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Out-of-Pocket Spending in Healthcare, 6th Edition

Publication Date: July 12, 2023

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SKU: 23-026

Tags: Out-of-Pocket Spending, Pharmaceuticals

Pages: 205

SKU: 23-026

Description:

Out-of-pocket (OOP) healthcare expenses in the United States are on the rise due to various demographic, business, and government trends. Out-of-Pocket Spending in Healthcare (Pharmaceuticals, Surgeries, Tests, Electives, Premiums, Copays, Doctor Visits, Other), 6th Edition delves into these trends, focusing on the financial aspects of OOP spending growth. It provides forecasts of total expenditures and specialized healthcare financing, offering valuable insights for stakeholders.

Gain valuable insights into the trends and factors shaping the landscape of OOP healthcare expenditures in the United States. Order your copy of Out-of-Pocket Spending in Healthcare (Pharmaceuticals, Surgeries, Tests, Electives, Premiums, Copays, Doctor Visits, Other), 6th Edition to stay informed and make informed decisions in this dynamic market.

Key Insights:

Total consumer OOP expenditures for healthcare are expected to continue rising over the next five years, following historical trends.
Despite a temporary pullback in 2020 and 2021 due to the COVID-19 pandemic, consumer OOP healthcare spending resumed its historic trend in 2022 and is projected to continue through the forecast period.

Data Points Presented:

Growth of Consumer Out-of-Pocket Expenditures 2018-2028
Methods of Financing Elective Procedures
Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing 2018-2028
Distribution of Out-of-Pocket Healthcare Spending for the Average Person 2020

Market Drivers and Restraints:

The report identifies the strong growth drivers and few restraints influencing consumer OOP healthcare spending, providing a comprehensive understanding of the market dynamics.

Company Profiles:

The report profiles companies that help consumers pay their OOP medical expenses or significantly influence those expenses. It covers their history, lines of business, financial information, and relevant operations.

Table: Consumer Out-of-Pocket Elective Procedure Expenditures Paid with Specialized Healthcare Financing, 2018-2028 ($ Billion)

Year	Expenditures	Change
2018	$XX Billion	XX%
2019	$XX Billion	XX%
2020	$XX Billion	XX%
2021	$XX Billion	XX%
2022	$XX Billion	XX%
2023	$XX Billion	XX%
2024	$XX Billion	XX%
2025	$XX Billion	XX%
2026	$XX Billion	XX%
2027	$XX Billion	XX%
2028	$XX Billion	XX%
CAGR 2018 – 2023	XX%	–
CAGR 2018- 2028	XX%	–
CAGR 2023 – 2028	XX%	–

Source: Kalorama Information

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Chapter 1: Executive Summary

Out-of-Pocket Expenditures in the U.S. Healthcare Industry

Scope and Methodology

Out-of-Pocket Spending Summary

Figure 1-1: Consumer Out-of-Pocket Expenditures, 2018-2028 ($ Billion)
Table 1-1: Consumer Out-of-Pocket Spending Market Drivers and Restraints, 2023
Figure 1-2: How Consumer Out-of-Pocket Expenses Are Financed in 2022, by Type Used (Cash or Check, Credit Cards, FSAs, Health Care Financing Programs, HSAs, Loans or Lines of Credit) (%)
Figure 1-3: Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing 2018-2028, ($ Billion)

Chapter 2: The U.S. Healthcare System in 2023

Healthcare System Overview

Background

Public Healthcare

Medicare

Medicaid

Veteran’s Administration

Children’s Health Insurance Program

Private Healthcare

Commercial Health Insurers

Blue Cross Blue Shield Plans

HMOs

Self-Funded Employee Health Plans

On Demand Healthcare

Urgent Care Centers

Retail Clinics

Other Healthcare Venues

Insufficient Focus on Wellness and Prevention

Cost Issues

U.S. Healthcare Spending

Table 2-1: Percent of U.S. National Healthcare Spending by Category (Hospital Care, Physician and Clinical Services, Prescription Drugs, Clinical Services, Nursing Care Facilities, Home Healthcare), 2021

