Out-of-Pocket Healthcare Expenditures in the United States, 5th Edition

This report estimates U.S. consumer out-of-pocket spending on healthcare, particularly direct payments to providers and financed payments.

A variety of demographic, business, and government trends are contributing to rising out-of-pocket (OOP) healthcare expenses in the United States. Out-of-Pocket Healthcare Expenditures in the United States, 5th Edition examines these trends in detail, focusing on the financial aspects of OOP spending growth and quantifying the growth of OOP spending with forecasts of total expenditures and specialized healthcare financing.

Total Expenditures

The report examines past, current, and future levels of U.S. out-of-pocket healthcare expenditures both in total and as specific sub-groups (by type, by payment method, by elective vs. non-elective). Through the next five years, total consumer out-of-pocket expenditures for healthcare are expected to continue rising, with trends established over the past several years continuing through the foreseeable future.

The report presents the following data points:

• Growth of Consumer Out-of-Pocket Expenditures 2015 - 2025, in $ Billion
• How Consumer Out-of-Pocket Expenses Are Financed in 2020 (%) (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing, HSAs)
• Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing 2015 - 2025, in $ Billion

Types and Amounts of Expenses Financed

In 2020, U.S., consumers financed many different types of healthcare expenses; these can broadly be grouped into two categories: elective procedures including over-the-counter (OTC) medications and non-elective procedures including prescription drugs. These types of procedures are distinct, and discussed separately within the report.

Elective procedures are those that are not strictly necessary to address a medical condition. They are thus not covered by medical insurance and their utilization is discretionary on the part of the consumer. The amount of non-elective healthcare and prescription drug expenses financed by individual consumers varies widely, although a very large proportion of consumers must finance some expenditures.

The report provides the following data:

• Methods of Financing Elective Procedures, 2020 (Credit Cards, Cash or Check, Healthcare Financing Programs, Loans or Lines of Credit)
• Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Percentile of Total Health Spending, 2020 (Top 1st, 1st to 5th, 5th to 10th, 10th to 20th, Lowest 80th)
• Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Type of Service, 2020 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care)
• Average Share Paid Out-of-Pocket by U.S.

Residents by Percentile of Total Health Spending and Type of Service, 2020 (in top 5%: Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care; in top 10% to 5%: Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care; in top 20% to 10%: Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care; in the bottom 80%: Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care)

• Distribution of Out-of-Pocket Healthcare Spending for the Average Person, 2020 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Vision, Other Health Care)
• Drug Cost Coverage by Payor Type (Public, Private, Cash) 1965, 1985, 2000, 2005, 2010, 2020

Consumers Who Pay Out-Of-Pocket

Consumers from all socioeconomic groups are facing high out-of-pocket expenditures for healthcare. Certain groups are more vulnerable than others to having trouble paying their medical bills and represent a larger proportion of this spending. These include the uninsured and underinsured, Medicaid recipients, disabled persons, senior citizens, the mentally ill, obese persons, people suffering from drug or alcohol addiction, persons with chronic medical conditions.

Out-of-Pocket Healthcare Expenditures in the United States, 5th Edition provides the following related information:

• Size of High Risk Groups for Out-of-Pocket Healthcare Expenditures, 2015 - 2025, in Millions of Persons (The Uninsured & Under-insured, Medicaid Recipients, The Disabled, Senior Citizens, The Mentally Ill, The Obese, Persons with Drug or Alcohol Addictions, Persons with Chronic Conditions)
• Comparative Sizes of High Risk Groups for Out-of-Pocket Healthcare Expenditures, 2015 - 2025, in Millions of Persons (The Uninsured & Under-insured, Medicaid Recipients, The Disabled, Senior Citizens, The Mentally Ill, The Obese, Persons with Drug or Alcohol Addictions, Persons with Chronic Conditions)
• Obesity in the United States, 1980 - 2025 (U.S. Population [Millions], Percentage Obese, Number Obese [Millions])
• Proportion of Adults under Age 65 with Chronic Conditions, 2020 (Privately Insured, Medicare or Medicaid, Uninsured, Other)

Expenditures by Type, Payment Methods, Elective vs. Non-Elective Procedures

Consumers in the United States utilize a variety of methods to pay for healthcare products and services, required in instances when payment is not made directly from a healthcare plan to the provider. The report examines expenditure by type, including direct payments and co-pays, and illustrates that the amount of out-of-pocket expenditures financed by consumers in the coming years will vary considerably between elective and non-elective procedures.

