Cash or charge?

That seems to be the question on the minds of more and more nonprofit hospitals, who are asking even insured patients to pay up front for their share of nonemergency treatment—anything from an elective cosmetic procedure to a scheduled cardiac catheterization test.

The Wall Street Journal took a look at this trend, focusing on cancer patients and chemotherapy, back in April and today the South Florida Sun Sentinel examines how the payment pattern is playing out in Florida.

Hospitals argue that rising health care costs and hard economic times have caused an explosion in care for which they are not paid. An IRS survey in 2006 found that 14 percent of 481 nonprofit U.S. hospitals required patients either pay or work out a payment plan before admission.

According to the Florida Hospital Association, state hospitals spent $2.4 billion on uncompensated care in 2006, up 73 percent from 2000. About 3.7 million people—21 percent of Florida’s population—were uninsured, adding to the hospitals’ burden of uncompensated care. And the state hospital association also told the paper that Florida has a “number of visitors” who use the state’s health services and leave, a sort of medical equivalent of the hit and run.

But patient advocates decry the practice of asking for payment before care is delivered, particularly with little advance notice for a patient who is may be facing life-threatening illness. "Somebody facing a catastrophic illness and having to be burdened with the extra stress of paying a co-pay or premium is just unconscionable," Laura Goodhue, executive director of Florida CHAIN, a consumer-health advocacy organization based in Palm Beach Gardens, told the newspaper.

Without comprehensive reform aimed at slowing down health care costs, the problem is unlikely to go away. As costs continue to rise, patients shoulder a larger share of the cost of their own treatment. And the hospitals want the payment sooner rather than later—or never.