Out-of-Pocket Healthcare Expenditures in the United States

Apr 17, 2017
51 Pages - Pub ID: KLI15319908
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Out-of-Pocket Healthcare Expenditures in the United States

Out-of-pocket expenditures for healthcare products and services in the United States have risen in 2017 to the point that these represent a significant portion of consumers’ incomes. As these out-of-pocket healthcare costs have gone up, consumers in the best healthcare plans continue to receive excellent care, but those in less comprehensive plans often do not. Consumers’ out-of-pocket healthcare costs have risen from $250 per year in 1980 to over $1,400 in 2016. Out-of-Pocket Healthcare Expenditures in the United States examines the market for consumers’ out-of-pocket medical costs, including the following data:
  • Consumer Out-of-Pocket Healthcare Expenditures by Payment Type, 2016
  • Average Share Paid Out-of-Pocket by U.S. Residents with Healthcare Spending by Type of Service, 2016
  • Average Share Paid Out-of-Pocket by U.S. Residents with Healthcare Spending by Percentile of Total Health Spending and Type of Service, 2016
  • Consumer Out-of-Pocket Expenditures per Worker, 2011–2021
  • Consumer Out-of-Pocket Expenditures by Type, 2011–2021
  • Proportion of Consumer Out-of-Pocket Spending by Type of Healthcare Expenditure, 2011, 2016, 2021
  • Amount of Consumer Out-of-Pocket Expenditures That Are Financed, 2011–2021
  • Distribution of Out-of-Pocket Spending for the Average Person, 2016, 2021
  • Proportion of Consumer Out-of-Pocket Spending for Non-Elective Procedures That Is Financed (All Methods), 2016 – 2021
  • Size of High Risk Groups for High Out-of-Pocket Healthcare Expenditures, 2011–2021
Consumers in the United States utilize a variety of methods to pay for healthcare products and services. The report discusses the amount of spending by payment types, the following being the key payment methods utilized:
  • Cash or Check
  • Credit Cards
  • Loans and Lines Of Credit
  • Flexible Spending Accounts
  • Health Savings Accounts
Prescription medications represent the single largest out-of-pocket healthcare expenditure for the average person. The report notes drug cost coverage by payor type (public, private, cash) for 1965, 1986, 2000, 2005, 2010, and 2016. Further, the report discusses the contribution of office-based procedures, which include examinations and vaccinations, and hospital stays to the overall level of a person’s healthcare expenditures.

Out-of-Pocket Healthcare Expenditures in the United States concludes that, through 2021, out-of-pocket expenditures for healthcare products and services in the United States will continue to rise. In addition to demographic trends - such as lack of comprehensive healthcare insurance, disability, age, mental illness, obesity, drug and/or alcohol addiction and chronic medical conditions - which combined affect the majority of the U.S. population, two key factors are expected to support the growth of out-of-pocket consumer expenditures over the next five years: ongoing healthcare cost inflation and managed care cost shifting.
1: EXECUTIVE SUMMARY
OVERVIEW
PAYMENT METHODS
PRESCRIPTION MEDICATIONS
FORECAST
Table 1-1: Consumer Out-of-Pocket Expenditures per Worker, 2016 and 2021
2: INTRODUCTION: OUT-OF-POCKET EXPENDITURES, THE MARKET IN 2017
TYPES OF EXPENDITURES
Insurance Co-Payments
Direct Payments
Premiums and Plan Fees
PAYMENT METHODS
Figure 2-1: Consumer Out-of-Pocket Healthcare Expenditures by Payment Type, 2016
Cash or Check
Credit Cards
Loans and Lines of Credit
Flexible Spending Accounts
Health Savings Accounts
AMOUNT FINANCED
Non-Elective Procedures and Prescription Drugs
Figure 2-2: Average Share Paid Out-of-Pocket by U.S. Residents with Healthcare Spending by Type of Service, 2016
Figure 2-3: Average Share Paid Out-of-Pocket by U.S. Residents with Healthcare Spending by Percentile of Total Health Spending and Type of Service, 2016
Figure 2-4: Distribution of Out-of-Pocket Healthcare Spending for the Average Person, 2016
Figure 2-5: Distribution of Out-of-Pocket Spending for the Average Person, by Spending Level, 2016
Figure 2-6: Drug Cost Coverage by Payor Type (Public, Private, Cash): 1965, 1986, 2000, 2005, 2010, 2016
CONSUMERS WHO PAY OUT-OF-POCKET
The Uninsured and Underinsured
Medicaid Recipients
The Disabled
Senior Citizens
The Mentally Ill
The Obese
Table 2-1: Obesity in the United States, 1980 – 2021
Persons with Alcohol and Drug Addictions
Figure 2-7: National Overdose Deaths from Prescription Drugs, 2001 - 2014
Figure 2-8: National Overdose Number of Deaths from Heroin, 2001 - 2014
Persons with Chronic Conditions
Figure 2-9: Type of Insurance Coverage for Adults between the Ages of 18 and 65 with Chronic Conditions, 2016
3: MARKET ANALYSIS: GROWTH FROM 2016 - 2021
TRENDS
Out-of-Pocket Expenditure Growth Drivers
Out-of-Pocket Expenditure Growth Constraints
FORECASTS
Table 3-1: Consumer Out-of-Pocket Expenditures per Worker, 2011–2021
Expenditures by Type
Table 3-2: Consumer Out-of-Pocket Expenditures by Type, 2011–2021
Figure 3-1: Proportion of Consumer Out-of-Pocket Spending by Type of Healthcare Expenditure, 2011, 2016, 2021
Payment Methods
Table 3-3: Consumer Out-of-Pocket Expenditures by Type, 2011–2021
Figure 3-2: Proportion of Consumer Out-of-Pocket Spending by Payment Type, 2011, 2016, 2021
Amount Financed
Table 3-4: Amount of Consumer Out-of-Pocket Expenditures That Are Financed, 2011–2021
Types of Expenses Financed
Figure 3-3: Distribution of Out-of-Pocket Spending for the Average Person, 2016, 2021
Figure 3-4: Proportion of Consumer Out-of-Pocket Spending for Non-Elective Procedures That Is Financed (All Methods), 2016 – 2021
Consumers Who Pay Out-of-Pocket
Table 3-5: Size of High Risk Groups for High Out-of-Pocket Healthcare Expenditures, 2011–2021 (Millions of Persons)

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