市場調査レポート - 238128

米国における自己負担の医療費

Out-of-Pocket Healthcare Expenditures in the United States

発行 Kalorama Information
出版日 ページ情報 英文 130 Pages
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米国における自己負担の医療費 Out-of-Pocket Healthcare Expenditures in the United States
出版日: 2015年05月15日 ページ情報: 英文 130 Pages
概要

米国消費者の医療関連の製品・サービスに対する自己負担額は拡大を続けており、この支払額は消費者所得の中でも大きな部分を占めると推計されています。米国人口の高齢化、医療関連製品・サービスの利用レベルの向上、公的健康保険および民間医療保険の適用範囲の縮小などがこの拡大の要因となっています。米国消費者の医療関連自己負担額は、1980年の250ドルから年間40-50ドルずつ増加し、2015年には1,300ドルの規模に至っています。

当レポートでは、米国消費者による医療関連製品・サービスに対する自己負担支払額について調査し、自己負担する医療関連支出のタイプ、支払い方法の種類と概要、自己負担額の多い消費者のプロファイル、自己負担額拡大の促進要因・抑制要因、支出額の推移と予測などをまとめています。

第1章 エグゼクティブサマリー

第2章 イントロダクション

  • 支出のタイプ
  • 保険の自己負担固定額
  • 直接支払い
  • 保険料
  • 支払い方法
    • 現金・小切手
    • クレジットカード
    • ローン・クレジットライン
    • フレキシブル支出口座
    • 医療貯蓄口座
    • 医療ローン
  • 貸出額
  • 選択的処置
  • 非選択的処置・処方薬
  • 自己負担する消費者
    • 無保険者/過小保険者
    • メディケイド受給者
    • 慢性疾患患者
  • 動向
  • 自己負担額の拡大要因
  • 自己負担額の拡大抑制要因

第3章 市場分析

  • 予測
    • タイプ別資質額
    • 支払い方法
    • 融資額
    • 融資対象の費用のタイプ
    • 自己負担する消費者

図表

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目次

Out-of-pocket expenditures for health care products and services in the United States continue to rise and in 2015 represent a significant portion of consumers' incomes. This is the result of a variety of factors including an aging U.S. population, rising utilization of medical products and services, and ongoing cutbacks to both public (federal and state) and private health coverage. Over the years, U.S. consumers' annual out-of-pocket health care costs have risen from about $250 per person in 1980 to $1,300 in 2015, with yearly increases of about $40 to $50. Increases for health plan premiums, in particular, have outpaced increases in overall prices and workers' earnings.

This Kalorama Information report, Out-of-Pocket Spending n the United States, details the trend of consumers purchasing their healthcare with their own cash or credit cards and/or various financing programs. Included in this report's analysis is the following:

  • Total Spending By Consumers
  • Proportion That is Cash, Credit Card, HSA and Other Programs
  • Co-Pay Spending, 2009-2014 and Projected to 2019
  • Premium Spending, 2009-2014 and Projected to 2019
  • Direct Healthcare Purchases, 2009-2014 and Projected to 2019
  • Elective Spending
  • Non-Elective Spending

Direct payments represent payments made from consumers directly to health care providers without reimbursement by insurers. For the uninsured and many underinsured, such payments represent the primary means of funding health care. For those with health care insurance, direct payments supplement plan payments. Initially, direct payments will be made to meet deductible levels; after that, direct payments may be required to meet plan co-payments in the case of plans that do not fund 100% of expenses after deductibles are met. This is the case for a growing number of plans that pay 80% to 90% of expenses after deductibles. Furthermore, many plans also set limits on payments for certain products or services, so that participants must self-fund further expenditures after those limits are met. Thus, direct payments may be made by both uninsured and insured persons. For both groups, however, the size of direct payments for health care continues to rise.

Health care premiums represent fees paid by plan participants to maintain membership in the plan. Unlike co-payments and deductibles, they are not tied directly to receipt of products or services. As the single most important way that health care plans are financed, premiums continue to rise as MCOs attempt to offset their own increasing expenses. In 2013, the most recent year for which data is available, HMO premiums rose by more than 10%, according to Hewitt Associates. Much of this growth is attributed to healthcare price increases in excess of inflation (such as through the utilization of higher-priced technologies) and about one quarter is the result of increased utilization.

Co-payments may be set either at a fixed rate or as a proportion of the cost of each covered product or service. Over the past two decades, co-pays have been rising as MCOs continue to utilize them as a means to both help offset payments to providers and encourage/discourage certain consumer behaviors. For example, co-payments are often set higher on more expensive alternatives (new and/or brand name medicines, utilization of out-of-network providers, innovative procedures, etc.) and lower on less expensive choices (generic and/or lower cost medicines, etc.).

Consumers in the United States utilize a variety of methods to pay for health care products and services. These are required in instances when payment is not made directly from a health care plan directly to the provider. The key payment methods utilized are:

  • cash or check;
  • credit cards;
  • loans and lines of credit;
  • flexible spending accounts;
  • health savings accounts;
  • medical financing.

Consumers from all socioeconomic groups are facing high out-of-pocket expenditures for health care. However, certain groups are more vulnerable to this threat and represent a larger proportion of total such spending. These include:

  • the uninsured and underinsured;
  • Medicaid recipients;
  • disabled persons;
  • senior citizens;
  • the mentally ill;
  • obese persons;
  • persons with chronic medical conditions.

