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The Growing "Out of Pocket" Healthcare Market (Spending on Surgeries, Pharmaceuticals and Other Healthcare Services)


Attention: There is an updated edition available for this report.

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.

Health care costs are high and accelerating as a result of a confluence of factors within the broader economy, as well as the health care marketplace. 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.

Kalorama Information's unique report The Growing "Out of Pocket" Healthcare Market examines these phenomena, estimates the size of these expenses over the next five years, and discusses established and emerging financial programs that help consumers pay them. Included in the report is:

  • Estimates of the Current 'Out of Pocket' Market and Forecasts to 2011.
  • Breakdown of Elective and Non-elective out of pocket markets.
  • Description of the Types of Consumers Most Likely to Pay Out of Pocket
  • Drivers of the Out of Pocket Trend
  • Overview of the U.S. Healthcare System, Insured and Uninsured Population.
  • The Types of Services and Products purchased with out of pocket dollars
  • Detailed Overview of the growing healthcare finance market and the major players.
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.

The following companies are profiled in this study:

  • APFUSA
  • Aurora Quick Care
  • Capital One Healthcare Finance
  • Care Credit
  • Checkups
  • Credit Medical
  • CSI Financial Services
  • E-Financing Solutions
  • Health Ready
  • Medchoice Financial
  • Meddirect
  • Medprova
  • Minuteclinic
  • PFS
  • Rediclinic
  • Reliance Medical Finance
  • Solantic
  • Take Care Health Systems
  • Target Clinical Medical Associates
NOTE: This study was published under the same research that originated in Packaged Fact's ground-breaking study of this market (LA1383058 Out of Pocket Healthcare Spending Options in the United States). Customers of this Packaged Facts title would find the material duplicative.


TABLE OF CONTENTS

    CHAPTER ONE: EXECUTIVE SUMMARY

  • Out of Pocket Expenditures : Current Market
  • The U.S. Healthcare Market
  • The Need for Alternatives
  • High Cost of Care
  • Inconsistent Quality of Care
  • Inaccessible Care
  • Vulnerable Populations
  • Consumers Who Pay Out of Pocket
  • Medicaid Recipients
  • Disabled Persons
  • Senior Citizens
  • The Mentally Ill
  • Obese Persons
  • Persons with Chronic Medical Conditions
  • Health Care Reform
  • Types Of Out Of Pocket Payments
  • 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
  • Health Care Financing
  • Non-Elective Procedures and Prescription Drugs
  • Types of Expenses Financed
  • Elective Procedures
  • Non-Elective Procedures and Prescription Drugs
  • Trends In Out Of Pocket Spending
  • Health Care Inflation
  • Managed Care Cost Shifting
  • Retail Clinics
  • Disease Management Programs
  • Medicare Prescription Drug Benefit
  • Generic Drugs
  • Rx-to-OTC Switches
  • Medical Tourism
  • Health Care Advisers
  • Medical Procedure Financing
  • Types of Procedures Financed
  • Elective Procedures
  • Non-Elective Procedures
  • Financing Products
  • Scope and Methodology

    CHAPTER TWO: HEALTH CARE PAYMENTS AND COVERAGE

  • Overview
  • Public Health Care
  • Private Health Care
  • 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
  • The Uninsured And Underinsured
  • The Uninsured
  • The Underinsured
  • Regulation
  • Health Care Reform
  • Universal Federal Health Care Coverage
  • State Health Care Coverage
  • Current State Health Care Initiatives
  • Federal Support of State Health Care Reform

    CHAPTER THREE: OUT-OF-POCKET EXPENDITURES: THE CURRENT MARKET
  • Overall Out-Of-Pocket Spending
  • Payments Types
  • 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
  • Health Care Financing
  • Amount Financed
  • Elective Procedures
  • Non-Elective Procedures and Prescription Drugs
  • Consumers Who Pay Out Of Pocket
  • Medicaid Recipients
  • The Disabled
  • Senior Citizens
  • The Mentally Ill
  • Obese Persons
  • Persons with Chronic Conditions
    CHAPTER FOUR: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2007-2011

