25th Percentile At a Glance | December 15, 2022 Out-of-Pocket Spending Has Increased, Driven in Part by Outpatient Services & High Spenders We analyzed a database of medical claims to examine whether patients covered by workplace- sponsored plans are bearing a greater share of their medical expenditures from 2013–2020. TRENDS IN COST SHARING Share of Medical Expenditures Paid Out of Pocket by Patients The share of total medical expenditures paid out of pocket ... by Health Care Spending Type Pharmacy Claims (OoP) by patients covered by Outpatient Spending 1 an employer-sponsored plan + 5.4% Inpatient Spending 25.1% 23.8% 22.8% increased by nearly 10 percent between 2013 and 2019, before Pandemic 19.4% + 16.5% dropping in 2020, most likely + 9.2% 19% 17.4% 16.5% 16.7% a result of delayed care amid 16.2% the pandemic. Simply examining the share of out-of-pocket costs borne by patients tells an + 7.6% incomplete story, however. 6.6% 6.2% 6.0% SERVICES RENDERED After disaggregating by spend- 2013 2019 2020 2013 2019 2020 2013 2019 2020 ing type, we find the average spending on outpatient services Highest Spenders saw the largest increase. The (90th Percentile) ... by Health Care Spending Percentile rise in spending on inpatient 44.7% + 12% 42.1% services was more muted, and 39.9% prescription drug spending, in High Spenders dollar terms, dropped slightly. (75th Percentile) HEALTH CARE USAGE 31.6% + 15.6% Out-of-pocket expenditures for Low Spenders 29.0% low-spending patients (lower 27.3% (25th Percentile) users of healthcare) slightly Pandemic decreased. The median patient did not see their out-of-pocket + 8.4% 18.8% 16.2% 17.3% spending rise significantly. Higher spenders (75th and 90th percentiles) definitionally represent a minority of patients, – 1.7% but they have seen their out-of- 9.3% 9.1% 6.1% pocket obligations increase significantly. 2013 2019 2020 2013 2019 2020 2013 2019 2020 1. To capture expenses faced by the typical person covered by an employer-sponsored plan, people with no medical expenditures over the course of the year were included. This study was supported by a grant from the FINRA Investor Education Foundation. The study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), which receives funding support from the following organizations: Aon, Blue Cross Blue Shield Association, FINRA Investor Education Foundation, ICUBA, JP Morgan Chase, Pfizer, and PhRMA. SOURCE: Spiegel, Jake, and Paul Fronstin, “Recent Trends in Patient out-of-Pocket Cost Sharing,” EBRI Issue Brief, no. 564 (July 28, 2022). © 2022 EBRI This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report, provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s prior express permission. For permissions, please contact EBRI at permissions@ebri.org. Spending in Aggregate