The study, part of a broader analysis of what scholars call anticipatory impression management, is based on data collected at three non-profit hospitals in a single urban area. The hospitals asked that their names not be disclosed. The researchers' conclusions are based on bills, letters, observations, and interviews with hospital staff and patients. The researchers began their work in 1994, approximately six months after a series of critical articles about hospital billing led to a surge in inquiries to the three hospitals.

"Citizens are becoming more educated about hospital billing and taking the responsibility of insuring that their charges are correct," said the principal author of the study, Dr. Kimberly D. Elsbach of the Graduate School of Management, the University of California, Davis. "Hospitals are countering that with their own efforts to discourage people from becoming involved with challenges or audits because it costs them a great deal of time and money."

The study shows that hospitals may discourage inquiries into bills by putting on a friendly face in their initial correspondence and conversations with patients. Those patients who actually call for an audit of their bills may meet what amounts to explicit hostility.

Using Threats to Avert Challenges to Bills

The study's most disturbing finding was that some hospitals try to prevent patients who call from launching a formal investigation of their bills by using intimidating images filled with threats. The threats are aimed at distracting consumer attention and evoking fear, even intimidation. These can include the threat of sending a bill to a c
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Contact: Barry List
barry.list@informs.org
410 691-7852
Institute for Operations Research and the Management Sciences
11-Mar-1998