majority surveyed said they had been contacted by collections agents about past-due bills. But a disproportionate number of people at or below the poverty line had faced debt-related lawsuits – 7.6% for those below the poverty line compared with 4.5% for wealthier respondents.”

Yet the Urban Institute report clearly states this: “Though adults with incomes below 100 percent of [the Federal Poverty Level] were more likely than adults at higher income levels to report being sued, these differences were not statistically significant.” The report also notes instances of lawsuits were far less common than simply being contacted for payment, as any business would do for a past-due amount.

Conclusion

How does a story or narrative get perpetuated? In this case, journalists across the country (do a Google search for yourself) took hold of this Urban Institute report because it was dropped into their email inboxes and it was easy. The narrative is straight from the organization’s summary and it fits the wash-rinse-repeat storyline reporters are accepting. Headlines like, “Americans are knee-deep in medical debt” ensue.

These journalists didn’t get much beyond the first two pages of a 17-page report. It was easy copy, quickly published and the reporters moved on to the next thing. Yet at the time of writing this blog, there were 522 comments at the bottom of the WaPo article:

“The entire medical billing system is a conspiracy to defraud.”

“Healthcare cares more about profits than patients.”

And so these thinly reported concepts are multiplied, effectively silencing needed national discourse, and much worse, affecting the psyche of real people and the decisions they’re making about their own healthcare.

Do you have comments on this blog or ideas for future blogs? Contact HFMA Chief Content Executive Brad Dennison at [email protected]. To support the editorial work we’re doing, please consider an HFMA membership.