Featured data include:

• Change in Consumer Out-of-Pocket Expenditures by Type 2015 - 2025, in $ Billion (Direct Payments, Co-pays, Total, Change [%])
• Proportion of Consumer Out-of-Pocket Spending by Type of Healthcare Expenditure, 2015, 2020, 2025 (Direct Payments, Co-pays)
• Change in Consumer Out-of-Pocket Expenditure by Payment Type, 2015 - 2025, in $ Billion (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing Programs, HSAs, Total, Change [%])
• Proportion of Consumer Out-of-Pocket Expenditures by Payment Type, 2015, 2020, 2025 (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing Programs, HSAs)
• Growth of Consumer Out-of-Pocket Expenditures for Elective vs. Non-Elective Procedures, 2015 - 2025, in $ Billion (Elective, Non-Elective)
• Change in Consumer Out-of-Pocket Expenditures for Elective Procedures That Are Financed, by Payment Type, 2015 - 2025, in $ Billion (Paid by Cash or Check, Financed, Total, Change [%])
• Proportion of Consumer Out-of-Pocket Spending for Elective Procedures That Are Financed (All Methods), 2015, 2020, 2025 (Paid by Cash or Check, Financed)
• Change in Amount of Consumer Out-of-Pocket Expenditures for Non-Elective Procedures That Are Financed, 2015 - 2025, in $ Billion (Paid by Cash or Check, Financed, Total, Change [%])
• Proportion of Consumer Out-of-Pocket Spending for Non-Elective Procedures That Are Financed (All Methods), 2015, 2020, 2025 (Paid by Cash or Check, Financed)
• Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2013 (Ill-defined conditions, Circulatory, Musculoskeletal, Respiratory, Endocrine, Nervous system, Cancers, Injury, Genitourinary, Digestive, Mental Illness, Other, Infectious diseases, Pregnancy and childbirth, Dermatological)

Market Drivers and Restraints

The strong growth in U.S. out-of-pocket spending is the result of a preponderance of market drivers, which are mitigated by relatively few market restraints.

The report shows leading drivers and restraints of consumer out-of-pocket healthcare spending, in order of strength, across the market:

• Drivers & Restraints of the Consumer Out-of-Pocket Spending Market
• Drivers & Restraints of Direct Pay and Co-Pay Expenditures
• Drivers & Restraints of Credit Cards, Cash/Check, FSA, Loan/Line of Credit, Healthcare Financing Program and HSA Expenditures
• Drivers & Restraints of Elective Procedure Out-of-Pocket Expenditures
• Drivers & Restraints of Non-Elective Procedure Out-of-Pocket Expenditures
• Drivers & Restraints of Specialized Healthcare Financing
• Drivers & Restraints of Specialized Healthcare Financing for Elective Procedures
• Drivers & Restraints of Specialized Healthcare Financing for Non-Elective Procedures

Company Profiles

A large number of companies help consumers pay their out-of-pocket medical expenses and/or significantly influence those expenses. Most companies that provide patient financing focus on funding elective procedures, with a smaller number offering financing for non-elective therapies and providing other financial services. While companies participating in the credit card, and lines/lines of credit segment are numerous and do not specialize in healthcare products, the companies operating in the specialized healthcare financing are highly focused on financing medical and dental expenses. In general, the market is very dynamic, with many players entering and exiting. Out-of-Pocket Healthcare Expenditures in the United States, 5th Edition provides profiles of players in the market, noting history and lines of business, financial information, and relevant business operations.