In 2022, U.S. out-of-pocket health care payments was reported to come to an average of 1,424.6 U.S. dollars per capita. In the U.S., especially out-of-pocket payments for prescribed drugs can be very high.This statistic depicts the per capita out-of-pocket health care payments in the United States from 1970 to 2022.

The statistic represents the percentage of out-of-pocket expenses, which are not covered by health insurance in the U.S. The results show that 15 percent of Americans pay between 500 and 999 U.S. dollars of out-of-pocket expenses.

The United States has the highest expenditure on health care per capita globally. However, the U.S. has an unique way of paying for their health care where a majority of the expenditure falls upon private insurances. In FY 2023, around one third of all health expenditure is paid by private insurance. Public insurance programs Medicare and Medicaid accounted for 22 and 18 percent, respectively, of health expenditure during that same year.

U.S. health care system

Globally health spending has been increasing among most countries. However, the U.S. has the highest public and private per capita health expenditure among all countries globally, followed by Switzerland. As of 2020, annual health care costs per capita in the United States totaled to over 12 thousand U.S. dollars, a significant amount considering the average U.S. personal income is around 54 thousand dollars.

Out of pocket costs in the U.S.

Aside from overall high health care costs for U.S. residents, the total out-of-pocket costs for health care have been on the rise. In recent years, the average per capita out-of-pocket health care payments have exceeded one thousand dollars. Physician services, dental services and prescription drugs account for the largest proportion of out-of-pocket expenditures for U.S. residents.

United States US: Proportion of Population Spending More Than 25% of Household Consumption or Income on Out-of-Pocket Health Care Expenditure: % data was reported at 0.781 % in 2013. This records a decrease from the previous number of 0.856 % for 2012. United States US: Proportion of Population Spending More Than 25% of Household Consumption or Income on Out-of-Pocket Health Care Expenditure: % data is updated yearly, averaging 0.880 % from Dec 1995 (Median) to 2013, with 18 observations. The data reached an all-time high of 1.078 % in 2000 and a record low of 0.724 % in 2008. United States US: Proportion of Population Spending More Than 25% of Household Consumption or Income on Out-of-Pocket Health Care Expenditure: % data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s USA – Table US.World Bank: Poverty. Proportion of population spending more than 25% of household consumption or income on out-of-pocket health care expenditure, expressed as a percentage of a total population of a country; ; Wagstaff et al. Progress on catastrophic health spending: results for 133 countries. A retrospective observational study, Lancet Global Health 2017.; Weighted Average;

In the United States, average employee premium contributions and deductibles as a percentage of median household income have risen in the past decade. In 2020, an employee’s total potential out-of-pocket medical costs (premium and deductible) amounted to 11.6 percent of median income. This included 6.9 percent in employee premium contributions and 4.7 percent in deductibles. However, states varied greatly in median income spent on premiums and deductibles, with workers in Mississippi having to spend on average 19 percent of their income on potential out-of-pocket medical costs.

Employer sponsored health insurance In 2020, over half of the U.S. population has some type of employment-based health insurance coverage. The Affordable Care Act penalizes large employers (with 50 or more full-time employees), if they do not provide health insurance to their employees. Nevertheless, of the uninsured aged under 65 years, the large majority worked either full or part-time (or someone in their household did).

Out-of-pocket medical costs Despite having insurance coverage, most plans have a deductible, the amount an insured must pay themselves that year before their insurance starts covering for them. The average annual deductible for single coverage amounted to roughly 1,700 U.S. dollars in 2021. Even after reaching their deductible, most insured have other forms of out-of-pocket health costs in the form of co-payments and co-insurance for health services or prescription drugs.

United States US: Out-of-Pocket Health Expenditure: % of Private Expenditure on Health data was reported at 21.365 % in 2014. This records a decrease from the previous number of 21.927 % for 2013. United States US: Out-of-Pocket Health Expenditure: % of Private Expenditure on Health data is updated yearly, averaging 23.966 % from Dec 1995 (Median) to 2014, with 20 observations. The data reached an all-time high of 26.623 % in 1998 and a record low of 21.365 % in 2014. United States US: Out-of-Pocket Health Expenditure: % of Private Expenditure on Health data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s USA – Table US.World Bank: Health Statistics. Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. It is a part of private health expenditure.; ; World Health Organization Global Health Expenditure database (see http://apps.who.int/nha/database for the most recent updates).; Weighted average;

In 2022, the out-of-pocket health care payments in Canada were projected to come to an average of approximately 1189 Canadian dollars per capita, an increase from the previous year. This statistic depicts the per capita out-of-pocket health care payments in Canada from 2010 to 2022.

