Predictors of Payment Behavior among the Medically Uninsured: A Prospective Cohort Study of Patients Seeking Ambulatory Services

Background. Little is known about the characteristics of uninsured patients who attempt to pay for their care. Purpose. This study sought to identify predictors of payment after receiving care at three urban hospitals. Methodology. One hundred and seventy uninsured ambulatory patients were interviewed about their health status, income, and credit and payment histories at the point of care. Eighteen months later, data on payment outcomes were extracted from the medical financial records for each subject. Findings. Patients were more likely to make a payment if they reported higher income, health insurance for other services, or worrying about their credit. They were less likely to pay anything if they owed a large sum, were seeking care at the public site, or had received care in an emergency room. Conclusions. Specific characteristics of uninsured patients, the site of care, and the size of the bill are all associated with payment outcome.