Patient Out-of-Pocket Healthcare Costs Balloon by 10% Since 2020

Patient out-of-pocket healthcare costs are up 10 percent since last year, with the net total of patient financial responsibility coming in around $491 billion in 2021, according to Kalorama Information.

What’s more, the company estimated a 9.9 percent increase in out-of-pocket healthcare spending through 2026, amount to some $800 billion in patient spending.

This growth follows previous increases in out-of-pocket healthcare costs, the report continued. In 1980, the average annual patient financial responsibility came in at about $250 per patient. That figure ballooned to $1,650 by 2021, the researchers said. That shakes out to cost increases between $40 and $50 each year.

Healthcare consumers have particularly felt this pinch as it relates to health payer premiums, which the research firm said have in fact outpaced growth in overall prices and worker earnings.

The report also attributed changes in out-of-pocket healthcare spending changes to regulatory and payer requirements, like managed care organization changes or the repeal of the ACA’s individual mandate.

Business and economic changes, like those made by healthcare organizations themselves, have also contributed to the rise in out-of-pocket patient spending.

And finally, a rise in certain chronic illnesses, like obesity, have contributed to higher patient costs. Aging and general chronic disease burden may also be at play.

The research firm said key patient engagement efforts, like chronic disease management, will be essential for capping growing out-of-pocket spending. Additionally, referring patients to low-cost healthcare options, like generic drugs and different types of health plans, will be key.

Care access and utilization patterns will also likely affect out-of-pocket healthcare spending, although most experts would agree that’s not exactly a good thing. The research firm said that as patients shoulder more of their healthcare costs—and their own salaries don’t keep up—they might choose to forego care. That trend, plus foregone care due to the COVID-19 pandemic, could drive down out-of-pocket spending.

But again, most experts would agree that’s not exactly a good thing. The key to lowering consumer healthcare costs is not to discourage access, as that low utilization and disengagement could result in an eventual, high-cost acute care encounter.

Rather, addressing social determinants of health like income and healthcare affordability will be key to closing the cost-related care access gap. The above-mentioned cost-containment strategies like strong chronic disease management and referral to low-cost options will require stronger patient engagement, not lower utilization, making it imperative organizations connect with low-income patients and patients experiencing affordability barriers.

This information builds on previous data outlining rising healthcare costs and out-of-pocket spending as a serious patient healthcare issue. In April, West Health and Gallup Poll found that 18 percent of patients wouldn’t be able to pay for healthcare even if they needed it in that moment. Another 18 percent of respondents said someone in their household skipped healthcare access because of high patient financial responsibility.

Healthcare affordability was also more problematic for low-income patients; 35 percent of households with incomes lower than $24,000 annually said they would not be able to access healthcare right now because of affordability issues. For middle-income earners making between $40,000 and $98,000 annually, that number went down to 19 percent unable to afford care right now.

For those in the highest income bracket above $180,000 annually, 7 percent said they could not afford a healthcare visit right now. Said otherwise, just shy of one in ten individuals making well into six figures would be unable to afford a medical visit right now.

Healthcare professionals can work to offset those costs by addressing social determinants of health that make healthcare unaffordable, like cost of lost hourly wages of cost of transportation. But perhaps more important will be policy changes that affect the overall price of care.