Effects of Covid

U.S. Costs vs. Peer Country Costs

Figure 2-1: Percent of GDP Spent on Health by OECD Member, 1980-2021

High Cost Variation by City and Venue

Healthcare Inflation

Managed Care Cost Shifting

Effects on Consumers

Balance Bills

No Surprises Act of 2020

Prior Plan Approval

Staffing Shortages

Physician Shortages

System Errors and Inefficiencies

The Effect of the Economy

Table 2-2: Key U.S. Economic Strength Measures, April 2023 vs. April 2022

Inflation

Widening Wage Gap

Reduced Savings Rate

Discontinued Stimulus Payments

Replacement of Workers by Technology

Forecasts

Disease Management and Wellness Programs

Regulation

Table 2-3: Selected U.S. Federal and State Healthcare Oversight Bodies, 2023

Reimbursement Challenges

MACRA and Value Based Reimbursement

Payment for Approved Assays

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

Affordable Care Act

Individual Mandate Repeal

Association Health Plans

Short Term Limited Duration Insurance (STLDI)

Impact of the ACA on Out-of-pocket Expenditures

Impact of Covid

Diagnostic Tests

Vaccines

Sick Care

Life Expectancy

Chapter 3: U.S. Out-of-Pocket Expenditures

Types of Expenditures

Insurance Co-Payments

Direct Payments

High Deductible Health Plans

Premiums and Plan Fees

Payment Methods

Cash, Check or Money Transfer

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

Figure 3-1: Methods of Financing Elective Procedures, by Method (Cash or Check, Credit Cards, Healthcare Financing Programs, Loans or Lines of Credit), 2022 (%)

Non-Elective Procedures and Prescription Drugs

Figure 3- 2: Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Percentile of Total Health Spending, 2020 (%)
Figure 3-3: Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Type of Service (Dental, Emergency Room, Home Health, Hospital, Office Based Visit, Outpatient, Other Health Care, Prescription Drugs, Vision), 2020 (%)
Figure 3-4: Distribution of Out-of-Pocket Healthcare Spending for the Average U.S. Person, by Type (Dental, Emergency Room, Home Health, Hospital, Office Based Visit, Outpatient, Other Health Care, Prescription Drugs, Vision), 2020 (%)
Figure 3-5: Drug Cost Coverage, by Payor Type (Public, Private, Cash), 1965, 1985, 2000, 2005, 2010, 2020 (%)

Consumers Who Pay Out-Of-Pocket

Table 3-1: Size of High Risk Groups for Out-of-Pocket Healthcare Expenditures, (The Disabled, Medicaid Recipients, The Mentally Ill, Millennials, The Obese, Persons with Chronic Conditions, Persons with Drug or Alcohol Addictions, Senior Citizens, The Uninsured & Under-insured), 2018-2028 (Millions of Persons)
Figure 3-6: Comparative Sizes of High Risk Groups for Out-of-Pocket Healthcare Expenditures, by Group (The Disabled, Medicaid Recipients, The Mentally Ill, Millennials, The Obese, Persons with Chronic Conditions, Persons with Drug or Alcohol Addictions, Senior Citizens, The Uninsured & Under-insured), 2018–2028 (Millions of Persons)

The Uninsured and Underinsured

The Uninsured

Figure 3-7: Percentage Distribution of Working Age Adults Who Were Uninsured for One or More Years, by Age (19-34, 35-49, 50-64), Race (Black, Latino/Hispanic, White), Income (<200% FPL, 200% FPL+), Health Status (Sicker, Not Sticker) and Region (Northeast, Midwest, South, West), 2022 (%)

The Underinsured

Figure 3-8: Percentage Distribution of Working Age Adults Who Were Underinsured for One or More Years, by Income (<200% FPL, 200% FPL) and Health Status (Sicker, Not Sicker), 2022 (%)

Medicaid Recipients

The Disabled

Disabled Veterans

Millennials

Senior Citizens

The Mentally Ill

The Obese

Persons with Alcohol and Drug Addictions

Persons with Chronic Conditions

Figure 3-9: Proportion of Adults Under Age 65 With Chronic Conditions, by Insurance Type (Medicare or Medicaid, Privately Insured, Uninsured, Other), 2023 (%)

Chapter 4: Consumer Out-of-Pocket Spending Forecasts in the U.S.

