Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Business and Economics



First Advisor

Dr. Dan Stone

Second Advisor

Dr. Urton Anderson


Hospital financial assistance policies (FAPs) should inform uninsured and under-insured patients about options available to assist with their medical expenses. However, language and visual rhetoric variations in these documents may deter otherwise qualified patients from applying to programs meant to relieve their financial obligations. This project explores how visual rhetoric and linguistic differences such as tone and readability, in financial assistance policy documents may influence community benefit reporting in hospitals as a consequence of patient engagement in the application process.

Visual rhetoric and design, as well as linguistic style variation can have a profound impact on program utilization and financial reporting. This study seeks to evaluate whether these elements within the FAP document contribute to patients not seeking relief of their financial obligations through the financial assistance program and provide insights into how elements of visual design influence patient behavior, specifically lower amounts of reported community benefit due to patients not applying for financial assistance.

A review of literature relevant to visual rhetoric, tone, and readability in the context of financial decision making situates the research questions within the context of document design and financial decision making and identifies knowledge gaps in the real-world context in which the problem exists, while the archival study discusses and utilizes a visual design framework (HATS—Headings, Accessibility, Typography, Space) and measures of tone and readability to classify visual rhetoric and linguistic style variations within the population of policy documents sourced from California’s Office of Statewide Health Planning and Development, to evaluate program utilization and financial reporting in a hospital setting.

Results from this study provide evidence that document design plays a significant role in financial reporting in the hospital setting. Lower patient participation in financial assistance programs increases information asymmetry between the patient and the organization which may increase the need for complex estimate methodologies to determine the amount of bad debt that may be mislabeled as charity care. By offering an understanding of why patients avoid applying to beneficial programs, these studies offer opportunities to increase patient engagement; thereby decreasing information asymmetry and decreasing the need for complex estimate methodologies, leading to more accuracy and greater comparability in hospital financial statements.

Digital Object Identifier (DOI)

Funding Information

Von Allmen Scholarship 2018-2022

Available for download on Thursday, January 09, 2025