Skyrocketing out-of-pocket spending outpaces wage growth

Dive Brief:

  • In the latest study to show how out-of-pockets costs could create barriers to care, the Kaiser Family Foundation (KFF) found that out-of-pocket spending is outpacing wage growth.
  • The average deductible for people with employer-based health insurance increased from $303 in 2006 to $1,505 in 2017.
  • Researchers also found that average payments for deductibles and coinsurance skyrocketed faster than overall cost for covered benefits. That’s happened while average copayments have decreased.

Dive Insight:

KFF researchers reviewed health benefit claims from the Truven MarketScan Commercial Claims and Encounters Database to calculate the average that members pay for deductibles, copayments and coinsurance. What they found should not surprise anyone in healthcare or with employer-based health insurance — deductibles and overall out-of-pocket health costs are rising.

The organization found patient cost-sharing “rose substantially faster than payments for care by health plans as insurance coverage became a little less generous” between 2005 and 2015.

Deductibles went from accounting for less than 25% of cost-sharing payments in 2005 to almost half in 2015. The average payments toward deductibles rose 229% from $117 to $386 and the average payments toward coinsurance increased 89% from $134 to $253 in that period.

On the plus side, copayments fell by 36% from $218 to $139 as payers and employers have moved more costs to healthcare utilization.

Overall, patient-cost sharing increased by 66% from an average of $469 in 2005 to $778 in 2015. Average payments by health plans also increased 56% from $2,932 to $4,563.

While out-of-pocket health costs have skyrocketed, wages in the same period increased by 31%.

The KFF study comes on the heels of a JPMorgan Chase Institute report that found Americans are struggling with out-of-pocket costs. In many cases, JPMorgan Chase Institute found that people are delaying healthcare payments until they get “liquid assets.” In fact, healthcare payments spike in March and April when Americans get tax refunds.

In another recent study on the topic, HealthFirst Financial Patient Survey said more than 40% of respondents are “very concerned” or “concerned” about whether they could pay out-of-medical bills over the next two years. More than half said they are worried that they might not be able to afford a $1,000 bill, 35% were concerned about a $500 bill and 16% said they’re worried about paying a bill less than $250.

Those amounts are usually well below health plan deductibles. The Kaiser Family Foundation/Health Research & Educational Trust 2017 Employer Health Benefits Survey recently found that health plan deductibles often exceed $3,000.

That could be a problem not just for those individuals. Providers and hospitals are already struggling with sagging reimbursements and payer cost-saving measures and policies. More bad debt would only make matters worse.


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