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2021 Medical Billing Statistics

The healthcare industry is constantly changing – how hospitals and health systems deal with these changes can make the difference for a healthy bottom line and ability to continue servicing the communities in which they exist.

The statistics below are in reverse chronological order and updated on a regular basis.

**Updated February 17, 2021**

Healthcare Spending and Medical Billing Statistics

  • 75% of patients are looking up the cost of medical procedures online.
  • 62% of patients said knowing their out-of-pocket expenses in advance of service impacts the likelihood of pursuing care.
  • 49% of patients said having clear information on expected out-of-pocket costs before receiving treatment impacts their decision to use a healthcare provider.

A new TransUnion Healthcare (NYSE:) analysis revealed that patients experienced an 11% increase in average out-of-pocket costs during 2017, rising from $1,630 in Q4 2016 to $1,813 in Q4 2017. The analysis also revealed that in 2017, on average, 49% of patient out-of-pocket costs per healthcare visit were below $500; 39% were $501-$1,000; and 12% were more than $1,000. Total hospital revenue attributable to patient financial responsibility after insurance increased 88 percent between 2012 and 2017

Source: New TransUnion Healthcare analysis finds patients continue to see rising costs

  • 69% have a budget process that takes more than three months from initial rollout to board presentation (the process takes more than six months for 9% of these organizations)
  • 41% use rolling forecasts to complement or to replace an annual budgeting process (31% have to plans to implement rolling forecasts)
  • 50%+ CFOs want access to easier report creation, better dashboards and visuals, and enhanced ability to drill into reports to understand underlying details (2/3 struggle to pull data from multiple resources).

Source: Becker’s CFO Report, Hospital CFOs: 3 things demanding your attention in 2018

Link to original Kaufman Hall study here»

A Bloomberg study showed that healthcare bankruptcy have more than tripled in 2017. As of 2012, 75 million people reported problems paying their medical bills or were paying off medical debt.

The administrative costs associated with billing and insurance-related activities as estimated to be up to 25.2% for emergency department visits.
Source: Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System

  • Patient healthcare costs – including both deductibles and out-of-pocket maximum payments – have increased by almost 30% percent since 2015.
  • The average deductible is $1,820 and the average out-of-pocket maximum cost is $4,400.
  • 83% of Physician Practices under five practitioners said the slow payment of high-deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81%).

Source: Black Book™ 2017 Revenue Cycle Management Survey 

2018 Deductible Breakdown For Single Coverage Employer Health Insurance:

  • 7% have no deductible
  • 16% have a deductible under $500
  • 19% have a deductible between $500 and $999
  • 46% have a deductible between $1,000 and $2,999
  • 6% have a deductible between $3,000 and $3,999
  • 6% have a deductible that is $4,000 or higher.

2018 Deductible Breakdown For Family Coverage Employer Health Insurance:

  • 7% have no deductible
  • 3% have a deductible under $500
  • 11% have a deductible between $500 and $999
  • 29% have a deductible between $1,000 and $2,999
  • 26% have a deductible between $3,000 and $4,999
  • 23% have a deductible of $5,000 or higher.

Source: Average Health Care Deductible Nearly $1,500 for Individual Coverage Through an Employer Plan, International Foundation of Employee Benefit Plans; September 11, 2018

As of January 2017, 52 health insurance providers reported 21.8 million HSA/HDHP enrollees, up from 20.2 million in 2016.

Source: America’s Health Insurance Plans: Health Savings Accounts and High Deductible Health Plans Grow as Valuable Financial Planning Tools 

68% of patients failed to fully pay off medical bill balances in 2016, up from 53 percent in 2015, and 49 percent in 2014. This number is expected to climb to 95% by 2020

Source: Patients May be the New Payers, But Two in Three Do Not Pay Their Hospital Bills in Full, TransUnion Healthcare, June 26, 2017

67% of Americans are either very worried or somewhat worried about unexpected medical bills (compared to 41% who are very or somewhat worried about paying their rent or mortgage)

Source: Data Note: Americans’ Challenges with Health Care Costs, Kaiser Family Foundation; June 11, 2019

Consumers are demanding more from healthcare
92% of consumers want to know payment responsibility prior to a provider visit
74% of consumers are confused by Explanation of Benefits (EOBs) and medical bills
73% of providers report that it takes one month or longer to collect from patients

Omnichannel payments are impacting healthcare
68% of consumers prefer electronic payment methods to pay their medical bills
80% of consumers prefer online payment channels to pay their health plan premiums
20% of online healthcare payments are made on a mobile device

Paper is hurting all healthcare stakeholders
86% of consumers receive paper medical bills
88% of providers report receiving paper checks and Explanation of Payment (EOPs) from one or more of their payers
85% of providers prefer ERA/EFT payments

Healthcare data is under attack
2016 saw more healthcare data breaches than any other year on record
90% of providers report that payment security is very important when collecting patient payments
59% of consumers have significant concerns regarding the security of making payments for both their medical bills and health plan premiums

Source: InstaMed, 2016 Trends in Healthcare Payments Annual Report, June 13, 2017

It costs four times more to collect from a patient than it does from an insurance company.