Forecasts

Total Expenditures

Table 4-1: Consumer Out-of-Pocket Expenditures, 2018-2028 ($ Billion)
Figure 4-1: Growth of Consumer Out-of-Pocket Expenditures, 2018-2028 ($ Billion)

Drivers & Restraints

Figure 4-2: Drivers & Restraints of Consumer Out-of-Pocket Expenditures, 2023

Expenditures by Type

Table 4-2: Consumer Out-of-Pocket Expenditures, by Type (Co-Pays, Direct Payments), 2018-2028 ($ Billion)
Figure 4-3: Change in Consumer Out-of-Pocket Expenditures, by Type (Co-Pays, Direct Payments), 2018-2028 ($ Billion)
Figure 4-4: Proportion of Consumer Out-of-Pocket Spending, by Type of Healthcare Expenditure (Co-Pays, Direct Payments), 2018, 2023, 2028 (%)

Drivers & Restraints

Figure 4-5: Drivers & Restraints of Direct Pay and Co-Pay Expenditures, 2023

Payment Methods

Table 4-3: Consumer Out-of-Pocket Expenditure, by Payment Type (Cash or Check, Credit Cards, FSAs, Healthcare Financing Programs, HSAs, Loans or Lines of Credit), 2018-2028, ($ Billion)
Figure 4-6: Change in Consumer Out-of-Pocket Expenditure, by Payment Type (Cash or Check, Credit Cards, FSAs, Healthcare Financing Programs, HSAs, Loans or Lines of Credit), 2018-2028 ($ Billion)
Figure 4-7: Proportion of Consumer Out-of-Pocket Expenditures, by Payment Type (Cash or Check, Credit Cards, FSAs, Healthcare Financing Programs, HSAs, Loans or Lines of Credit), 2018, 2023, 2028 (%)

Drivers & Restraints

Figure 4-8: Drivers & Restraints of Credit Cards, Cash/Check, FSA, Loan/Line of Credit, Healthcare Financing Program and HSA Expenditures, 2023

Total Financing of Elective vs. Non-Elective Procedures

Table 4-4: Consumer Out-of-Pocket Expenditures for Elective vs. Non-Elective Procedures, 2018-2028 ($ Billion)
Figure 4-9: Growth of Consumer Out-of-Pocket Expenditures for Elective vs. Non-Elective Procedures, 2018-2028 ($ Billion)

Elective Procedures

Table 4-5: Consumer Out-of-Pocket Expenditures for Elective Procedures That Are Financed, by Payment Type (Paid by Cash or Check, Financed), 2018-2028 ($ Billion)
Figure 4-10: Change in Consumer Out-of-Pocket Expenditures for Elective Procedures, by Payment Type (Paid by Cash or Check, Financed), 2018-2028, ($ Billion)
Figure 4-11: Proportion of Consumer Out-of-Pocket Spending for Elective Procedures That Are Financed (All Methods), by Method (Paid by Cash or Check, Financed), 2018, 2023, 2028 (%)

Drivers & Restraints

Figure 4-12: Drivers & Restraints of Elective Procedure Out-of-Pocket Expenditures, 2023

Non-Elective Procedures

Table 4-6: Amount of Consumer Out-of-Pocket Expenditures for Non-Elective Procedures That Are Financed, by Payment Type (Paid by Cash or Check, Financed), 2018-2028 ($ Billion)
Figure 4-13: Change in Consumer Out-of-Pocket Expenditures for Non-Elective Procedures, by Payment Type (Paid by Cash or Check, Financed), 2018-2028 ($ Billion)
Figure 4-14: Proportion of Consumer Out-of-Pocket Spending for Non-Elective Procedures That Are Financed (All Methods), by Payment Type (Paid by Cash or Check, Financed), 2018, 2023, 2028 (%)
Figure 4-15: Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, by Procedure (Cancers and Tumors, Circulatory System, Dermatological, Digestive, Endocrine, Genitourinary, Ill Defined Conditions, Infectious Diseases, Injury and Poisoning, Mental Illness, Musculoskeletal, Nervous System, Pregnancy and Childbirth, Respiratory, Other), 2017 (%)

