Patients who arrive unprepared, e.g., lacking relevant medical history, medication lists, insurance information, or understanding of their conditions , generate substantial additional costs through delayed diagnosis, duplicative testing, preventable complications, and inefficient care delivery.

Direct Financial Burdens for Patients

Unprepared patients face higher out-of-pocket costs due to extensive diagnostic workups necessitated by absent medical history. Emergency departments perform more comprehensive evaluations when baseline status is unknown, with marginal costs per patient ranging from $300-$400.[1] For uninsured patients specifically, 18% of treat-and-release ED visits resulted in catastrophic health expenditures (defined as out-of-pocket costs exceeding 10% of family income), with this risk increasing 66% between 2006 and 2017.[2] Among the lowest income quartile, nearly one-third (28.5%) of uninsured ED visits met catastrophic expenditure criteria by 2017.[2]

Medical bills from unprepared encounters compromise basic household needs, damage credit scores, and create long-term economic hardship. Large unexpected medical bills prevent patients from purchasing necessities, contribute to psychosocial stress, and affect future care-seeking behavior.[2] Over 4 years, 17.4% of adults face cost burdens at least once, with 53.2% of decedents experiencing cost burdens in the years before death — suggesting most individuals will eventually face burdensome healthcare spending.[3] The majority of individuals experiencing catastrophic health expenditures annually have private health insurance, indicating that insurance alone does not eliminate financial risk.[2]

System-Level Costs and Inefficiencies

Lack of preparation drives delayed care and paradoxically higher total expenditures. When cost sharing increases, patients’ use of care declines, but people with the worst health are most likely to cut back, and this reduction can fail to cut system-wide use, instead shifting care from sick and poor to healthy and wealthy patients.[4] When Medicare added new co-payments, outpatient visits decreased but hospital admissions increased, demonstrating how delayed care generates downstream costs.[4]

Emergency department care is inherently more expensive when patient information is unavailable. EDs apply the heuristic of “consider the worst first” and perform extensive diagnostic evaluations because past medical history is unavailable and clinicians don’t know patients’ baseline status.[1] This makes the ED an expensive and inefficient place to receive most nonurgent care, with costs substantially higher than primary care alternatives.

Health Outcomes and Preventable Spending

Delayed presentation due to lack of preparation results in more severe disease, longer hospitalizations, and higher costs. Higher cost sharing is associated with decreased odds of patients presenting with early, uncomplicated disease, for example, patients with perforated diverticulitis are hospitalized longer (10.4 vs 8.6 days) and pay approximately $1,100 more per admission than patients with uncomplicated diverticulitis.[5] Patients are less likely to receive optimal or minimally invasive surgery when they present late with complicated disease.

Preventable spending is concentrated among unprepared, high-cost patients. Among high-cost Medicare patients, 44.0% experienced at least one potentially preventable encounter, accounting for 71.5% of total preventable spending.[6] High-cost patients averaged $11,502 in potentially preventable spending — more than 20 times that of non-high-cost patients ($510).[6] Seriously ill, frail, or mentally ill patients accounted for the highest proportion of potentially preventable spending overall.

Access Disparities and Risk Pooling

Reliance on out-of-pocket payments rather than prepaid pooled funds leaves patients poorly positioned to access care without financial hardship. Countries with stronger prepayment and risk pooling mechanisms reduce the likelihood of individuals facing financial catastrophe or forgoing necessary care due to inability to pay.[7] High reliance on out-of-pocket payments is associated with increased risk of households being pushed into poverty because of healthcare payments or forgoing needed treatment.[7]

Additional Costs from Preventable Complications

Hospital-acquired conditions and medical errors , potentially exacerbated by incomplete patient information, generate substantial additional costs and mortality. When comprehensive patient history is unavailable, the risk of adverse events, medication errors, and duplicative or contraindicated interventions increases, though specific cost estimates for preparation-related errors require further quantification.[8]

1. Uninsured Adults Presenting to US Emergency Departments: Assumptions vs Data. The Journal of the American Medical Association. 2008. Newton MF, Keirns CC, Cunningham R, Hayward RA, Stanley R.

2. Assessing Catastrophic Health Expenditures Among Uninsured People Who Seek Care in US Hospital-Base… JAMA Health Forum. 2021. Scott KW, Scott JW, Sabbatini AK, et al.

3. Risk of Burdensome Health Care Spending Over Time in the US. JAMA Internal Medicine. 2025. Gaffney A, McCormick D, Dickman SL, et al.

4. Inequality and the Health-Care System in the USA. Lancet. 2017. Dickman SL, Himmelstein DU, Woolhandler S.

5. Association of Cost Sharing With Delayed and Complicated Presentation of Acute Appendicitis or Dive… JAMA Health Forum. 2021. Loehrer AP, Leech MM, Weiss JE, et al.

6. Potentially Preventable Spending Among High-Cost Medicare Patients: Implications for Healthcare Del… Journal of General Internal Medicine. 2020. Khullar D, Zhang Y, Kaushal R.

7. Does Progress Towards Universal Health Coverage Improve Population Health? Lancet. 2012. Moreno-Serra R, Smith PC.

8. Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-A… Agency for Healthcare Research and Quality (2017). 2017. Tyler Bysshe MPH, Yue Gao MPH, Krysta Heaney-Huls MPH, et alGuideline