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Press Release

USofCare Releases New Report Highlighting Negative Impact of Facility Fees on Health Equity

Published On June 3, 2024

The new report details how hospital facility fees disproportionately impact communities that are historically marginalized by our health care system. 

Washington, DC — Today, United States of Care (USofCare) released a new report highlighting the impact hospital facility fees – or hidden, unexpected charges tacked onto a patient’s bill simply because they received care at an outpatient facility owned by a hospital or health system – have on health equity. This impact is disproportionately placed on communities of color, low-income and rural communities, and communities experiencing chronic or complex medical conditions. 

Facility fees are a symptom of hospital consolidation, which can lead to higher prices and less access to care. These fees are often charged in addition to professional fees that pay providers to support staffing and equipment costs, and can exceed the cost of the care provided and often are not completely covered by insurance

Some of the key findings from this report include: 

  • Medical debt – which includes debt incurred from hospital facility fees – has a disproportionate impact among communities historically marginalized by the health care system, with 56% of Black and Hispanic or Latino adults facing medical debt in 2022 compared to 37% of white adults. 
  • People with chronic and complex conditions tend to be the most exposed to affordability barriers like facility fees, with the higher volume of health care visits resulting in more facility fees charged.
    • An analysis by the Leukemia & Lymphoma Society (LLS) found that across eight chronic or complex disease groups, the services received in hospital outpatient settings were significantly more expensive than those same services received in a doctor’s office – leading to significant variations in cost for the same services depending on where they were received. 
  • People in rural areas are more likely to lack health insurance coverage, have fewer provider choices, and are more likely to be older and have more health care needs than those in urban areas – exposing them to more facility fees. 

“The equity impact of hospital facility fees is clear and deeply concerning,” said United States of Care Director of Policy Solutions Liz Hagan. “We know there is strong political will across the nation and across party lines to address facility fees. Policymakers should take meaningful steps towards reducing the significant health equity barriers posed by facility fees for people.”

Included in this report are a set of state and federal policy recommendations to address facility fees and improve health equity, including: 

  • Policymakers should impose site, service, and billing specific limits on the use of hospital facility fees, using an equity lens to identify specific limits. 
  • Regulators should require hospitals to report data on facility fees – including revenue generated from facility fees and hospitals that charge them. 
  • Policymakers should require facility fees to be clearly disclosed in patient notices to establish transparency for people. 
  • Policymakers should ensure that facility fee protections and transparency measures are adequately enforced. 
  • Policymakers should invest in research that further evaluates the health equity implications of facility fees. 

Read the full report here.


About United States of Care
United States of Care is a nonpartisan organization committed to ensuring that everyone has access to quality, affordable health care.

Adam Wilkerson
(314) 852-7718
[email protected]