Drivers & Restraints

Figure 4-16: Drivers & Restraints of Non-Elective Procedure Out-of-Pocket Expenditures, 2023

Chapter 5: Specialized Healthcare Financing

Introduction

Patient Population

Improving Collections

Market Expansion

Customer Satisfaction

Types of Procedures Financed

Elective Procedures

Figure 5-1: Share of Medical Procedure Financing Market, by Major Segment (Chiropractic Services, Cosmetic Dentistry, Cosmetic Surgery, Fertility Treatment, Hair Restoration, Vision Correction, Weight Loss Surgery, Others), 2023

Cosmetic Surgery

Table 5-1: Cosmetic Surgical Procedures Offered in the U.S., by Type (Invasive, Minimally Invasive, Non-Invasive), 2023

Cosmetic Dentistry

Chiropractic Services

Fertility Treatments

Table 5-2: Fertility Treatments Offered in the U.S., 2023

Weight Loss Surgery

Table 5-3: Leading Weight Reduction Surgeries Offered in the U.S., 2023

Vision Correction

Hair Restoration

Other Procedures

Non-Elective Procedures

Types of Products

Costs to Consumers

Costs to Providers

Usage and Acceptance

Industry Exits

Chapter 6: Specialized Healthcare Financing Forecasts

Total Expenditures

Table 6-1: Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing, 2018-2028 ($ Billion)
Figure 6-1: Growth of Consumer Out-of-Pocket Expenditures Paid with Specialized Healthcare Financing, 2018-2028 ($ Billion)

Drivers & Restraints

Figure 6-2: Drivers & Restraints of Specialized Healthcare Financing, 2023

Elective Procedures

Table 6-2: Segmentation of Selected Medical Finance Companies in the U.S., 2023
Table 6-3: Consumer Out-of-Pocket Elective Procedure Expenditures Paid with Specialized Healthcare Financing, 2018-2028 ($ Billion)
Figure 6-3: Growth of Consumer Out-of-Pocket Elective Procedure Expenditures Paid with Specialized Healthcare Financing, 2018-2028 ($ Billion)

Drivers & Restraints

Figure 6-4: Drivers & Restraints of Specialized Healthcare Financing for Elective Procedures, 2023

Non-Elective Procedures

Table 6-4: Consumer Out-of-Pocket Non-Elective Procedure Expenditures Paid with Specialized Healthcare Financing, 2018-2028 ($ Billion)
Figure 6-5: Growth of Consumer Out-of-Pocket Non-Elective Procedure Expenditures Paid with Specialized Healthcare Financing, 2018-2028 ($ Billion)

Drivers & Restraints

Figure 6-6: Drivers & Restraints of Specialized Healthcare Financing for Non-Elective Procedures, 2023

Key Players

Table 6-5: Leading Providers of Specialized Healthcare Financing, by Company (Ally, CareCredit, ClearBalance, ClearGage, GreenSky, Lending Club, Lending USA, Prosper Healthcare, Wells Fargo, Others), 2022 ($ Billion)
Figure 6-7: Market Positions of Leading Providers of Specialized Healthcare Financing, by Company (Ally, CareCredit, ClearBalance, ClearGage, GreenSky, Lending Club, Lending USA, Prosper Healthcare, Wells Fargo, Others), 2022 (%)

Chapter 7: Efforts to Contain Out-of-Pocket Spending

Introduction

Industry

Tele-Health

Mobile Health

Artificial Intelligence

Chatbots and ChatGPT

Future Applications

Consumer Education

Government

Federal Government

Inflation Reduction Act

State Governments

Premium Rate Review

Reference-Based Pricing

Cost Growth Benchmarks

Reblancing

CalAIM

Consumer Groups, Community Organizations and Others