[Skip to Navigation]
February 4, 2020

Billing Quality Is Medical Quality

Author Affiliations
  • 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
JAMA. 2020;323(5):409-410. doi:10.1001/jama.2019.19648

Health care has become a $3.5 trillion economy in the United States as prices for medical services have reached record-high levels.1,2 This spending is straining households, as in the past decade patients have been increasingly asked to pay a greater out-of-pocket share of costs for medical services. A 2019 report from the US Consumer Financial Protection Bureau that analyzed a national representative sample of 5 million consumers found that more than 25% of individuals had delinquent debt on their credit reports, with medical bills accounting for 58% of all debt.3 In a 2018 survey of 1513 patients with stage IV breast cancer, 50% reported that they had been contacted by debt collectors regarding a medical bill, suggesting their medical bills were significantly overdue.4 High medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills.5 The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    Hina Usman Mahmood, M.B.B.S, M.Phil | Shaikh Zayed Medical Complex, Lahore, Pakistan
    What an interesting viewpoint. Couldn't help smiling after reading the title. It gives me extreme pain to admit that in developing countries like Pakistan unfortunately quality of health care is dependent on the socioeconomic status of an individual. Only those who can afford to pay get the best medical treatment. Private practitioners charge so much that lower class cannot afford it. As health is a fundamental right of each & every individual, this issue needs attention of the policy makers so that health inequities could be reduced.