United Arab Emirates AE: Out-of-Pocket Health Expenditure Per Capita: Current Price data was reported at 0.000 USD mn in 2015. This records a decrease from the previous number of 0.000 USD mn for 2014. United Arab Emirates AE: Out-of-Pocket Health Expenditure Per Capita: Current Price data is updated yearly, averaging 0.000 USD mn from Dec 2000 (Median) to 2015, with 16 observations. The data reached an all-time high of 0.000 USD mn in 2008 and a record low of 0.000 USD mn in 2001. United Arab Emirates AE: Out-of-Pocket Health Expenditure Per Capita: Current Price data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s United Arab Emirates – Table AE.World Bank: Health Statistics. Health expenditure through out-of-pocket payments per capita in USD. Out of pocket payments are spending on health directly out of pocket by households in each country.; ; World Health Organization Global Health Expenditure database (http://apps.who.int/nha/database).; Weighted Average;

Bahamas BS: Out-of-Pocket Health Expenditure: % of Private Expenditure on Health data was reported at 53.982 % in 2014. This stayed constant from the previous number of 53.982 % for 2013. Bahamas BS: Out-of-Pocket Health Expenditure: % of Private Expenditure on Health data is updated yearly, averaging 50.724 % from Dec 1995 (Median) to 2014, with 20 observations. The data reached an all-time high of 53.982 % in 2014 and a record low of 40.127 % in 1995. Bahamas BS: Out-of-Pocket Health Expenditure: % of Private Expenditure on Health data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Bahamas – Table BS.World Bank.WDI: Social: Health Statistics. Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. It is a part of private health expenditure.; ; World Health Organization Global Health Expenditure database (see http://apps.who.int/nha/database for the most recent updates).; Weighted average;

This dataset contains data for the Healthcare Payments Data (HPD): Medical Out-of-Pocket Costs and Chronic Conditions report. The data covers three measurement categories: annual member count, annual median out-of-pocket count, annual median claim count. The annual member count quantify the number of unique individuals who received at least one medical service in the reporting year. Annual median out-of-pocket measurements quantifies the sum of copay, coinsurance, and deductible incurred by members. Annual median claim count measurements quantifies the number of distinct claims or encounters associated with members. Both 25th and 75th percentiles for out-of-pocket cost and claim count are also included. Measures are grouped by payer types, chronic conditions flag, chronic condition types, and chronic condition numbers.

United Arab Emirates AE: Out-of-Pocket Health Expenditure: % of Current Health Expenditure data was reported at 17.790 % in 2015. This records a decrease from the previous number of 17.808 % for 2014. United Arab Emirates AE: Out-of-Pocket Health Expenditure: % of Current Health Expenditure data is updated yearly, averaging 20.015 % from Dec 2000 (Median) to 2015, with 16 observations. The data reached an all-time high of 30.408 % in 2004 and a record low of 15.086 % in 2001. United Arab Emirates AE: Out-of-Pocket Health Expenditure: % of Current Health Expenditure data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s United Arab Emirates – Table AE.World Bank: Health Statistics. Share of out-of-pocket payments of total current health expenditures. Out-of-pocket payments are spending on health directly out-of-pocket by households.; ; World Health Organization Global Health Expenditure database (http://apps.who.int/nha/database).; Weighted Average;

In 2020, the average out-of-pocket (OOP) spending on healthcare services per person in the U.S. for women amounted to 1,344 U.S. dollars, and for men, was 1,035 U.S. dollars. During the provided time interval, women on average spend approximately three hundred U.S. dollars more than men OOP annually on healthcare services.

The data set includes the top 25 list for costliest prescribed drugs, most frequently prescribed drugs and the prescribed drugs with the highest monthly median out-of-pocket costs. Each of these top 25 lists are given for commercial plans and are broken out by brand or generic category (i.e., Brand or Generic, Brand, and Generic). The includes National Drug Code (NDC), Drug Name, number of prescriptions, number of individuals, total costs, cost per prescription and monthly median out-of-pocket costs for each NDC in each top 25 list.

Qatar QA: Out-of-Pocket Health Expenditure: % of Current Health Expenditure data was reported at 6.228 % in 2015. This records an increase from the previous number of 5.648 % for 2014. Qatar QA: Out-of-Pocket Health Expenditure: % of Current Health Expenditure data is updated yearly, averaging 18.640 % from Dec 2000 (Median) to 2015, with 16 observations. The data reached an all-time high of 30.034 % in 2000 and a record low of 5.648 % in 2014. Qatar QA: Out-of-Pocket Health Expenditure: % of Current Health Expenditure data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Qatar – Table QA.World Bank: Health Statistics. Share of out-of-pocket payments of total current health expenditures. Out-of-pocket payments are spending on health directly out-of-pocket by households.; ; World Health Organization Global Health Expenditure database (http://apps.who.int/nha/database).; Weighted Average;

Recent estimates indicate that there has been a gradual drop in the actual percentage increase of U.S. health care costs over the last decade. For 2020, it is estimated that the yearly costs to treat patients increased by 6 percent. However, it is forecast that this will rise to 7 percent in 2021. The costs of healthcare are intrinsically linked to a country’s healthcare system.

