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Out-of-Pocket (OOP) Healthcare Expenditures in the United States, 5th Edition
Publication Date: July 9, 2021
Tags: Out-of-Pocket Spending, Pharmaceuticals
Pages: 210
SKU: 21-019
Rising out-of-pocket (OOP) healthcare expenses in the United States are driven by a variety of demographic, business, and government trends. Kalorama Information’s report, Out-of-Pocket (OOP) Healthcare Expenditures in the United States, 5th Edition, delves deeply into these trends, focusing on the financial aspects of OOP spending growth and providing forecasts for total expenditures and specialized healthcare financing.
Report Highlights:
- Total Expenditures: The report examines past, current, and future levels of U.S. out-of-pocket healthcare expenditures, segmented by type, payment method, and elective vs. non-elective procedures. Forecasts indicate that consumer out-of-pocket expenditures for healthcare will continue rising through the next five years.
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- Growth of Consumer Out-of-Pocket Expenditures (2015 – 2025) in $ Billion
- Financing Methods for Consumer Out-of-Pocket Expenses in 2020 (%) (Credit Cards, Cash or Check, FSAs, Loans or Lines of Credit, Healthcare Financing, HSAs)
- Specialized Healthcare Financing for Consumer Out-of-Pocket Expenditures (2015 – 2025) in $ Billion
- Types and Amounts of Expenses Financed: Analysis of the types of healthcare expenses financed by U.S. consumers in 2020, categorized into elective procedures (e.g., OTC medications) and non-elective procedures (e.g., prescription drugs). Detailed data includes:
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- Financing Methods for Elective Procedures, 2020
- Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Percentile of Total Health Spending, 2020
- Average Share of Non-Elective Healthcare Expenses Paid Out-of-Pocket by Type of Service, 2020
- Distribution of Out-of-Pocket Healthcare Spending for the Average Person, 2020
- Drug Cost Coverage by Payor Type (Public, Private, Cash) from 1965 to 2020
- Consumers Who Pay Out-of-Pocket: Insight into the demographics of consumers facing high out-of-pocket expenditures, highlighting vulnerable groups such as the uninsured, Medicaid recipients, and individuals with chronic conditions. Key data includes:
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- Size of High-Risk Groups for Out-of-Pocket Healthcare Expenditures (2015 – 2025) in Millions of Persons
- Comparative Sizes of High-Risk Groups (2015 – 2025) in Millions of Persons
- Obesity in the United States (1980 – 2025)
- Proportion of Adults under Age 65 with Chronic Conditions, 2020
- Expenditures by Type, Payment Methods, Elective vs. Non-Elective Procedures: Examination of consumer payment methods for healthcare products and services, with forecasts indicating significant variations in financing between elective and non-elective procedures. Featured data includes:
-
- Change in Consumer Out-of-Pocket Expenditures by Type (2015 – 2025) in $ Billion
- Proportion of Consumer Out-of-Pocket Spending by Type of Healthcare Expenditure (2015, 2020, 2025)
- Change in Consumer Out-of-Pocket Expenditures by Payment Type (2015 – 2025) in $ Billion
- Growth of Consumer Out-of-Pocket Expenditures for Elective vs. Non-Elective Procedures (2015 – 2025) in $ Billion
- Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2013
- Market Drivers and Restraints: Identification of the key drivers and restraints influencing U.S. out-of-pocket spending, including direct pay, co-pay expenditures, and specialized healthcare financing.
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- Drivers & Restraints of the Consumer Out-of-Pocket Spending Market
- Drivers & Restraints of Elective and Non-Elective Procedure Out-of-Pocket Expenditures
- Company Profiles: Profiles of key companies influencing or providing financing for out-of-pocket medical expenses, focusing on their history, financial information, and business operations. The report highlights the dynamic nature of the market with many new entrants and exits.
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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
Chapter 2: The U.S. Healthcare System in 2021
- Healthcare System Overview
- Public Healthcare
- Private Healthcare
- On Demand Healthcare
- Insufficient Focus on Wellness and Prevention
- Cost Issues
- S. Costs vs. Peer Country Costs
- High Price Cost Variation by City
- Healthcare Inflation
- Managed Care Cost Shifting
- Balance Bills
- Physician Shortages
- System Errors and Inefficiencies
- The Effect of the Economy
- Disease Management and Wellness Programs
- Regulation
- 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
- Affordable Care Act
- Individual Mandate Repeal
- Association Health Plans
- Short Term Limited Duration Insurance (STLDI)
- Impact of Covid
- Background
- Diagnostic Tests
- Vaccines
- Sick Care
Chapter 3: U.S. Out-of-pocket Expenditures
- Types of Expenditures
- Insurance Co-Payments
- Direct Payments
- 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
- Non-Elective Procedures and Prescription Drugs
- Consumers Who Pay Out-Of-Pocket
- The Uninsured and Underinsured
- Medicaid Recipients
- The Disabled
- Senior Citizens
- The Mentally Ill
- The Obese
- Persons with Alcohol and Drug Addictions
- Persons with Chronic Conditions
Chapter 4: Consumer Out-of-Pocket Spending Forecasts in the U.S.
- Forecasts
- Total Expenditures
- Expenditures by Type
- Payment
- Total Financing of Elective vs. Non-Elective Procedures
Chapter 5: Specialized Healthcare Financing
- Introduction
- Improving Collections
- Market Expansion
- Customer Satisfaction
- Types of Procedures Financed
- Elective Procedures
- Non-Elective Procedures
- Industry Exits
Chapter 6: Specialized Healthcare Financing Forecasts
- Total Expenditures
- Drivers & Restraints
- Elective Procedures
- Drivers & Restraints
- Non-Elective Procedures
- Drivers & Restraints
- Key Players
Chapter 7: Efforts to Contain Out-of-Pocket Spending
- Introduction
- Industry
- Tele-Health
- Artificial Intelligence
- Consumer Education
- Professional Organizations
- Government
- Federal Government
- State Governments
- 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
- 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/Rite Aid Virtual Care
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- SimpleSelect Patient Finance
- History and Lines of Business
- Financial Information
- Relevant Business Operations
- Wells Fargo
- History and Lines of Business
- Financial Information
- Relevant Business Operations
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