"We discovered that patients' out-of-pocket costs increased overall between 2013 and 2019." Surprisingly, this appears to be driven by the increased adoption of higher-deductible plans rather than changes in cost-sharing. In fact, when we divided the study by individual plan types, such as high deductible health plans (HDHPs), preferred provider organizations (PPOs), or health maintenance organizations (HMOs), we discovered that the share of out-of-pocket expenditures for patients in those plans has either decreased or remained stable," explained Jake Spiegel, research associate at EBRI.
The following are some of the study's key findings:
- The share of out-of-pocket costs paid by patients with employer-sponsored health plans increased from 17.4 percent in 2013 to 19 percent in 2019, before dropping to 16.4 percent in 2020 due to the pandemic.
- However, breaking down the data by health plan type reveals a more nuanced picture: for most plan types, the share of expenses paid out of pocket by patients has remained stable or decreased slightly. The rise in the proportion of out-of-pocket expenses observed between 2013 and 2019 appears to be driven by an increasing number of workers enrolling in higher-deductible plans.
- Between 2013 and 2019, out-of-pocket spending on outpatient services increased faster ($470 to $631) than spending on inpatient services ($109 to $127). During this time, prescription drug out-of-pocket spending fell from $158 to $148.
- The amount of money patients spend out of pocket is influenced by their medical conditions. For example, the median patient with high cholesterol spent more than patients in general ($882 vs. $205) and paid a higher proportion of their expenses out of pocket (16.9 percent vs. 16.2 percent).
"Employers face a conflict between controlling the financial impact of health care costs and assisting employees in achieving financial wellness." On the one hand, employers are increasingly implementing financial wellness programs to improve the financial well-being of their employees. Employers, on the other hand, frequently raise their health plan's deductible to combat rising health-care costs, potentially offsetting the positive impact of any financial wellness initiatives." Spiegel stated.
The IBM® Marketscan® Commercial Claims and Encounters Database was used in the study, which contained member enrollment information as well as adjudicated medical (inpatient and outpatient) and pharmacy claims. Claims data from 2013 to 2020 were examined for this analysis. Over 45 million patients were continuously enrolled in an employer-sponsored health plan for at least one year between 2013 and 2020, according to the analytical dataset. Between 2013 and 2020, patients in the database accounted for $998 billion in claims, including inpatient and outpatient encounters as well as prescription drug claims.
To read the full Issue Brief, "Recent Trends in Patient Out-of-Pocket Cost Sharing," go to https://www.ebri.org/oop-costsharing.
The EBRI Center for Research on Health Benefits Innovation, which receives funding from Aon, Blue Cross Blue Shield Association, FINRA Investor Education Foundation, ICUBA, JP Morgan Chase, Pfizer, and PhRMA, conducted this Issue Brief with the help of a grant from the FINRA Investor Education Foundation.