A survey of Marion County residents found that 80 percent of respondents owe money to a local hospital—and about half of them say they were never informed about the availability of charity care or payment plans.

The non-scientific assessment does not appear to be drawn from a random sample of residents, meaning Hoosiers with hospital debt may have been more likely to respond than those without.

Nevertheless, the groups who conducted the survey say it points up the problematic prevalence of medical debt and the need for hospitals to do a better job making charity care available.

Not-for-profit hospitals have been under scrutiny from Congress for much of the past decade because of concerns that the amount of free care they provide is not enough to justify their exemptions from income taxes.

“Medical debt is a huge problem in Indianapolis that is putting many families at risk of losing their life-long savings, homes, credit ratings and futures,” Beryl Cohen, author of a report about the survey findings, said in a statement. “Hospitals must step up and do better jobs of letting patients know what help might be available.”

Cohen works for the Indianapolis-based Citizens Action Coalition Education Fund, a consumer advocacy organization. The survey also was supported by Indiana Legal Services, a local not-for-profit law firm, and Community Catalyst, a national consumer advocacy organization based in Boston.

Their findings were based on 547 responses collected since September at health fairs, block parties and other community events, as well as through door-to-door canvassing.

Among all respondents, 440 owed money to at least one hospital. The amount of debt averaged $23,000 per person.

When those bills were incurred, 251 of 500 respondents said they were told about a payment plan, discounts for the uninsured or under-insured, or told how to apply for a government health insurance program, such as Medicare or Medicaid.

But the other half of respondents said hospital personnel told them about none of these programs.

The survey included patients who had received care at Clarian Health’s Methodist, Indiana University and Riley hospitals; Community Health Network’s East, North and South hospitals; St. Francis Hospital & Health Centers’ Beech Grove and Indianapolis hospitals; and St. Vincent Indianapolis Hospital.

Cohen said Citizens Action Coalition and Indiana Legal Services want to partner with those hospitals to improve their community benefit and charity care programs.

“These programs must not continue to be the best-kept secret,” Cohen said.

As IBJ reported earlier this month, Indianapolis-area hospital systems saw their amounts of uncompensated care fall last year after steep rises in 2008. But continued high unemployment augurs for another increase this year.

Clarian Health’s combination of unpaid bills and free care for the poor dipped ever so slightly to $167.4 million last year, compared with $168.1 million the year before.

St. Vincent Health recorded charity care and bad debts of $128.5 million last year, down more than 7 percent from the previous year’s total of $138.4 million.

At Sisters of St. Francis Health Services Inc., charity care and bad debts totaled $92.1 million, down more than 12 percent from the prior year’s $100.4 million. Three of the 12 hospitals operated by the Mishawaka-based chain are in the Indianapolis area.

Only Community Health Network saw its charity care and bad debt rise. The four-hospital chain recorded $79.1 million in those categories last year, up 2 percent from the previous year’s total of $77.5 million.

“We’ve seen more people in charity care or taking advantage of charity care or working out more structured payment programs,” said Joel Hoff, senior vice president for administrative services at Sisters of St. Francis.

All four hospital systems saw charity and bad debt spike in 2008 as the recession set in and unemployment rose. The increases ranged from 18 percent at Community to 25 percent at Clarian.

Most hospitals waive the bills of patients making less than twice the federal poverty limit. For those with incomes above that threshold, unpaid bills are classified as bad debt.