Out-of-Pocket Healthcare Spending and Payment Options in the U.S.

• Scope and Methodology
• The U.S. Healthcare Market
• The Need for Alternatives
• High Cost of Care
• Inconsistent Quality of Care
• Inaccessible Care
• Vulnerable Populations
• Medicaid Recipients
• Disabled Persons
• Senior Citizens
• The Mentally Ill
• Obese Persons
• Persons with Chronic Medical Conditions
• Healthcare Reform
• Out-of-Pocket Expenditures in 2006
  • Payment Types
  • Figure 1-1: Distribution of Out-of-Pocket Healthcare Expenditures by
  • Payment Type, 2006
  • Insurance Co-Payments
  • Direct Payments
  • Premiums and Plan Fees
  • Payment Methods
  • Cash or Check
  • Credit Cards
  • Flexible Spending Accounts
  • Loans and Lines of Credit
  • Health Savings Accounts
  • Healthcare Financing
  • Amount Financed
  • Elective Procedures
  • Non-Elective Procedures and Prescription Drugs
  • Consumers Who Pay Out of Pocket
  
  
• Out-of-Pocket Expenditures in 2007-2011
  • Healthcare Inflation
  • Managed Care Cost Shifting
  • Retail Clinics
  • Disease Management Programs
  • Medicare Prescription Drug Benefit
  • Generic Drugs
  • Rx-to-OTC Switches
  • Medical Tourism
  • Healthcare Advisers
  • Forecasts
  
  
• Medical Procedure Financing in 2006
  • Types of Procedures Financed
  • Elective Procedures
  • Non-Elective Procedures
  • Financing Products
  • Key Players
  
  
• Medical Procedure Financing in 2007-2011
  • Consumer Debt
  • Payday Loans
  • Weak Housing Market
  • Widening Wage Gap
  • Financial Awareness
  • Security Concerns
  • New Credit Card Products and Customers
  • Forecasts

Chapter 2 The U.S. Healthcare System Today

• Overview
• Public Healthcare
• Private Healthcare
• State-Licensed Health Insuring Organizations
• Commercial Health Insurers
• Blue Cross and Blue Shield Plans
• Health Maintenance Organizations
• Self-Funded Employee Health Benefit Plans
• Participation
• Cost Issues
• Figure 2-1: National Health Expenditures (NHE) and NHE as a Percentage
• of GDP, 1980-2011
• Figure 2-2: Premium Increases vs. Increases in Workers’ Earnings and
• Inflation, 1989-2005
• The Uninsured and Underinsured
• The Uninsured
• The Underinsured
• Regulation
• Table 2-1: Selected U.S. Federal and State Healthcare Oversight Bodies,
• 2007
• Healthcare Reform
• Universal Federal Healthcare Coverage
• State Healthcare Coverage
• Current State Healthcare Initiatives
• Table 2-2: U.S. Healthcare Coverage by State, 2007
• Federal Support of State Healthcare Reform

Chapter 3 Out-of-Pocket Expenditures: The Market in 2006

• Overall Out-of-Pocket Spending
• Figure 3-1: Average Share Paid Out-of-Pocket by U.S. Consumers, by
• Percentile of Total Healthcare Expenses, 2003
• Figure 3-2: Average Amount Paid Out-of-Pocket by U.S. Consumers, by Percentile of Total Healthcare Expenses, 2003
• Payments Types
• Figure 3-3: U.S. Consumer Out-of-Pocket Healthcare Expenditures by
• Payment Type, 2006
• Insurance Co-Payments
• Direct Payments
• Premiums and Plan Fees
• Payment Methods
• Figure 3-4: U.S. Consumer Out-of-Pocket Healthcare Expenditures by
• Payment Type, 2006
• Cash or Check
• Credit Cards
• Table 3-1: Credit Card Debt of Consumers with Medical Debt by Health Insurance Status, 2007
• Table 3-2: Credit Card Debt of Consumers with Medical Debt by
• Demographic Group, 2007
• Flexible Spending Accounts
• Loans and Lines of Credit
• Health Savings Accounts
• Healthcare Financing
• Amount Financed
• Elective Procedures
• Figure 3-5: Methods of Payment for Elective Procedures, 2006
• Figure 3-6: U.S. Consumer Out-of-Pocket Spending for Elective Procedures, Amount Financed vs. Paid with Cash or Check, 2003
• Non-Elective Procedures and Prescription Drugs
• Figure 3-7: Average Share of U.S. Healthcare Expenses Paid Out of Pocket,
• by Type of Service, 2003
• Figure 3-8: Average Share Paid Out of Pocket by U.S. Consumers, by
• Percentile of Total Healthcare Spending and Type of Service, 2003
• Figure 3-9: Distribution of Out-of-Pocket Spending on Non-Elective
• Procedures for the Average Person, 2003
• Figure 3-10: Distribution of Out-of-Pocket Spending for the Average Person,
• by Spending Level and Type of Service, 2003
• Figure 3-11: Drug Cost Coverage by Payor Type (Public, Private, Cash),
• 1965, 1986, 2000, 2004
• Consumers Who Pay Out Of Pocket
  • Medicaid Recipients
  • Figure 3-12: Change in Out-of-Pocket Healthcare Expenses for Medicaid Recipients, 1997 to 2002
  • The Disabled
  • Figure 3-13: Out-of-Pocket Healthcare Expenses for Disabled and
  • Non-Disabled Medicaid Recipients, 1997 vs. 2002
  • Senior Citizens
  • The Mentally Ill
  • Obese Persons
  • Table 3-3: Obesity in the U.S., 1980-2011
  • Persons with Chronic Conditions
  • Figure 3-14: Adults Under Age 65 with Chronic Conditions by Type of
  • Insurance, 2003