  • Trends
  • Out-of-Pocket Expenditure Growth Drivers
  • Health Care Inflation
  • Managed Care Cost-Shifting
  • Retail Clinics
  • Services
  • Pricing
  • Consumer Response
  • Expansion
  • Out-of-Pocket Expenditure Growth Constraints
  • Disease Management Programs
  • Medicare Prescription Drug Benefit
  • Generic Drugs
  • Private-Label OTC Medications
  • Rx-to-OTC Switches
  • Medical Tourism
  • Health Care Advisers
  • Forecasts
  • Payment Type
  • Payment Methods
  • Amount Financed
  • Elective Procedures
  • Non-Elective Procedures
  • Consumers Who Pay Out of Pocket
    CHAPTER FIVE: SOURCES OF MEDICAL PROCEDURE FINANCING, 2006
  • Types Of Procedures Financed
  • Elective Procedures
  • Chiropractic Services
  • Cosmetic Surgery
  • Cosmetic Dentistry
  • Elective Eye Procedures
  • PRK Procedures
  • LASIK Procedures
  • LASEK
  • Forecast
  • Hair Restoration
  • Fertility Treatments
  • Weight Loss Surgery
  • Non-Elective Procedures
  • Financing Programs
  • Costs to Consumers
  • Costs to Providers
  • Usage and Acceptance
  • Key Players
  • Elective Procedures
  • Non-Elective Procedures
    CHAPTER SIX: SOURCES OF MEDICAL PROCEDURE FINANCING, 2007-2011
  • Trends
  • Consumers
  • Consumer Debt
  • Payday Loans
  • Weak Housing Market
  • Widening Wage Gap
  • Financial Awareness
  • Security Concerns
  • Financial Institutions
  • Increasing Share of Wallet
  • New Credit Card Products
  • New Credit Card Customer Segments
  • Forecasts
    CHAPTER SEVEN: COMPANY PROFILES
  • APFUSA
  • Aurora Quick Care
  • Capital One Healthcare Finance
  • Care Credit
  • Checkups
  • Credit Medical
  • CSI Financial Services
  • Health Ready
  • Medchoice Financial
  • Meddirect
  • Medprova
  • Minuteclinic
  • PFS
  • Rediclinic
  • Reliance Medical Finance
  • Solantic
  • Springstone Patient Financing
  • Take Care Health Systems
  • Target Clinical Medical Associates

TABLE OF EXHIBITS

    CHAPTER ONE: EXECUTIVE SUMMARY
  • Figure 1-1:The U.S. Out of Pocket Healthcare Market, 2006-2011, Elective and Non-Elective Spending (in billions)
  • Figure 1-2: U.S. Consumer Out-of-Pocket Health Care Expenditures by Service Required, 2006
  • Figure 1-3: U.S. Healthcare Consumers Highly Likely to Pay Out of Pocket, 2006-2011 (millions)
  • Figure 1-4: U.S. Healthcare Consumers Likely to Pay Out of Pocket, by Contributing Factor 2006 (Persons with Chronic Conditions, Medicaid, Disabled, Senior Citizens, Mentally Ill, Obese)
  • Figure 1-5 : Average Share Paid Out of Pocket by U.S. Consumers, by Percentile of Total Health Care Spending and Type of Service, 2003

