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For many patients, one of the most antagonizing parts of a hospital visit is paying for parking.

Those parking fees aren’t just an annoyance for the sick and injured, according to a new paper in the Journal of Medical Imaging and Radiation Sciences. The charges are actually eating into their financial well-being, particularly for people who have cancer and have to make frequent visits to the hospital for treatments like radiation and chemotherapy.

Parking fees consistently come up, unprompted, in conversations that Mustafa Al Balushi, a radiation oncology resident at the University of Alberta, has with his patients. Al Balushi is one of the authors of the new paper and will soon start a fellowship at Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston — where parking fees are up to $20 per day, if validated.

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When he goes over the radiation treatment plans with some of his patients, many become upset about not just having to pay for parking, but doing so repeatedly when they may not be able to afford it. And this is in Canada, which has a publicly-funded health system where patients don’t have to pay much, if anything, out of pocket for their care.

“That’s a major concern when you tell them they need to come to the hospital every single day for the next five or six weeks,” Al Balushi said. “Parking is expensive.”

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The study looked at parking rates at cancer centers across Canada, where the median daily cost was about $7 in U.S. dollars. Then researchers analyzed whether those prices correlated with a city’s cost of living, available transit, and average median household income. The authors found that cities with higher costs of living and better forms of public transportation usually had less free parking, meaning people who had to drive to bigger cities for specialized cancer care had to pony up even more to park their cars.

Patient anger over hospital parking fees is not new. People in the United Kingdom, Australia, and Canada often criticize the parking charges, considering the rest of their care at the point of service is free.

“It’s disgraceful to charge those who are critically ill, those who take someone injured or ill to a hospital, or those who are visiting terminally ill,” one person told a local U.K. newspaper this past September after the local hospital brought back parking fees that had been suspended throughout the Covid-19 pandemic.

Other research in the U.S. has similarly found hospital parking prices contribute to what’s known as “financial toxicity” — the idea that having a serious illness like cancer is stressful and costly on its own, and only made worse when people may have to cope with other expenses like travel while potentially missing work and losing income.

Many community hospitals in rural and suburban areas of the U.S. don’t charge anything for parking. But if people need or want more specialized care in a larger city, where parking is more scarce, they often will encounter some kind of parking fee. And if a loved one is stuck in the hospital for days, weeks, or months, hospitals can saddle families and visitors with hundreds if not thousands of dollars in parking costs.

Mirroring the study’s findings in Canada, parking fees are usually higher in U.S. cities that have higher costs of living. Parking rates for New York hospitals are often $30 or more per day. Houston Methodist charges $7 for a visit that lasts fewer than three hours and $13 maximum per day. Indiana University Health’s main hospital in Indianapolis charges $5 for visits under two hours and $18 for a full day. The University of California Irvine Medical Center charges $1 for every 20 minutes, which maxes out at $16 per day. Baylor University Medical Center in Dallas charges a daily maximum of $5. Parking is free at Detroit Medical Center.

Rush University Medical Center in Chicago recently hiked its parking prices, saying on its website that the “slight increase in rates will allow Rush to continue to improve the parking experience for our patients and visitors.” Rush’s parking costs $20 for staying overnight, and parking for less than two hours costs $10. “Special parking arrangements may be possible for long-term patients,” according to Rush’s website.

Some possible solutions, according to Al Balushi and his colleagues, include screening patients to see if they qualify for travel vouchers or waived parking fees — which some nonprofit groups provide. Given the hurdles patients already face in getting treatment, parking shouldn’t be one of them. “It’s ridiculous,” Al Balushi said.

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