"Understanding healthcare spending through the lens of the household is completing the picture," Keckley says. "We hear about national health spending, but it tends to conveniently fall into buckets that are defined by Medicare or commercial health insurance plans. And yet much of the impacts on the households' spending are the things that are not showing up in claims."
The Deloitte study estimates that 60% of healthcare expenditures are "necessary expenditures" that include: $829 billion for physician, clinical, and other professional services and account for 26% of total expenditures. Hospital care accounted for $814 billion, or 25% of total expenditures, and prescription drugs accounted for $259 billion, or 8% of total expenditures.
The remaining 40% of total expenditures are in long-term care, retail products, supervisory care, and direct administrative costs, the study estimates. Direct and indirect discretionary costs for healthcare totaled $2,898 per capita in 2010.
Major categories included out-of-pocket spending by consumers on professional services (24%), retail products and services (19%), long-term care (10%), prescription drugs (8%), and hospital care (4%). For the average household earning around $50,000 out of pocket direct costs average about $1,300 per-capita.
Keckley says the healthcare industry needs to give consumers a true picture of their healthcare costs, both what is covered and what is not.
"Most of the information that is out there for consumers is not very useful," he says. "If you think about it, we should be able to, with the technologies we have now, before you walk up to the prescription counter know what the alternatives are for medications and what the cost would be for my insurance product."
"We should know before elective procedures what the over/under is based on some simple figures. If you are having a colonoscopy or some of the more simple things even that level of transparency of cost available to people in a way they can use it is virtually non-existent. And the industry pushes back on it."