To the Editor.
—Dunham et al1 presented interesting data on bad debt and uncompensated care in office-based practices. They surveyed physicians in various urban, suburban, and rural office-based settings and obtained data from which they estimated losses of $4300, $9300, and $7500 overall for charity care, bad debt, and discounted Medicaid care, respectively.As these sorts of data are collected, it becomes imperative to think about what these numbers mean in terms of costs and the impact on the providers who are absorbing these losses. For example, consider the concept of bad debt."Bad debt" is a bookkeeping phenomenon of practices that record losses from payments lower than their usual and customary fee. The usual and customary fee is a "sticker price" that is set by each practice for each service and is generally competitive with other practices in the local area. The amount of bad debt is affected