Out-of-Pocket Costs Rising Even as Patients Transition to Lower Cost Settings of Care

New TransUnion Healthcare analysis found that most patients face a $500+ cost burden

CHICAGO, June 25, 2019 (GLOBE NEWSWIRE) -- A new TransUnion Healthcare (NYSE: TRU) analysis found that most patients likely felt a bigger pinch to their wallets as out-of-pocket costs across all settings of care increased in 2018. The new findings were revealed today at the 2019 Healthcare Financial Management Association Annual Conference in Orlando.

The analysis reveals that patients experienced annual increases of up to 12% in their out-of-pocket responsibilities for inpatient, outpatient and emergency department care in 2018.

Average Inpatient, Outpatient and Emergency Department Healthcare Costs on the Rise

Year/ServiceInpatientOutpatientEmergency Department

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

The TransUnion Healthcare analysis found that, during a hospital visit, patients are likely experiencing cost increases which continues the trend of higher out-of-pocket costs. Approximately 59% of patients in 2018 had an average out-of-pocket expense between $501 and $1,000 during a healthcare visit. This was a dramatic increase from 39% in 2017. Conversely, the number of patients that had an average out- of-pocket expense of $500 or below decreased from 49% in 2017 to 36% in 2018.

Majority of Patients Facing Out-of-Pocket Costs between $501 and $1,000


Out-of-Pocket Healthcare Costs
2018 2017 
$500 or less36%49%
$1,001 or more5%12%

Consumerism Leads More Patients to Lower Cost Settings of Care
As out-of-pocket costs increase, the trend toward consumerism is growing as more patients, payers and providers transition to lower cost settings of care.

An example of this: inpatient care, traditionally the most expensive healthcare option, has seen a leveling off with the percentage of price estimates remaining at 8% between 2017 and 2018. The percentage of outpatient services estimates, generally about one-quarter of the cost of inpatient services, rose in that same timeframe from 65% to 73%.

“Patients are likely seeing more providers and payers recommending that they take advantage of cost-effective healthcare options, which brings down costs for all parties,” said Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare. “This is especially important as costs continue to rise in all areas of healthcare, particularly in inpatient, outpatient and emergency department services.”

Patient Payment Challenges and Denial Rates
As healthcare costs increase across all care settings, it is becoming increasingly difficult for patients to pay their bills. A recent Kaiser Family Foundation study indicated that 34% of patients are finding it difficult to pay their deductible before insurance kicks in.1 In addition to patients being challenged to make payments, many studies indicate providers are also feeling the pressure of increased denial rates and write-offs which is increasing bad debt.

Considering these factors together – increased out-of-pocket expenses, a patient’s challenge to make payment, and increased denial rates – collecting payments from all payers is critical for providers.  In order for providers to ensure they receive payment for the patient-care services rendered, it is vital that they implement strategies that maximize reimbursements by implementing a holistic revenue protection strategy. 

TransUnion Healthcare’s Revenue Protection® solutions, including Insurance Discovery – which received “A” grades in the 2019 Best in KLAS Software and Services Report, and A/R Recovery and Denials Management, work together to help hospitals prevent revenue leakage, and ensure earned revenue gets paid while optimizing hospital collection strategies. TransUnion Healthcare works with more than 1,800 hospitals and health systems and has protected over $5.2 billion in net revenue to date for its entire client base.

To help healthcare providers learn new strategies to prevent denials and find hidden coverage, TransUnion Healthcare will be hosting a webinar on July 11 at 1 p.m. EST. The webinar will feature how a large health system leverages robust solutions for denials prevention, A/R recoveries and insurance coverage discovery to drive maximum reimbursements and improve profitability. To register for the webinar or secure a recording at a later date, please click here.

About TransUnion Healthcare
TransUnion Healthcare, a wholly owned subsidiary of global information and insights company TransUnion, is a trusted provider of Revenue Protection® solutions that prevent revenue leakage by helping over 1,800 hospitals and 500,000 physicians engage patients early, ensure earned revenue gets paid and optimize collection strategies. TransUnion Healthcare leverages extensive data assets, patented and peer-reviewed revenue cycle technologies and advanced analytics to uncover deep insights that help providers improve the patient financial experience, understand patient behavior patterns, reduce uncompensated care, maximize reimbursement and collectively recover over $1.0 billion annually in revenue. TransUnion Healthcare’s Revenue Protection solutions represent the most comprehensive suite of Patient Access and Revenue Recovery solutions in the industry and serve a wide range of hospitals and health systems, ambulatory and physician practices, government, healthcare payers, and healthcare partners and resellers.


About TransUnion (NYSE:TRU)
Information is a powerful thing. At TransUnion, we realize that. We are dedicated to finding innovative ways information can be used to help individuals make better and smarter decisions. We help uncover unique stories, trends and insights behind each data point, using historical information as well as alternative data sources. This allows a variety of markets and businesses to better manage risk and consumers to better manage their credit, personal information and identity. Today, TransUnion has a global presence in more than 30 countries and a leading presence in several international markets across North America, Africa, Europe, Latin America and Asia. Through the power of information, TransUnion is working to build stronger economies and families and safer communities worldwide.

We call this Information for Good.SM 


  1. KFF:  June 11, 2019:  Data Note:  American’s Challenges with Health Care Costs
Contact Dave Blumberg