title: Effect of high up front charges on access to surgery for poor patients at a public hospital in New Mexico.
abstract: BACKGROUND
  A public hospital in New Mexico required collection of 50% of estimated costs prior to elective surgeries for self-pay patients. This study assesses the impact of this policy on access to elective surgical procedures.
  
  
  METHODS
  Chi-square tests determined if there was a statistically significant difference between the number of self-pay and insured patient cancellations for financial reasons. A multivariate binomial regression model was used to calculate risk ratios and confidence limits for effects of race/ethnicity, and insurance status, controlling for gender, on these cancellations.
  
  
  RESULTS
  Of the 667 cancellations, there were 99 self-pay and 568 insured patients. Cancellations for financial reasons occurred in 55.6% of self-pay and 9.3% of insured patients (p < 0.0001). Inability to pay 50% up front accounted for 76.4% of self-pay patient cancellations for financial reasons. Self-pay, non-Hispanic whites and minority race/ethnicities were 8.76 and 8.61 times more likely to cancel for financial reasons, respectively, than insured non-Hispanic whites.
  
  
  CONCLUSIONS
  Self-pay patients, regardless of race/ethnicity, have elective surgical procedures cancelled for financial reasons significantly more often than insured patients. The hospital's 50% up-front payment policy represents a significant financial barrier to accessing elective surgical procedures for self-pay patients.
authors.affiliation: University of New Mexico School of Medicine, MSC08-4720, 1 University of New Mexico, Albuquerque, New Mexico 87131, USA. wkaufman@glfhc.org
authors.forename: Will
authors.initials: W
authors.lastname: Kaufman
authors.forename: Augustine S
authors.initials: AS
authors.lastname: Chavez
authors.forename: Betty
authors.initials: B
authors.lastname: Skipper
authors.forename: Arthur
authors.initials: A
authors.lastname: Kaufman