I know you're just providing a hypothetical example, but I think it's common for services provided by doctors or a hospital emergency room to cost quite a bit more than $100; in many cases an order of magnitude more. At the end of the day, I do agree that a hospital will or should make a collection decision based on a cost benefit analysis of some kind, but I think that decision will be to collect a good portion of the time.

While the bill might be $1k+, the amount collections would reasonably collect is probably more in the $100 range for what amount to doctors visits.

> The hospital just doesn't bother following up. Are you going to spend $200 to chase down a $100 hospital bill?

I think I would. Do it few times at random and get the offenders to pay $1k+, and soon people will stop scamming hospitals. For what I can tell, similar system (random ticket checks + penalties 10x the ticket price) works quite well for public transit in many cities worldwide.

Here in San Diego going to the ER without insurance costs a minimum of $1,000. I once had to do so for my son. Cost for a room was $600, a $40 shin splint cost $250, and I am not sure what else but it was pretty expensive.