Description
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 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 2014 – 2024, in $ Billion
- How Consumer Out-of-Pocket Expenses Are Financed in 2019 (%) (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing, HSAs)
- Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
Types and Amounts of Expenses Financed
In 2019, 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, 2018 (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, 2018 (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, 2018 (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, 2018 (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 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, 2018 (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, 2018
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 provides the following related information:
- Size of High Risk Groups for Out-of-Pocket Healthcare Expenditures, 2014 – 2024, 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, 2014 – 2024, 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 – 2024 (U.S. Population [Millions], Percentage Obese, Number Obese [Millions])
- Proportion of Adults under Age 65 with Chronic Conditions, 2018 (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 2014 – 2024, in $ Billion (Direct Payments, Co-pays, Total, Change [%])
- Proportion of Consumer Out-of-Pocket Spending by Type of Healthcare Expenditure, 2014, 2019, 2024 (Direct Payments, Co-pays)
- Change in Consumer Out-of-Pocket Expenditure by Payment Type, 2014 – 2024, 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, 2014, 2019, 2024 (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, 2014 – 2024, in $ Billion (Elective, Non-Elective)
- Change in Consumer Out-of-Pocket Expenditures for Elective Procedures That Are Financed, by Payment Type, 2014 – 2024, 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), 2014, 2019, 2024 (Paid by Cash or Check, Financed)
- Change in Amount of Consumer Out-of-Pocket Expenditures for Non-Elective Procedures That Are Financed, 2014 – 2024, 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), 2014, 2019, 2024 (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 provides profiles of players in the market, noting history and lines of business, financial information, and relevant business operations. The companies profiled include:
- Ajeva
- Aurora Quick Care
- CareCredit
- CareSpot
- ClearBalance
- ClearGage
- Concentra
- Denefits
- E-Financing Solutions
- FastMed
- Lending Club Patient Solutions
- LendingUSA
- MinuteClinic
- NextCare
- PatientFi
- Prosper Healthcare Lending
- RediClinic
- Reliance Medical Financial
- SimpleSelect Patient Finance
- U.S. HealthWorks
- Wells Fargo
Table of Contents
Chapter 1: Executive Summary
- Out-of-Pocket Expenditures in the U.S. Healthcare Industry
- Scope and Methodology
- Out-of-Pocket Spending Summary
- Exhibit 1-1: Total U.S. Out-of-Pocket Spending Growth, 2014 – 2024
- Exhibit 1-2: Consumer Out-of-Pocket Spending Market Drivers and Restraints
- Exhibit 1-3: How Consumer Out-of-Pocket Expenses Are Financed in 2019 (%) (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing, HSAs)
- Exhibit 1-4: Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
Chapter 2: The U.S. Healthcare System in 2019
- Healthcare System Overview
- Public Healthcare
- Private Healthcare
- On Demand Healthcare
- Insufficient Focus on Wellness and Prevention
- Cost Issues
- Exhibit 2-1: Percent of U.S. National Healthcare Spending by Category, 2019 (Hospital Care, Physician and Clinical Services, Retail Sales of Medical Products, Prescription Drugs, Long-term Care Including Nursing Care, Dental Services)
- Healthcare Inflation
- Managed Care Cost Shifting
- Balance Bills
- Physician Shortages
- System Errors and Inefficiencies
- The Effect of the Economy
- Exhibit 2-2: Key U.S. Economic Strength Measures, March 2019 (Inflation Rate, Unemployment Rate, Median Household Income, Poverty Rate, Household Debt, Household Debt per Capita, Consumer Confidence)
- Widening Wage Gap
- Disease Management and Wellness Programs
- Regulation
- Exhibit 2-3: Selected U.S. Federal and State Healthcare Oversight Bodies, 2019
- Reimbursement Challenges
- Consumer Healthcare Information
- Consumer Information Online
- DTC Ad Spending
- Personal Health Records (PHRs)
- Lower Cost Medications
- Generic Drugs
- Private-Label OTC Medications
- Rx-to-OTC Switches
- Medical Tourism
- Affordable Care Act
- Individual Mandate Repeal
- Association Health Plans
- Short Term Limited Duration Insurance (STLDI)
- Further Changes to the ACA
Chapter 3: U.S. Out-of-Pocket Expenditures
- Types of Expenditures
- Insurance Co-Payments
- Direct Payments
- Premiums and Plan Fees
