United States Out of Pocket Spending in Healthcare Research Report 2023: Financial Aspects, Growth Quantification, Total Expenditures Forecasts and Specialized Healthcare Financing


DUBLIN, Sept. 21, 2023 /PRNewswire/ — The “Out of Pocket Spending in Healthcare,(Pharmaceuticals, Surgeries, Tests, Electives, Premiums, Copays, Doctor Visits, Other), 6th Edition” report has been added to  ResearchAndMarkets.com’s offering.

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).

A variety of demographic, business, and government trends are contributing to rising out-of-pocket (OOP) healthcare expenses in the United States. The report 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.

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.

While the Covid pandemic of 2020 and 2021 caused a temporary pullback in consumer out-of-pocket healthcare spending, the historic trend resumed in 2022 and is expected to continue through the five year forecast period of this report.

Types and Amounts of Expenses Financed

In 2023, 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.

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.

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.

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.

Competitive Analysis

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.

Company Profiles

  • Ally
  • 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/Rite Aid Virtual Care
  • SimpleSelect Patient Finance
  • Wells Fargo

Key Topics Covered:

Chapter 1: Executive Summary

  • Out-of-Pocket Expenditures in the U.S. Healthcare Industry
  • Scope and Methodology
  • Out-of-Pocket Spending Summary
  • Health Care Financing Programs, HSAs, Loans or Lines of Credit) (%)

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
  • Effects of Covid
  • U.S. Costs vs. Peer Country Costs
  • 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
  • Inflation
  • Widening Wage Gap
  • Reduced Savings Rate
  • Discontinued Stimulus Payments
  • Replacement of Workers by Technology
  • Forecasts
  • Disease Management and Wellness Programs
  • Regulation
  • 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
  • Non-Elective Procedures and Prescription Drugs
  • Consumers Who Pay Out-Of-Pocket
  • The Uninsured and Underinsured
  • The Uninsured
  • The Underinsured
  • Medicaid Recipients
  • The Disabled
  • Disabled Veterans
  • Millennials
  • 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
  • Drivers & Restraints
  • Expenditures by Type
  • Total Financing of Elective vs. Non-Elective Procedures

Chapter 5: Specialized Healthcare Financing

  • Introduction
  • Patient Population
  • Improving Collections
  • Market Expansion
  • Customer Satisfaction
  • Types of Procedures Financed
  • Elective Procedures
  • Cosmetic Surgery
  • Cosmetic Dentistry
  • Chiropractic Services
  • Fertility Treatments
  • Weight Loss Surgery
  • 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
  • Drivers & Restraints
  • Elective Procedures
  • Non-Elective Procedures
  • Key Players
  • Leading Providers of Specialized Healthcare Financing, by Company (Ally, CareCredit, ClearBalance, ClearGage, GreenSky, Lending Club, Lending USA, Prosper Healthcare, Wells Fargo, Others), 2022 ($ Billion)
  • 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
  • Rebalancing
  • CalAIM
  • Consumer Groups, Community Organizations and Others

Chapter 8: Company Profiles

  • History and Lines of Business
  • Financial Information
  • Relevant Business Operations

For more information about this report visit https://www.researchandmarkets.com/r/e1xvja

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