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Purpose: Previous research investigating a 50% down payment policy for elective surgeries demonstrated that a substantial number of self pay patients failed to receive recommended surgery due to the down payment cost. The current study analyzes the effect of a new, more liberal sliding scale down payment policy implemented at this same public hospital and assesses the impact on health care access for self pay patients. Methods: Data was collected from the admissions office and the pre-operative assessment office where elective surgery cancellation reasons were recorded. Chi-square tests were used to determine the statistical significance between data sets. Results: 448 recorded cancellations were documented over an 8 month period. Of those records, 6.9% (n=31) were self pay patients and 93% (n=417) had insurance. Of the 31 self pay patients, 51.6% (n=16) had cancelled stating financial reasons, while 4.8% (n=20) of the insured canceled for financial reasons (p<0.0001). In comparison to the previous study performed by Kaufman and Chavez, the results revealed a 50% decrease in the number of self pay patients failing to receive recommended surgery. Of those self pay patients who did not receive surgery, there was no significant difference in the rate of canceling for financial reasons (p=0.18). Conclusions: Despite gender or race, self-pay patients cancel elective surgeries at a rate significantly greater than insured patients. The more liberal sliding scale down payment policy appears effective in reducing the overall number of self pay patients who decline elective surgery for financial reasons. Self pay patients are still facing financial barriers to health care access despite the sliding scale payment policy.