Chapter 4 Out-of-Pocket Expenditures: The Market in 2007-2011

• Trends
• Out-of-Pocket Expenditure Growth Drivers Healthcare Inflation
• Managed Care Cost-Shifting
• Figure 4-1: Extent to Which Consumers Believe Cost-Shifting Will Result in Beneficial Outcomes, 2003
• Retail Clinics
• Services
• Pricing
• Consumer Response
• Expansion
• Figure 4-2: Growth of U.S. Retail Clinics, 2001-2011
• Out-of-Pocket Expenditure Growth Constraints
• Disease Management Programs
• Medicare Prescription Drug Benefit
• Generic Drugs
• Private-Label OTC Medications
• Rx-to-OTC Switches
• Table 4-1: Selected Rx-to-OTC Switches in the United States, 1982-2007
• Table 4-2: Rx-to-OTC Switch Candidates in the U.S., 2007-2012
• Medical Tourism
• Table 4-3: Cost Savings From Medical Tourism for Various Procedures,
• 2007
• Healthcare Advisers
• Forecasts
• Table 4-4: U.S. Consumer Out-of-Pocket Expenditures per Worker, 2001-2011 (in billion $)
• Payment Type
• Table 4-5: U.S. Consumer Out-of-Pocket Expenditures by Payment Type, 2001-2011 (in billion $)
• Figure 4-3: Distribution of U.S. Consumer Out-of-Pocket Spending by Payment Type, 2001, 2006, 2011
• Payment Methods
• Table 4-6: U.S. Consumer Out-of-Pocket Expenditures by Payment Method, 2001-2011 (in billion $)
• Figure 4-4: Distribution of U.S. Consumer Out-of-Pocket Spending by Payment Method, 2001, 2006, 2011
• Amount Financed
• Elective Procedures
• Table 4-7: Amount of U.S. Consumer Out-of-Pocket Expenditures for Elective Procedures That Are Financed, 2001-2011 (in billion $)
• Figure 4-5: Share of U.S. Consumer Out-of-Pocket Spending for Elective Procedures Paid for Through Financing, 2006-2011
• Non-Elective Procedures
• Table 4-8: Amount of U.S. Consumer Out-of-Pocket Expenditures for Non-Elective Procedures That Are Financed, 2001-2011 (in billion $)
• Figure 4-6: Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2006 vs. 2011
• Figure 4-7: Share of U.S. Consumer Out-of-Pocket Spending for Non-Elective Procedures Paid for Through Financing, 2006-2011
• Consumers Who Pay Out of Pocket
• Table 4-9: Size of High-Risk Groups for High Out-of-Pocket Healthcare Expenditures,2001-2011 (in millions)

Chapter 5 Medical Procedure Financing: The Market in 2006

• Types of Procedures Financed
• Elective Procedures
• Figure 5-1: Distribution of Medical Procedure Financing Market, 2006
• Chiropractic Services
• Cosmetic Surgery
• Table 5-1: Cosmetic Surgical Procedures Offered in the U.S., 2007
• Cosmetic Dentistry
• Elective Eye Procedures
• PRK Procedures
• LASIK Procedures
• LASEK Procedures
• Forecast
• Hair Restoration
• Fertility Treatments
• Table 5-2: Fertility Treatments Offered in the U.S., 2007
• Weight Loss Surgery
• Table 5-3: Leading Weight Reduction Surgeries Offered in the U.S., 2007
• Non-Elective Procedures