Source: The Rise of Self-Pay Accounts, The Association of Credit and Collection Professionals, Collector Magazine, February 2015

30% of the average healthcare bill now comes from the patient’s pocket.

74 percent of healthcare providers reported an increase in patient financial responsibility in 2015

90% of patients felt it was important to know their payment responsibility upfront.

Source: InstaMed, Trends in Healthcare Payments, Sixth Annual Report: 2015

U.S. health care spending increased 4.6 percent to reach $3.6 trillion, or $11,172 per person in 2018. The growth in 2018 was faster than in 2017 when health care spending increased 4.2 percent. The faster growth in 2018 was associated with faster growth in the net cost of health insurance, which increased 13.2 percent following growth of 4.3 percent in 2017, due primarily to the reinstatement of the health insurance tax in 2018. The overall share of gross domestic product (GDP) related to health care spending was 17.7 percent in 2018, down from 17.9 percent in 2017. The insured share of the population was 90.6 percent in 2018 and 90.8 percent in 2017, as the number of uninsured increased by 1 million to 30.7 million in 2018.

Source: Centers for Medicare and Medicaid Services, National Health Expenditures 2018 Highlights

The 19 states that have not yet expanded Medicaid could reduce the number of uninsured by more than four million people collectively by expanding Medicaid. Expanding Medicaid in these states would also increase their federal funding by $595.8 billion to $664.8 billion from 2018-2027, while raising state Medicaid costs by just $82.5 billion to $90.8 billion over ten years.

Source: The Cost of Not Expanding Medicaid: An Updated Analysis, The Urban Institute & the Robert Wood Johnson Foundation, April 2017

  • 75% of patients say that understanding their out-of-pocket costs improves their ability to pay for healthcare.
  • 54% – More than half of insured Americans reported they were either sometimes or always confused by medical bills.
  • 62% reported being either sometimes or always surprised by out-of-pocket costs.

Source: TransUnion Health Survey, June 1, 2014 (Press release)

 Medicaid Disproportionate Share Hospital (DSH) payments covered about half of the uncompensated care costs incurred by qualifying hospitals nationwide in 2014, according to a Government Accountability Office (GAO) analysis of most recently available audited data.

Source: Medicaid DSH Payments Cover 51% of Uncompensated Care Costs, RevCycle Intelligence, August 6, 2019

The average annual premiums for employer-sponsored health insurance in 2019 are $7,188 for single coverage and $20,576 for family coverage. The average single premium increased 4% and the average family premium increased 5% over the past year. Workers’ wages increased 3.4% and inflation increased 2%.

Source: 2019 Employer Health Benefits Survey, Kaiser Family Foundation

The cost of uncompensated care has more than doubled in the past 10 years.

Source: American Hospital Association, Annual Survey of Hospitals, 2014

U.S. hospitals provided $45.9 billion in uncompensated care in 2012, representing 6.1 percent of annual hospital expenses.

Source: American Hospital Association, “Uncompensated Hospital Care Cost Fact Sheet,” January 2014

The average deductible for plans with combined medical and prescription drugs is $4,544.

Source: Cost-Sharing for Plans Offered in the Federal Marketplace, 2014-2020, Kaiser Family Foundation, December 9, 2019

In 2018, 30.4 million persons of all ages (9.4%) were uninsured at the time of interview—not significantly different from 2017, but 18.2 million fewer persons than in 2010.

Source: National Health Interview Survey Early Release Program, CDC

PPOs continue to be the most common plan type, enrolling 44% of covered workers in 2019. Thirty percent of covered workers are enrolled in a high-deductible plan with a savings option (HDHP/SO), 19% in an HMO, 7% in a POS plan, and 1% in a conventional (also known as an indemnity) plan.

Source: 2019 Employer Health Benefits Survey, Kaiser Family Foundation, September 25, 2019

28% of uninsured adults either delayed or did not receive care because of cost

Source: How Does Cost Affect Access to Care, Kaiser Family Foundation; January 22, 2019

Patients’ out-of-pocket costs averaged $1,109 for an outpatient visit in 2018, up 12% compared with $990 in 2017.