The U.S. healthcare system

In the wake of the U.S. presidential elections in 2020 the U.S. healthcare system has been heavily criticized. The U.S. health system is a hybrid system of public and private insurances and high out of pocket costs for consumers. The United States has some of the highest public and private spending on healthcare globally. Consumers themselves are also spending a significant amount on healthcare out-of-pocket. Yearly out-of-pocket health care payments have been increasing significantly in recent years.

The politicization of U.S. health care

Since 2014, the Affordable Care Act (ACA) has mandated that most U.S. residents must be covered by some form of health insurance and has provided a marketplace for people to shop for affordable options. The share of U.S. Americans without health insurance has decreased over the last several years. However, health insurance policy is still a hotly debated topic in current politics. In a recent online poll, a majority of respondents indicated that they have a favorable opinion of the ACA. There is a fairly strong political split in opinions on health policy. Another recent survey shows that a majority of democrat respondents strongly disapproved of President Trump’s management of health care issues while a majority of Republican respondents approved of his management of health care.

Additional file 2: Table S1. Estimated Average Health Care Utilization and Out-of-pocket Medical Spending Difference in Medical Aid Type I panel by difference-in-differences analysis. Abbreviation: Medical Aid, MA, National Health Insurance, NHI, Confidence Interval, CI. * Log Link with Zero-Inflated Negative Binomial Distribution was applied in the regression analysis because of exceess zeros in the outcomes. a Models additionally adjusted for individuals’ health related characteristics (mostly visited type of medical institution, lasted period of chronic disease). b Propensity score matched for sex, age, region, equivalized household disposable income, marital status, economic activity status, number of private insurance, expenditure on private insurance.

Nigeria NG: Increase in Poverty Gap at $3.20: Poverty Line Due To Out-of-Pocket Health Care Expenditure: 2011 PPP: USD data was reported at 7.515 USD in 2012. This records an increase from the previous number of 6.662 USD for 2010. Nigeria NG: Increase in Poverty Gap at $3.20: Poverty Line Due To Out-of-Pocket Health Care Expenditure: 2011 PPP: USD data is updated yearly, averaging 6.662 USD from Dec 2003 (Median) to 2012, with 3 observations. The data reached an all-time high of 7.515 USD in 2012 and a record low of 5.609 USD in 2003. Nigeria NG: Increase in Poverty Gap at $3.20: Poverty Line Due To Out-of-Pocket Health Care Expenditure: 2011 PPP: USD data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Nigeria – Table NG.World Bank.WDI: Poverty. Increase in poverty gap at $3.20 ($ 2011 PPP) poverty line due to out-of-pocket health care expenditure, expressed in US dollars (2011 PPP). The poverty gap increase due to out-of-pocket health spending is one way to measure how much out-of-pocket health spending pushes people below or further below the poverty line (the difference in the poverty gap due to out-of-pocket health spending being included or excluded from the measure of household welfare). This difference corresponds to the total out-of-pocket health spending for households that are already below the poverty line, to the amount that exceeds the shortfall between the poverty line and total consumption for households that are impoverished by out-of-pocket health spending and to zero for households whose consumption is above the poverty line after accounting for out-of-pocket health spending.; ; World Health Organization and World Bank. 2019. Global Monitoring Report on Financial Protection in Health 2019.; Weighted average;

Benin BJ: Out-of-Pocket Health Expenditure: % of Total Expenditure on Health data was reported at 39.100 % in 2014. This records a decrease from the previous number of 39.679 % for 2013. Benin BJ: Out-of-Pocket Health Expenditure: % of Total Expenditure on Health data is updated yearly, averaging 49.206 % from Dec 1995 (Median) to 2014, with 20 observations. The data reached an all-time high of 57.856 % in 1997 and a record low of 35.877 % in 2011. Benin BJ: Out-of-Pocket Health Expenditure: % of Total Expenditure on Health data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Benin – Table BJ.World Bank.WDI: Social: Health Statistics. Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. It is a part of private health expenditure.; ; World Health Organization Global Health Expenditure database (see http://apps.who.int/nha/database for the most recent updates).; Weighted average;

This layer shows the percentage of people without health insurance in the U.S. by state and county, from American Community Survey 5-year estimates: 2011-2015 (Table GCT2701). The map switches from state data to county data as the map zooms in. The national average was 13.0%, down from approximately 20% in 2005.A person’s ability to access health services has a profound effect on every aspect of his or her health. Many Americans do not have a primary care provider (PCP) or health center where they can receive regular medical services. People without medical insurance are more likely to lack a usual source of medical care, such as a PCP, and are more likely to skip routine medical care due to costs, increasing their risk for serious and disabling health conditions. When they do access health services, they are often burdened with large medical bills and out-of-pocket expenses. Increasing access to both routine medical care and medical insurance are vital steps in improving the health of all Americans.

IntroductionThis study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China.MethodsData were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses.ResultsThe total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009–2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15–30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001).ConclusionsThe direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.