Out-of-pocket patient costs climbed before pandemic, study finds

Out-of-pocket costs paid by patients with employer-sponsored health plans rose between 2013 and 2019, before seeing a pandemic-related dip in 2020, according to a July 28 report from the Employee Benefit Research Institute.

Researchers used the IBM Marketscan Commercial Claims and Encounters database to examine claims data from 2013 through 2020, according to the report. The dataset contained data on more than 45 million patients who were continuously enrolled in an employer-sponsored health plan for at least one year between 2013 and 2020. Patients in the database accounted for $998 billion in claims over that period, covering inpatient and outpatient encounters, and prescription drug claims. 

Four things to know: 

1. The share of out-of-pocket costs paid by patients rose from 17.4 percent in 2013 to 19 percent in 2019. 

2. Out-of-pocket cost share dipped to 16.4 percent in 2020. 

3. Out-of-pocket expenditures for outpatient services grew faster between 2013 and 2019 ($470 to $631) than for inpatient services ($109 to $127). Prescription drug expenditures decreased from $158 to $148 over that span. 

4. The share of expenses paid by patients for most plan types remained stable or decreased slightly. The increase in share of out-of-pocket costs appears to be driven by an increase in the number of workers enrolling in plans with higher deductibles, according to the report. In 2013, 13 percent of patients in the database were enrolled in a high-deductible health plan or  consumer-directed health plan. By 2020, 28 percent of patients were enrolled in those plans. 



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