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

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Sep 21, 2023, 05:30 ET

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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