40% of commercially insured patients incur half of yearly out-of-pocket spending in 1 visit

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Nearly 40 percent of all commercially insured patients acquire half of their annual out-of-pocket medical spending in a single encounter, according to a study published Feb. 1 in Health Affairs.

Researchers used administrative records from the 2017 IBM MarketScan Commercial Claims and Encounters database, examining data on individual healthcare use, expenditures, and plan enrollment for commercially insured Americans age 0–64. The sample was limited to about 18 million patients who were enrolled in a health insurance plan for the entire year.

The study also found that 26 percent of all commercially insured patients incurred 90 percent of their annual out-of-pocket medical spending in just one or two encounters. 

This trend remained prevalent even among patients whose annual out-of-pocket spending exceeded $400, who made up 42 percent of the sample. Among this group, 33 percent incurred half of their annual out-of-pocket spending in a single medical encounter.

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