Assessing bad debt in New Hampshire and Vermont office-based practices.
OBJECTIVE
Bad debt is one measure of the cost of medical indigence on health care institutions. This two-part study identifies a methodology for and presents findings from measuring bad debt in a collection of office-based practices.


METHODS
In Part I of the study, data were gathered on site from 26 practices in Sullivan County, New Hampshire, after first conducting a survey of bad debt losses at these offices. Survey findings were compared to on-site findings and it was determined that only the practices with computerized record-keeping systems were able to supply accurate data by survey alone. In Part II, 71 randomly chosen computerized practices in New Hampshire and Vermont (identified in a screen of 275 practices) were surveyed on bad debt.


RESULTS
The practices from Part II wrote off an average of $23,115 per physician in 1990 from bad debt in a region in which primary care physician income averages approximately $70,000.


CONCLUSIONS
The author calculates that bad debt losses are greater than either Medicare or Medicaid losses. Uninsured patients account for 21.6% of office visits but 45% of practice write-offs. Bad debt accounts for a 16% loss from total earnings from regular office visits. Office-based practices in this study are shouldering a significant portion of the cost of care of their uninsured and underinsured patients.
Weiner
S J
SJ
Department of Community and Family Medicine, Dartmouth Medical School.
D005194:Family Practice / Q000191:economics*; D006801:Humans; D008489:Medical Indigency; D009513:New Hampshire; D010350:Patient Credit and Collection / Q000379:methods; D010865:Pilot Projects; D011216:Practice Management, Medical / Q000191:economics*; D017664:Uncompensated Care / Q000191:economics / Q000706:statistics & numerical data*; D014707:Vermont