    CHAPTER TWO: HEALTH CARE PAYMENTS AND COVERAGE

  • 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
  • Table 2-1:Selected U.S. Federal and State Health Care Oversight Bodies,2007
  • Table 2-2:U.S. Health Care Coverage by State,2007
    CHAPTER THREE: OUT-OF-POCKET EXPENDITURES: THE CURRENT MARKET
  • Figure 3-4: Average Share Paid Out-of-Pocket by U.S. Consumers, by Percentile of Total Health Care Expenses, 2003
  • Figure 3-5: Average Amount Paid Out-of-Pocket by U.S. Consumers, by Percentile of Total Health Care Expenses, 2003
  • Figure 3-1: U.S. Consumer Out-of-Pocket Health Care Expenditures: Direct Payments, Co-Pays and Premiums, 2006
  • Figure 3-2: U.S. Consumer Out-of-Pocket Health Care Expenditures by Payment Type, 2006
  • 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
  • Figure 3-3: Methods of Payment for Elective Procedures, 2006
  • Figure 3-4: U.S. Consumer Out-of-Pocket Spending for Elective Procedures, Amount Financed vs. Paid with Cash or Check, 2003
  • Figure 3-7:Average Share of U.S. Health Care 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 Health Care Spending and Type of Service, 2003
  • Figure 3-9: Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2003 71
  • 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
  • Figure 3-12: Change in Out-of-Pocket Health Care Expenses for Medicaid Recipients, 1997 to 2002
  • Figure 3-13: Out-of-Pocket Health Care Expenses for Disabled and Non-Disabled Medicaid Recipients, 1997 vs. 2002
  • Table 3-3: Obesity in the U.S., 1980-2011
  • Figure 3-14: Adults Under Age 65 with Chronic Conditions by Type of Insurance, 2003
    CHAPTER FOUR: OUT-OF-POCKET EXPENDITURES: FORECASTED MARKET TO 2011
  • Figure 4-1: Extent to Which Consumers Believe Cost-Shifting Will Result in Beneficial Outcomes, 2003
  • Figure 4-2: Growth of U.S. Retail Clinics, 2001-2011
  • 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
  • Table 4-3: Cost Savings From Medical Tourism for Various Procedures, 2007
  • Table 4-4:U.S. Consumer Out-of-Pocket Expenditures per Worker, 2001-2011
  • Table 4-5: U.S. Consumer Out-of-Pocket Expenditures by Payment Type, 2001-2011
  • Figure 4-3: Distribution of U.S. Consumer Out-of-Pocket Spending by Payment Type, 2001, 2006, 2011
  • Table 4-6:U.S. Consumer Out-of-Pocket Expenditures by Payment Method, 2001-2011 Figure 4-4: Distribution of U.S. Consumer Out-of-Pocket Spending by Payment Method, 2001, 2006, 2011
  • Table 4-7: Amount of U.S. Consumer Out-of-Pocket Expenditures for Elective Procedures , 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
  • Table 4-8: Amount of U.S. Consumer Out-of-Pocket Expenditures for Non-Elective Procedures , 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
  • Table 4-9: Size of High-Risk Groups for High Out-of-Pocket Health Care Expenditures, 2001-2011 (in millions)
    CHAPTER FIVE: SOURCES OF MEDICAL PROCEDURE FINANCING, 2006
  • Figure 5-1:Distribution of Medical Procedure Financing Market, 2006
  • Table 5-1:Cosmetic Surgical Procedures Offered in the U.S., 2007
  • Table 5-2: Firtility Treatments in the U.S., 2007
  • Table 5-3:Leading Weight Reduction Surgeries Offered in the U.S., 2007
  • Table 5-4:Comparison of Selected Medical Financing Program Costs to Consumers, 2006
  • Table 5-5:Selected Elective Procedures Covered by Leading Medical Financing Companies, 2007
  • Figure 5-2:Leading Players’ Share of U.S. Elective Procedure Financing Market, 2006
  • Table 5-6:Selected Non-Elective Procedures Covered by Leading Medical Financing Companies, 2007
  • Figure 5-3:Leading Players’ Share of U.S. Elective Procedure Financing Market, 2006
    CHAPTER SIX: SOURCES OF MEDICAL PROCEDURE FINANCING, 2007-2011
  • Table 6-1: Consumer Out-of-Pocket Expenditures for Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)
  • Table 6-2: Consumer Out-of-Pocket Expenditures for Non-Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)
  • Figure 6-1: Consumer Out-of-Pocket Expenditures for Elective and Non-Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)
  • Figure 6-2: Proportion of Consumer Out-of-Pocket Spending for Elective Procedures Paid Through Patient Financing Programs, 2006-2011

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