Despite numerous attempts to reign in costs of healthcare, consumers are
increasingly paying for healthcare products and services from their own
monies. The costs of health care products and services continue to rise
briskly, significantly outpacing currently low inflation rates. While
insurance is the most common form of payment for healthcare services,
increasingly customers are paying for their own expenses. Pharmaceutical,
device and diagnostic companies, should recognize that a part of their
revenues are originating directly or indirectly from out of pocket
expenditures. Unique financial services have been created to facilitate
non-insurance-paid health care services, and more are expected to be created
in the near term.
This report, Out of Pocket Healthcare 2012, focuses on those costs of
health care which are not paid for by government or private insurance. Once a
small percentage of costs of the health care system, the percentage borne by
the consumer is increasing steadily. Included in the report is:
Estimates of the Current 'Out of Pocket' Healthcare Spending Market and
Forecasts to 2016.
Forecasts of Spending by Type (Elective, Hospital, Emergency Room, Dental,
Vision, Prescription Drugs, Office Based Visit)
Health Care Reform and Its Impact on Out of Pocket Spending
Statistics For the Types of Consumers Most Likely to Pay Out of Pocket
Drivers of the Out of Pocket Trend and Potential Limiters
Overview of the U.S. Healthcare System, Insured and Uninsured Population.
The economic recession of December 2007 to October 2009 and weak recovery
thereafter has represented a major downturn that led to broad-based
cost-cutting, rising unemployment and reduced disposable income. As part of
Kalorama Information's trusted process, secondary research from government,
medical and industry sources was utilized along with interviews with industry
experts in the healthcare finance industry.
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Table of Contents
ONE: EXECUTIVE SUMMARY
Healthcare Spending Out-of-Pocket
Types of Out-of-Pocket Spending
Out-of-pocket Expenditure Growth Drivers
Out-of-Pocket Growth Constraints
Out-of-Pocket Spending in Healthcare
Scope and Methodology
TWO: DRIVERS AND CONSTRAINTS
Background
The Need for Alternatives
High Costs
Out-of-pocket Expenditure Growth Drivers
The Economy
Healthcare Inflation
Demographics
Managed Care Cost Shifting
Retail Clinics
Obesity
Smoking
Out-of-Pocket Growth Constraints
Disease Management Programs
Medicare Prescription Drug Benefit
Generic Drugs
Private-Label OTC Medications
Healthcare Reform
Reduction in Doctor Visits
THREE: OUT OF POCKET HEALTHCARE MARKET ESTIMATES
Payment Methods
Elective and Non Elective Out-of-Pocket Spending
Elective Procedures
Non-Elective Procedures
Out-of-Pocket Healthcare Spending By Type
Non-Elective
Hospital/Clinic
Physician Office
Prescription Drugs
Elective
Vision
Dental
Conclusions
LIST OF EXHIBITS
ONE: EXECUTIVE SUMMARY
Figure 1-1: Out-of-Pocket Spending, 2008-2016
TWO: DRIVERS AND CONSTRAINTS
Figure 2-1: GDP by quarter 2008-2012
Figure 2-2: Unemployment by Quarter
Table 2-1: US Population
Figure 2-3: US Population
Table 2-2: Percent U.S. Population Over Age 65 by Year
Figure 2-4: Estimated Population by Age Group, 2000 and 2050
Figure 2-5: Persons at Risk for Higher Out-of-Pocket Costs
Table 2-4: Obesity Rates by State, 2010
Table 2-5: Percent of Smokers by Country
Table 2-3: Statistics for Selected Rx-to-OTC Switches (United States)
Figure 2-6: Doctor Visits, U.S. (millions of visits)
Figure 2-7: Experian/Simmons Survey - Have You Visited the Doctor? What
Type?
THREE: OUT OF POCKET HEALTHCARE MARKET ESTIMATES
Table 3-1: Consumer Out-of-pocket Expenditures per Worker, 2008-2016
Table 3-2: Consumer Out-of-pocket Expenditures by Type, 2008 - 2013
Figure 3-1: Percentage of Out-of-Pocket Expenditures by Payment Type (Cash
or Check, Credit Cards, FSAs, HSAs, Loans, Healthcare Finance Program), 2011
Figure 3-2: Percentage of Out-of-Pocket Expenditures by Payment Type (Cash
or Check, Credit Cards, FSAs, HSAs, Loans, Healthcare Finance Program), 2016
Table 3-3: All Non-Elective Healthcare Out-of-Pocket Spending, 2008-2016
