Market Research Logo

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

Out of pocket health care expenditures represent a rapidly growing burden for consumers, both in terms of their increasing size and the lack of financing options to available to address them. While finance companies have rushed to provide credit for discretionary medical expenses, few funding sources are available to consumers needing money to pay for medically necessary procedures. These consumers often must rely on regular credit cards, then turn to other sources such as home equity, retirement savings and friends and family when they reach their credit limit. To a limited extent, health savings accounts and flexible spending accounts have helped consumers save money to meet their medical expenses, but the need for additional solutions far outweighs these programs’ capacity. Retail clinics, which offer basic medical services at affordable prices in a retail setting, have also helped somewhat, but cannot address expenses related to high cost medical treatments.

This report analyzes out-of-pocket health care spending by U.S. consumers and the resulting U.S. market for health care financing services. It specifically covers spending on elective and non-elective procedures in the following market segments:

  • Cash/check
  • Credit card
  • Loans and lines of credit
  • Medical financing programs
  • Health savings accounts (HSAs)
  • Flexible spending accounts (FSAs)

Data sources tapped for this report include the following:

  • Kaiser Commission on Medicaid and the Uninsured
  • Kaiser Family Foundation
  • Centers for Medicare and Medicaid Services (CMS)
  • U.S. Department of Labor, Labor Statistics
  • Demos and The Access Project, “Borrowing to Stay Healthy,” January 2007
  • Center on Budget and Policy Priorities, Medicaid Expenditure Panel surveys
  • Center for Studying Health System Change
  • Hewitt Associates
  • Corporate reports and other corporate publications
  • Miscellaneous trade journals, publications, websites


