And the deductible can be twice that for a family.

Beyond the financial issue, when faced with this financial challenge patients often “delay procedures,” Jessica Curtis, a senior advisor at Community Catalyst, a consumer advocacy group in Boston, told the wire service. “They don’t follow advice on prescription drugs, and when they see care, [it is usually] for more expensive procedures because they’ve waited.”

Faced with the reality of the enormous financial burden that hits patients, the best health care institutions can do is to help them do their best to manage the challenge.

“A well-informed patient is more likely to meet their obligations,” he said. “It’s just good patient relations and it helps to minimize bad debt,” Brian Sanderson, managing principal of Crowe Horwath's health care services group, advised, according to the news service.

That, coupled with alternative payment plans, can allow patients to survive financially as well as medically.

One strategy is for hospitals to turn to relationships with charities, by enlarging who is eligible for aid, and to also turn to banks for help with credit issues.

Some companies, such as ClearBalance, AccessOne and Commerce Bank can structure loans without interest and with longer time frames than the few months a hospital would typically allow a bill to ride before turning it over to a collection agency.

“People are more likely to pay a bank than a hospital,” Mark Huebner, director of Health Services Financing at Commerce Bank, told Reuters.

His bank sets up lines of credit at over 200 hospitals.

“People are aware that banks will come after them. Banks do collect on debt, and hospitals generally have been more relaxed,” he said.

Last September, HCB News noted that health care leaders are well aware of the cash flow challenges caused by self-pay.

Gary Breuer, vice president of revenue cycle at AMITA Health, noted to the magazine that, “at a simplistic level, our patient liability amounts are growing in the 6 to 7 percent range every year. So, in 2013, I was trying to collect $47 million. In 2014, I was trying to collect $50 million. I need to run my 2015 numbers, but I think it’s telling the same story.”

Self-pay shortcomings exist across the economic spectrum, from underemployed and lower-income sectors, to upper middle class budgets. Given that more employers will opt for high-deductible plans, alongside similar patterns in the ACA exchange programs, bad debt will continue to rise unless providers devise better ways to collect. Policymakers are hard-pressed to produce remedies beyond subsidies, which are politically unpopular anyway.”

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