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Out of Pocket Spending in Healthcare, (Pharmaceuticals, Surgeries, Tests, Electives, Premiums, Copays, Doctor Visits, Other), 6th Edition
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This report estimates U.S. consumer out-of-pocket spending on healthcare, particularly direct payments to providers and financed payments between 2020-2028.

A variety of demographic, business, and government trends are contributing to rising out-of-pocket (OOP) healthcare expenses in the United States. “Out-of-Pocket Healthcare Expenditures in the United States, 6th Edition” 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.

Total Expenditures

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). 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.

The report presents the following data points:

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. The report provides the following data:

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. “Out-of-Pocket Healthcare Expenditures in the United States, 6th Edition” provides the following related information:

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.

Featured data include:

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. The report shows leading drivers and restraints of consumer out-of-pocket healthcare spending, in order of strength, across the market:

Company Profiles

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. “Out-of-Pocket Healthcare Expenditures in the United States, 6th Edition” provides profiles of players in the market, noting history and lines of business, financial information, and relevant business operations.

The companies profiled include:

  • 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

Table of Contents

Chapter 1: Executive Summary

Chapter 2: The U.S. Healthcare System in 2023

Chapter 3: U.S. Out-of-Pocket Expenditures

Chapter 4: Consumer Out-of-Pocket Spending Forecasts in the U.S.

Chapter 5: Specialized Healthcare Financing

Chapter 6: Specialized Healthcare Financing Forecasts

Chapter 7: Efforts to Contain Out-of-Pocket Spending

Chapter 8: Company Profiles

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