- Payment Methods
- Cash or Check
- Credit Cards
- Loans and Lines of Credit
- Medical Financing
- Flexible Spending Accounts
- Health Savings Accounts
- Types and Amounts of Expenses Financed
- Elective Procedures and OTC Medications
- Exhibit 3-1: Methods of Financing Elective Procedures, 2018 (Credit Cards, Cash or Check, Healthcare Financing Programs, Loans or Lines of Credit)
- Non-Elective Procedures and Prescription Drugs
- Exhibit 3-2: Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Percentile of Total Health Spending, 2018 (Top 1st, 1st to 5th, 5th to 10th, 10th to 20th, Lowest 80th)
- Exhibit 3-3: Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Type of Service, 2018 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care)
- Exhibit 3-4: Average Share Paid Out-of-Pocket by U.S. Residents by Percentile of Total Health Spending and Type of Service, 2018 (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 bottom 80%: Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care)
- Exhibit 3-5: Distribution of Out-of-Pocket Healthcare Spending for the Average Person, 2018 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Vision, Other Health Care)
- Exhibit 3-6: Drug Cost Coverage by Payor Type (Public, Private, Cash) 1965, 1985, 2000, 2005, 2010, 2018
- Consumers Who Pay Out-Of-Pocket
- Exhibit 3-7: Size of High Risk Groups for Out-of-Pocket Healthcare Expenditures, 2014 – 2024, 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)
- Exhibit 3-8: Comparative Sizes of High Risk Groups for Out-of-Pocket Healthcare Expenditures, 2014 – 2024, 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)
- The Uninsured and Underinsured
- Medicaid Recipients
- The Disabled
- Senior Citizens
- The Mentally Ill
- The Obese
- Exhibit 3-9: Obesity in the United States, 1980 – 2024 (U.S. Population [Millions], Percentage Obese, Number Obese [Millions])
- Exhibit 3-10: Growth in Obesity in the United States, 1980 – 2024, in Millions of Persons (U.S. Population, Number Obese)
- Persons with Alcohol and Drug Addictions
- Persons with Chronic Conditions
- Exhibit 3-11: Proportion of Adults under Age 65 with Chronic Conditions, 2018 (Privately Insured, Medicare or Medicaid, Uninsured, Other)
Chapter 4: Consumer Out-of-Pocket Spending Forecasts in the U.S.
- Forecasts
- Total Expenditures
- Exhibit 4-1: Consumer Out-of-Pocket Expenditures 2014 – 2024, in $ Billion
- Exhibit 4-2: Growth of Consumer Out-of-Pocket Expenditures 2014 – 2024, in $ Billion
- Exhibit 4-3: Drivers & Restraints of Consumer Out-of-Pocket Expenditures
- Expenditures by Type
- Exhibit 4-4: Consumer Out-of-Pocket Expenditures by Type 2014 – 2024, in $ Billion (Direct Payments, Co-pays, Total, Change [%])
- Exhibit 4-5: Change in Consumer Out-of-Pocket Expenditures by Type 2014 – 2024, in $ Billion (Direct Payments, Co-pays)
- Exhibit 4-6: Proportion of Consumer Out-of-Pocket Spending by Type of Healthcare Expenditure, 2014, 2019, 2024 (Direct Payments, Co-pays)
- Exhibit 4-7: Drivers & Restraints of Direct Pay and Co-Pay Expenditures
- Payment Methods
- Exhibit 4-8: Consumer Out-of-Pocket Expenditure by Payment Type, 2014 – 2024, in $ Billion (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing Programs, HSAs, Total, Change [%])
- Exhibit 4-9: Change in Consumer Out-of-Pocket Expenditure by Payment Type, 2014 – 2024, in $ Billion (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing Programs, HSAs)
- Exhibit 4-10: Proportion of Consumer Out-of-Pocket Expenditures by Payment Type, 2014, 2019, 2024 (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing Programs, HSAs)
- Exhibit 4-11: Drivers & Restraints of Credit Cards, Cash/Check, FSA, Loan/Line of Credit, Healthcare Financing Program and HSA Expenditures
- Total Financing of Elective vs. Non-Elective Procedures
- Exhibit 4-12: Consumer Out-of-Pocket Expenditures for Elective vs. Non-Elective Procedures, 2014 – 2024, in $ Billion (Elective, Non-Elective, Total, Change [%])
- Exhibit 4-13: Growth of Consumer Out-of-Pocket Expenditures for Elective vs. Non-Elective Procedures, 2014 – 2024, in $ Billion (Elective, Non-Elective)
- Exhibit 4-14: Consumer Out-of-Pocket Expenditures for Elective Procedures That Are Financed, by Payment Type, 2014 – 2024, in $ Billion (Paid by Cash or Check, Financed, Total, Change [%])
- Exhibit 4-15: Change in Consumer Out-of-Pocket Expenditures for Elective Procedures by Payment Type, 2014 – 2024, in $ Billion (Paid by Cash or Check, Financed)
- Exhibit 4-16: Proportion of Consumer Out-of-Pocket Spending for Elective Procedures That Are Financed (All Methods), 2014, 2019, 2024 (Paid by Cash or Check, Financed)
- Exhibit 4-17: Drivers & Restraints of Elective Procedure Out-of-Pocket Expenditures
