In the United States, tens of millions of people who are uninsured or underinsured are exposed to the country’s high and rising costs of medical treatment. As a result, the US healthcare system has persistent problems with both high out-of-pocket costs for accessing health care and the indebtedness that these costs create. Together, these form sometimes insurmountable barriers to accessing health care and adversely affect people’s enjoyment of other human rights, including the rights to housing, food, and education.

A nationally representative survey conducted by the Kaiser Family Foundation in 2022 found that 41 percent of US adults had some form of outstanding debt due to medical or dental bills, while 24 percent of adults were either past due or unable to pay their health care bills at the time of the survey.

Hospital services, in particular, significantly contribute to the country’s medical debt crisis, with a March 2023 survey conducted by the Urban Institute finding that about 73 percent of adults with past-due medical debt reported owing at least some of that debt to hospitals.

However, nearly 60 percent of the more than 5,000 community hospitals across the US are privately operated nonprofits, which collectively receive public subsidies worth billions each year, largely in the form of tax exemptions, in exchange for providing “community benefits” like free or reduced-price health care. In other countries, such free or subsidized health care is the norm and widely understood as a key way that a government meets its right to health obligations. But in the US, this is tellingly referred to as “charity care.”

The US heavily relies on these privately operated nonprofit hospitals’ charity care to increase access to health care for patients who cannot pay for hospital services, such as emergency treatment, diagnostic work, and inpatient surgeries. But given the high prevalence of hospital-related medical debt in the US, this system is clearly not working.

This report documents how the US government’s lack of guidance and oversight gives private nonprofit hospitals wide discretion over how much they spend on making health care accessible for people who cannot pay, who qualifies for this assistance, and how far they will go to collect debts from patients who cannot pay their bills.

Read the full article about nonprofit hospitals at Human Rights Watch.