Table of Contents

CHAPTER ONE: EXECUTIVE SUMMARY

  • Out-of-Pocket Spending

CHAPTER TWO: INTRODUCTION

  • Types of Expenditures
  • Insurance Co-Payments
  • Direct Payments
  • Premiums and Plan Fees
  • Payment Methods
  • Cash or Check
  • Credit Cards
  • Loans and Lines of Credit
  • Flexible Spending Accounts
  • Health Savings Accounts
  • Medical Financing
  • Amount Financed
  • Elective Procedures
  • Non-Elective Procedures and Prescription Drugs
  • Non-Elective Procedures and Prescription Drugs
  • Consumers Who Pay Out-of-pocket
  • The Uninsured and Underinsured
  • Medicaid Recipients
  • Persons with Chronic Conditions
  • Trends
  • Out-of-pocket Expenditure Growth Drivers
  • Out-of-pocket Expenditure Growth Constraints

CHAPTER THREE: MARKET ANALYSIS

  • Forecasts
    • Expenditures by Type
    • Payment Methods
    • Amount Financed
    • Types of Expenses Financed
    • Consumers Who Pay Out of Pocket

LIST OF EXHIBITS

CHAPTER ONE: EXECUTIVE SUMMARY

  • Figure 1-1 Out-of-Pocket Spending on Healthcare in the United States (billions)

CHAPTER TWO: INTRODUCTION

  • Figure 2-1 Premium Increases vs. Increases in Workers Earnings and Prices, 2000 - 2014
  • Figure 2-2 Consumer Out-of-pocket Health Care Expenditures, 2014(Co-pays, Direct Payments, Premiums)
  • Figure 2-3 Consumer Out-of-pocket Health Care Expenditures by Payment Type, 2014 (HSAs, Health Care Financing Programs, Loans or Lines of Credit, FSAs, Credit Cards, Cash or Check )
  • Table 2-1 Main Business Activities of Selected Medical Financing Companies, 2014 (Financing Elective Procedures, Financing Non-Elective Procedures, Non-Medical Consumer Credit)
  • Figure 2-4 Average Out-of-pocket Payment by U.S. Residents with Health Care Spending by Percentile of Total Health Spending, 2014 (Cosmetic Surgery, Cosmetic Dentistry, Eye Procedures, Chiropractic Services, Hair Restoration, Fertility Treatments, Weight Loss , Other)
  • Figure 2-5 Methods of Financing Elective Procedures, 2014 (Loans or Lines of Credit, Cash or Check, Health Care Financing Programs, Credit Cards)
  • Figure 2-6 Average Share Paid Out-of-pocket by U.S. Residents with Health Care Spending by Type of Service, 2014 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care)
  • Figure 2-7 Average Share Paid Out-of-pocket by U.S. Residents with Health Care Spending by Percentile of Total Health Spending and Type of Service, 2014 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care) 26
  • Figure 2-8 Distribution of Out-of-pocket Spending on Non-Elective Procedures for the Average Person, 2014 (Prescription Drugs, Emergency Room, Dental, Vision, Other Health Care, Hospital, Outpatient, Office Based Visit)
  • Figure 2-9 Distribution of Out-of-pocket Spending for the Average Person, by Spending Level, 2014(Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental,Home Health, Vision, Other Health Care)
  • Figure 2-10 Drug Cost Coverage by Payor Type (Public, Private, Cash):1965, 1986, 2000, 2005, 2010, 2015
  • Table 2-2 Obesity in the United States, 1980 - 2019
  • Figure 2-11 Coverage of Adults under Age 65 with Chronic Conditions, 2014 (Privately Insured, Medicare orMedicaid, Uninsured, Other)

CHAPTER THREE: MARKET ANALYSIS - OUT-OF-POCKET SPENDING IN THE US, 2014- 2019

  • Table 3-1 Selected Rx-to-OTC Switches in the United States, 1990 - 2014
  • Table 3-2 Consumer Out-of-pocket Expenditures per Worker, 2009-2019
  • Table 3-3 Consumer Out-of-pocket Expenditures by Type, 2009-2019
  • Figure 3-1 Proportion of Consumer Out-of-pocket Spending by Type of Health Care Expenditure, 2009, 2014, 2019 (Direct Payments, Co-pays, Premiums)
  • Table 3-4 Consumer Out-of-pocket Expenditures by Type, 2009-2019
  • Figure 3-2 Proportion of Consumer Out-of-Pocket Spending by Payment Type, 2009, 2014, 2019 (Credit Cards, FSAs, Health Care Financing Programs, Cash or Check, Loans or Lines of Credit, HSAs)
  • Table 3-5 Amount of Consumer Out-of-Pocket Expenditures for Elective Procedures That Are Financed, 2009-2019
  • Table 3-6 Amount of Consumer Out-of-Pocket Expenditures for Non-Elective Procedures That Are Financed, 2009-2019
  • Figure 3-3 Proportio of Consumer Out of Pocket Spending for Elective Procedures (Cosmetic Surgery, Consmetic Dentistry, Eye Procedures, Chiropractic Services, Hair Restoration, Fertility Treatment, Weight Loss Surgery)
  • Figure 3-4: Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2014, 2019 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Vision, Other Health Care)
  • Figure 3-5 Proportion of Consumer Out-of-Pocket Spending for Non-Elective Procedures That is Financed(All Methods), 2014 - 2019 (Hospital, Outpatient, Office Based Visit, Prescription Drugs,Emergency Room, Dental, Home Health, Vision)
  • Table 3-7 Size of High Risk Groups for High Out-of-Pocket Health Care Expenditures, 2009-2019(Uninsured and Underinsured, Medicaid Recipients, The Disabled, Senior Citizens, The Mentally Ill, The Obese, Persons with Chronic Conditions)
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