Source: 68% of Consumers Did Not Pay Patient Financial Responsibility, RevCycle Intelligence, June 27, 2017

80 percent of patients say they would prefer to pay for  their care online.

Source: Health Consumers Want Digital Patient Payments from Providers, Patient Engagement Hit, June 15, 2017

No shows can cost the U.S. health-care system more than $150 billion a year.

Source: Missed appointments cost the U.S. healthcare system $150B each year, Health Management Technology, April  2017

“Since 2000, hospitals of all types have provided more than $620 billion in uncompensated care to their patients.”

Source: Uncompensated Hospital Care Cost Fact Sheet – January 2019, American Hospital Association; January 2019

Bad debt expense reported nationally has increased by $617 million to nearly $56.5 billion between 2015 and 2018.

Source: Bad debt expense benchmarks: U.S. acute care hospitals show improvements since 2015, HFMA, October 1, 2019

The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan increased from 43.7% in 2017 to 45.8% in 2018.

Source: National Health Interview Survey Early Release Program, CDC

68% of hospital bills under $500 were not paid in full

Source: Two in three patients can’t pay off their hospital bills, CNBC, June 26, 2017

Medical Debt Statistics

In 2020, 32% of American workers had medical debt

Source: 32% of American workers have medical debt—and over half have defaulted on it

A 2013 study found that 26% of bankruptcies were due to medical debt

Source: Medical Bankruptcy and the Economy

11% of people surveyed with medical debt in 2017 were 27 years old 

Source: Millennials rack up the most medical debt

As of 2012, 75 million people reported problems paying their medical bills or were paying off medical debt, up from 73 million in 2010 and 58 million in 2005. An estimated 48 million people were paying off medical debt in 2012, up from 44 million in 2010 and 37 million in 2006.

Source: Commonwealth Fund Biennial Health Insurance Survey, 2014.

In 2012, 41 percent of adults (ages 19-64) reported that they had medical debt or trouble paying medical bills. Of those who reported difficulties paying medical bills or paying off medical debt, 42 percent (32 million people) said they received a lower credit rating as result of unpaid medical bills.

In 2012, 43 percent of adults, or 80 million people, said they had skipped or delayed getting needed health care or filling prescriptions because of the cost. This is an increase from 75 million people who reported such problems in 2010, and 64 million in 2005. More than a quarter (28 percent) of adults with a chronic health condition said they had skipped doses or not filled a prescription for their health condition because of the cost.

Source: The Commonwealth Fund Biennial Health Insurance Survey 2012, April 2013.

Health-care bankruptcy filings have more than tripled in 2017.

Source: Next U.S. Restructuring Epidemic: Sick Health-Care Companies 

Medicaid Statistics

In September 2020, 77,306,714 people were enrolled in Medicaid and CHIP

Source: September 2020 Medicaid & CHIP Enrollment Data Highlights

Medicaid enrollment has significantly increased since the beginning of the pandemic

Source: Analysis of Recent National Trends in Medicaid and CHIP Enrollment

Medicaid enrollment is projected to reach 82 million by 2027

Source: Projected total Medicaid enrollment from 2020 to 2027

On average, states that expanded Medicaid paid less per enrollee ($6,110) in FY 2019 vs. states that did not expand Medicaid ($8.370.)

Source: Medicaid Expansion Enrollment and Spending Leading up to the COVID-19 Pandemic

62% of able-bodied adults enrolled in Medicaid are either working part-time or full-time

Source: Understanding the Intersection of Medicaid, Work, and COVID-19

Medicaid spending grew 2.9% to $613.5 billion in 2019

Source: NHE Fact Sheet

COVID-19 Statistics

COVID-19 in-patient hospitalizations may cost the U.S. healthcare system up to $16.9 billion in 2020

Source: Average cost of hospital care for COVID-19 ranges from $51,000 to $78,000, based on age

The average in-patient COVID-19 hospitalization costs patients with insurance $38,211 and $73,300 for those without

Source: Costs for a Hospital Stay for COVID-19

Hospitals will lose $323.1 billion in revenue due to COVID-19

Source: COVID-19 to cost hospitals $323 billion, American Hospital Association says

The cost to treat a COVID-19 patient is over $20,000 and over $88,000 for those who need a ventilator

Source: Hospitals and Health Systems Face Unprecedented Financial Pressures Due to COVID-19

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