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

Table of Contents

• 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

• 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

• 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

• 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)

• 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

• Financing Programs
  • Costs to Consumers
  • Table 5-4: Comparison of Selected Medical Financing Program Costs to Consumers, 2006
  • Costs to Providers
  • Usage and Acceptance
  • Key Players
  • Elective Procedures
  • 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
  • Non-Elective Procedures
  • 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

• 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
• 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

• Table 7-1: Main Business Activities of Selected Medical Financing Companies, 2007
• APFUSA
• History and Lines of Business
• Financial Information
• Patient Financing
• AURORA QUICK CARE
• History and Lines of Business
• Financial Information
• Convenience Clinics
• CAPITAL ONE HEALTHCARE FINANCE
• History and Lines of Business
• Financial Information
• Patient Financing
• CARECREDIT
• History and Lines of Business
• Financial Information
• Patient Financing
• CHECKUPS
• History and Lines of Business
• Financial Information
• Convenience Clinics
• CREDIT MEDICAL
• History and Lines of Business
• Financial Information
• Patient Financing
• CSI FINANCIAL SERVICES
• History and Lines of Business
• Financial Information
• Patient Financing
• E-FINANCING SOLUTIONS
• History and Lines of Business
• Financial Information
• Patient Financing
• HEALTH READY
• History and Lines of Business
• Financial Information
• Patient Financing
• MEDCHOICE FINANCIAL
• History and Lines of Business
• Financial Information
• Patient Financing
• MEDDIRECT
• History and Lines of Business
• Financial Information
• Patient Financing
• MEDPROVA
• History and Lines of Business
• Financial Information
• Patient Financing
• MINUTECLINIC
• History and Lines of Business
• Financial Information
• Convenience Clinics
• PFS
• History and Lines of Business
• Financial Information
• Patient Financing
• REDICLINIC
• History and Lines of Business
• Financial Information
• Convenience Clinics
• RELIANCE MEDICAL FINANCE
• History and Lines of Business
• Financial Information
• Patient Financing
• SOLANTIC
• History and Lines of Business
• Financial Information
• Convenience Clinics
• SPRINGSTONE PATIENT FINANCING
• History and Lines of Business
• Financial Information
• Patient Financing
• TAKE CARE HEALTH SYSTEMS
• History and Lines of Business
• Financial Information
• Convenience Clinics
• TARGET CLINIC MEDICAL ASSOCIATES
• History and Lines of Business
• Financial Information