Current Healthcare News Regarding Out-of-Pocket Costs

OUT OF POCKET HEALTH CARE COSTS

“A majority of patients (59%) paid an average out-of-pocket expense between $500 and $1,000 during a healthcare visit in 2018, a marked increase from 39% the year prior.”[1]  What are out of pocket expenses? Healthcare 101 will be our jumping off spot. In the United States, health insurance is any program that helps pay for medical expenses, whether through privately purchased insurance, employer-sponsored healthcare coverage, or a health plan funded by the government. Or out of your own pocket. [2]

2019 reality of healthcare CHART

That said, there are certain requirements the health care consumer must meet before the cost of healthcare can be handed off to whoever the “PAYOR” might be.  Those costs not covered by the PAYOR often means that the PAYOR becomes you, the patient. These are the dreaded OUT OF POCKET HEALTHCARE COSTS.

And while the average amount of MONEY OUT OF YOUR POCKET was $500-1,000, greater than one in every ten of you had out of pocket costs of $1,000 or more. “The analysis reveals that patients experienced annual increases of up to 12% in their out-of-pocket responsibilities for inpatient, outpatient and emergency department care in 2018.[3]“ It should come as no surprise that healthcare cost is important.

Nationally voters ranked healthcare as the top issue. [4] If we break down the components of that concern, one area where a good majority of you are “very concerned” is the total cost of healthcare.[5]

type of insurance payout chart

At the end of the day, this leads to many Americans choosing to go without healthcare coverage (UNINSURED) or delay health care services because of cost (UNDERINSURED).

What Does That Mean?

UNINSURED

The number of people without health insurance was 28.0 million in 2016. “According to a new Gallup report, 13.7% of U.S. adults were uninsured in the last quarter of 2018. This represents a 2.8% increase since 2016.”[6]

The composite picture of this group is 19 to 64 years old (84.6 percent) and male (54.6 percent even though the U.S. population has more women than men). They tend to have less than a high school education and/or have lower incomes.   About one quarter of the uninsured people are 26 to 34 years old, and about 20 percent are ages 34 to 44. Fourteen percent are under 19 years old. About 40 percent of uninsured people are non-Hispanic white (nearly 60 percent of people in the United States are non-Hispanic white).  The uninsured were disproportionately concentrated in the South.[7]

UNDERINSURED

Twenty-three percent of 19- to 64-year-old adults are underinsured, or an estimated 41 million people. Half (51 percent) of underinsured adults reported problems with medical bills or debt of $4,000 or more than two of five (44 percent) reported not getting needed care because of cost.[8]

reasons for being uninsured chart

barriers to healthcare chart

FOOTNOTES:

[1] Liss, Samantha, “Majority of patients faced out-of-pocket expense of $500 or more last year,” HealthCareDive, 26 Jun 2019, www.healthcaredive.com/news/majority-of-patients-faced-out-of-pocket-expense-of-500-or-more-last-year/557680/

[2] Earthquake-How the Ever-shifting Healthcare Model Victimizes Americans, Copyright @ 2019 by Brian H. Casull, MD, MPA

[3] “Out-of-Pocket Costs Rising Even as Patients Transition to Lower Cost Settings of Care,” TansUnion, 25 jun 2019, newsroom.transunion.com/out-of-pocket-costs-rising-even-as-patients-transition-to-lower-cost-settings-of-care/

[4] Edwards-Levy, Ariel, “Voters Say Health Care Is A Top Issue In The 2018 Election — A Good Sign For Democrats,” HuffPost Politics, 06 April 2018, www.huffpost.com/entry/voters-say-health-care-is-their-top-issue-in-the-2018-election-thats-a-good-sign-for-democrats_n_5ac642e2e4b09d0a119103c4

[5] Casprini, M., “Soaring costs, loss of benefits top Americans’ healthcare worries: Reuters/Ipsos poll.” Reuters, 15 June 2018, www.businessinsider.com/r-soaring-costs-loss-of-benefits-top-americans-healthcare-worries-reuters-ipsos-poll-2018-6

[6] Dalia, Sofer, “The Number of Uninsured Americans Is on the Rise Again,” AJN The American Journal of Nursing: April 2019 – Volume 119 – Issue 4 – p 15 doi: 10.1097/01.NAJ.0000554536.64901.d4, journals.lww.com/ajnonline/Fulltext/2019/04000/The_Number_of_Uninsured_Americans_Is_on_the_Rise.10.aspx

[7] Berchick, Edward. “Who Are the Uninsured?” Census Bureau QuickFacts, United States Census Bureau, 12 Sept. 2018, www.census.gov/library/stories/2018/09/who-are-the-uninsured.html.

[8]  “Underinsured Rate Increased Sharply In 2016; More Than Two Of Five Marketplace Enrollees And A Quarter Of People With Employer Health Insurance Plans Are Now Underinsured.” Commonwealth Fund, 18 Oct. 2017, www.commonwealthfund.org/press-release/2017/underinsured-rate-increased-sharply-2016-more-two-five-marketplace-enrollees-and.

By | 2019-11-05T10:33:40+00:00 November 5th, 2019|Categories: Healthcare|0 Comments

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