In 2018, no matter what setting patients received care in, their out-of-pocket costs probably rose.

That's according to a new analysis from TransUnion Healthcare, which finds that patients experienced annual increases of up to 12 percent in out-of-pocket expenses for inpatient, outpatient and emergency department care in 2018.

In fact, the report finds that most patients are dealing with out-of-pocket costs of more than $500—59 percent are having to fork over between $501 and $1,000 during a health care visit.

“For several years patients have faced a greater cost burden as healthcare expenses shifted from payers to patients,” says Dave Wojczynski, president of TransUnion Healthcare.

Wojczynski adds, “As a result, patients are now making decisions about where they receive care based on costs—not just the quality of care they may receive. This means price transparency is critical for healthcare providers who are not only competing for patients, but also want to secure timely payments from them.”

To show how quickly costs are rising, the analysis included figures on 2017 care in inpatient, outpatient and emergency department settings compared with 2018 figures. The results are daunting, with inpatient care in 2017 averaging $4,086 and rising to $4,659 in 2018; outpatient care in 2017 averaging $990 and rising to $1,109 in 2018; and emergency department care in 2017 averaging $577 and rising to $617 in 2018.

And while in 2017 39 percent of patients ended up with out-of-pocket costs in the $501–$1,000 range, in 2018 that had risen to 50 percent of patients—a “dramatic” increase, according to the report. In addition, the number of patients with an average out-of-pocket expense of $500 or below actually decreased from 49 percent in 2017 to 36 percent in 2018.

As patients become more consumerist and insurers and providers look to control costs, they're switching the site of care, insofar as possible, to cheaper settings, with inpatient care, historically the most expensive option, leveling off; its percentage of price estimates stayed at 8 percent between 2017 and 2018. The percentage of outpatient services estimates, which usually run about a quarter of inpatient services costs, increased during the same period from 65 percent to 73 percent.

So it should come as no surprise that patients are having a harder time paying bills and keeping up with their deductibles till insurance payments kick in. According to the Kaiser Family Foundation, 34 percent are strapped trying to make deductible payments.

And for their part, providers are experiencing increased denial rates and writeoffs, which in turn boost bad debt.

Instant Insights /

Lower-cost care settings don't stem rising out-of-pocket costs

More From HR Executive

Related Stories

Recommended For You