- Exhibit 4-18: Amount of Consumer Out-of-Pocket Expenditures for Non-Elective Procedures That Are Financed, 2014 – 2024, in $ Billion (Paid by Cash or Check, Financed, Total, Change [%])
- Exhibit 4-19: Change in Consumer Out-of-Pocket Expenditures for Non-Elective Procedures by Payment Type, 2014 – 2024, in $ Billion (Paid by Cash or Check, Financed)
- Exhibit 4-20: Proportion of Consumer Out-of-Pocket Spending for Non-Elective Procedures That Are Financed (All Methods), 2014, 2019, 2024 (Paid by Cash or Check, Financed)
- Exhibit 4-21: 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)
- Exhibit 4-22: Drivers & Restraints of Non-Elective Procedure Out-of-Pocket Expenditures
Chapter 5: Specialized Healthcare Financing
- Introduction
- Improving Collections
- Market Expansion
- Customer Satisfaction
- Types of Procedures Financed
- Elective Procedures
- Exhibit 5-1: Share of Medical Procedure Financing Market by Major Segment, 2019 (Cosmetic Surgery, Cosmetic Dentistry, Chiropractic Services, Fertility Treatments, Weight Loss Surgery, Vision Correction, Hair Restoration, Others)
- Exhibit 5-2: Cosmetic Surgical Procedures Offered in the U.S., 2019 (Invasive, Minimally Invasive, Non- Invasive)
- Exhibit 5-3: Fertility Treatments Offered in the U.S., 2019 (Approach, Description, Share of Patients [%])
- Exhibit 5-4: Leading Weight Reduction Surgeries Offered in the U.S., 2019
- Non-Elective Procedures
- Industry Exits
Chapter 6: Specialized Healthcare Financing Forecasts
- Total Expenditures
- Exhibit 6-1: Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
- Exhibit 6-2: Growth of Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
- Drivers & Restraints
- Exhibit 6-3: Drivers & Restraints of Specialized Healthcare Financing
- Elective Procedures
- Exhibit 6-4: Segmentation of Selected Medical Finance Companies in the U.S., 2019 (Elective Procedures, Non- Elective Procedures, Non-Medical Expenditures)
- Exhibit 6-5: Consumer Out-of-Pocket Elective Procedure Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
- Exhibit 6-6: Growth of Consumer Out-of-Pocket Elective Procedure Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
- Drivers & Restraints
- Exhibit 6-7: Drivers & Restraints of Specialized Healthcare Financing for Elective Procedures
- Non-Elective Procedures
- Exhibit 6-8: Consumer Out-of-Pocket Non-Elective Procedure Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
- Exhibit 6-9: Growth of Consumer Out-of-Pocket Non-Elective Procedure Expenditures Paid with Specialized Healthcare Financing 2014 – 2024, in $ Billion
- Drivers & Restraints
- Exhibit 6-10: Drivers & Restraints of Specialized Healthcare Financing for Non-Elective Procedures
- Key Players
- Exhibit 6-11: Leading Providers of Specialized Healthcare Financing in 2019, in $ Billion
- Exhibit 6-12: Market Positions of Leading Providers of Specialized Healthcare Financing in 2019
Chapter 7: Efforts to Contain Out-of-Pocket Spending
- Introduction
- Industry
- Consumer Education
- Artificial Intelligence
- Professional Organizations
- Government
- Federal Government
- State Governments
- Exhibit 7-1: Recent State Cost Cutting and Payment Reform Legislation
- Consumer Groups, Community Organizations and Others
Chapter 8: Company Profiles
- Ajeva
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Aurora Quick Care
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- CareCredit
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- CareSpot
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- ClearBalance
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- ClearGage
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Concentra
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Denefits
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- E-Financing Solutions
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- FastMed
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Lending Club Patient Solutions
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- LendingUSA
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- MinuteClinic
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- NextCare
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- PatientFi
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Prosper Healthcare Lending
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- RediClinic
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Reliance Medical Financial
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- SimpleSelect Patient Finance
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- S. HealthWorks
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Wells Fargo
- History and Lines of Business
- Financial Information
- Relevant Business Operations