  • Executive Summary
    • Scope and Methodology
      • The U.S. Healthcare Market
      • Vulnerable Populations
      • Healthcare Reform
    • Out-of-Pocket Expenditures in 2006
      • Payment Types
        • Table Distribution of Out-of-Pocket Healthcare Expenditures by Payment Type, 2006
      • Payment Methods
      • Amount Financed
      • 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
      • 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
  • The U.S. Healthcare System Today
    • Overview
      • Public Healthcare
      • Private Healthcare
      • The Uninsured and Underinsured
      • Regulation
        • Table Selected U.S. Federal and State Healthcare Oversight Bodies, 2007
      • Healthcare Reform
      • Universal Federal Healthcare Coverage
      • State Healthcare Coverage
        • Table U.S. Healthcare Coverage by State, 2007
  • Out-of-Pocket Expenditures: The Market in 2006
    • Overall Out-of-Pocket Spending
      • Table Average Share Paid Out-of-Pocket by U.S. Consumers, by Percentile of Total Healthcare Expenses, 2003
      • Table Average Amount Paid Out-of-Pocket by U.S. Consumers, by Percentile of Total Healthcare Expenses, 2003
      • Payments Types
        • Table U.S. Consumer Out-of-Pocket Healthcare Expenditures by Payment Type, 2006
      • Insurance Co-Payments
      • Direct Payments
      • Premiums and Plan Fees
      • Payment Methods
        • Table U.S. Consumer Out-of-Pocket Healthcare Expenditures by Payment Type, 2006
      • Cash or Check
      • Credit Cards
        • Table Credit Card Debt of Consumers with Medical Debt by Health Insurance Status, 2007
        • Table 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
        • Table Methods of Payment for Elective Procedures, 2006
      • Non-Elective Procedures and Prescription Drugs
        • Table Average Share of U.S. Healthcare Expenses Paid Out of Pocket, by Type of Service, 2003
        • Table Distribution of Out-of-Pocket Spending on Non-Elective Procedures for the Average Person, 2003
    • Consumers Who Pay Out Of Pocket
      • Medicaid Recipients
        • Table Change in Out-of-Pocket Healthcare Expenses for Medicaid Recipients, 1997 to 2002
      • The Disabled
        • Table Out-of-Pocket Healthcare Expenses for Disabled and Non-Disabled Medicaid Recipients, 1997 vs. 2002
      • Senior Citizens
      • The Mentally Ill
      • Obese Persons
        • Table Obesity in the U.S., 1980-2011
      • Persons with Chronic Conditions
        • Table Adults Under Age 65 with Chronic Conditions by Type of Insurance, 2003
  • Out-of-Pocket Expenditures: The Market in 2007-2011
    • Trends
      • Out-of-Pocket Expenditure Growth Drivers
      • Out-of-Pocket Expenditure Growth Constraints
        • Table Selected Rx-to-OTC Switches in the United States, 1982-2007
        • Table Rx-to-OTC Switch Candidates in the U.S., 2007-2012
        • Table Cost Savings From Medical Tourism for Various Procedures, 2007
      • Forecasts
        • Table U.S. Consumer Out-of-Pocket Expenditures per Worker, 2001-2011 (in billion $)
      • Payment Type
        • Table U.S. Consumer Out-of-Pocket Expenditures by Payment Type, 2001-2011 (in billion $)
      • Payment Methods
        • Table U.S. Consumer Out-of-Pocket Expenditures by Payment Method, 2001-2011 (in billion $)
      • Amount Financed
      • Elective Procedures
        • Table Amount of U.S. Consumer Out-of-Pocket Expenditures for Elective Procedures That Are Financed, 2001-2011 (in billion $)
      • Non-Elective Procedures
        • Table Amount of U.S. Consumer Out-of-Pocket Expenditures for Non-Elective Procedures That Are Financed, 2001-2011 (in billion $)
      • Consumers Who Pay Out of Pocket
        • Table Size of High-Risk Groups for High Out-of-Pocket Healthcare Expenditures,2001-2011 (in millions)
  • Medical Procedure Financing: The Market in 2006
    • Types of Procedures Financed
      • Table Distribution of Medical Procedure Financing Market, 2006
      • Table Cosmetic Surgical Procedures Offered in the U.S., 2007
      • Table Fertility Treatments Offered in the U.S., 2007
      • Table Leading Weight Reduction Surgeries Offered in the U.S., 2007
      • Non-Elective Procedures
    • Financing Programs
      • Costs to Consumers
        • Table Comparison of Selected Medical Financing Program Costs to Consumers, 2006
      • Costs to Providers
      • Usage and Acceptance
      • Key Players
        • Table Selected Elective Procedures Covered by Leading Medical Financing Companies, 2007
        • Table Leading Players' Share of U.S. Elective Procedure Financing Market, 2006
        • Table Selected Non-Elective Procedures Covered by Leading Medical Financing Companies, 2007
        • Table Leading Players' Share of U.S. Elective Procedure Financing Market, 2006
  • Medical Procedure Financing: The Market in 2007-2011
    • Trends
      • Consumers
      • Forecasts
        • Table Consumer Out-of-Pocket Expenditures for Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)
        • Table Consumer Out-of-Pocket Expenditures for Non-Elective Procedures Paid Through Patient Financing Programs, 2001-2011 (in billion $)
  • Company Profiles
    • Table Main Business Activities of Selected Medical Financing Companies, 2007
    • APFUSA
    • AURORA QUICK CARE
      • Table AURORA QUICK CARE
    • CAPITAL ONE HEALTHCARE FINANCE
      • Table CAPITAL ONE HEALTHCARE FINANCE
    • CARECREDIT
      • Table CARECREDIT
    • CHECKUPS
      • Table CHECKUPS
    • CREDIT MEDICAL
    • CSI FINANCIAL SERVICES
    • E-FINANCING SOLUTIONS
    • HEALTH READY
    • MEDCHOICE FINANCIAL
    • MEDDIRECT
    • MEDPROVA
    • MINUTECLINIC
    • PFS
    • REDICLINIC
    • RELIANCE MEDICAL FINANCE
    • SOLANTIC
    • SPRINGSTONE PATIENT FINANCING
    • TAKE CARE HEALTH SYSTEMS
    • TARGET CLINIC MEDICAL ASSOCIATES

Download our eBook: How to Succeed Using Market Research

Learn how to effectively navigate the market research process to help guide your organization on the journey to success.

Download eBook

Share this report