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RESEARCH Paying Out-of-Pocket

The Healthcare Spending of 2 Million U.S. Families

Healthcare costs are rising for families. In 2015, the US spent 18 percent of Gross Domestic Product (GDP) on healthcare, up from 13 percent in 2000. For every dollar spent on healthcare, families paid 11 cents out-of-pocket and 28 cents after including insurance costs. While the Centers for Medicare and Medicaid Services projects health spending to continue to grow faster than GDP through 2025, the future of family-paid healthcare costs also rests with policy choices currently being debated. Out-of-pocket costs are a key piece of that picture.

The JPMorgan Chase Institute set out to better understand out-of-pocket healthcare spending among US households. Building off a sample of 2.3 million de-identified core Chase customers aged 18 to 64 between 2013 and 2016, we created the JPMorgan Chase Institute Healthcare Out-of-pocket Spending Panel (JPMCI HOSP). We explored the levels, concentration, and growth of out-of-pocket healthcare spending and the implications of these spending trends for overall household financial health. The JPMCI HOSP provides a first-ever look into out-of-pocket healthcare spending for households on a month-to-month basis, at the state, metro, and county level, and as recent as 2016. In this report, we describe the creation of, and initial insights gleaned from, this new data asset.

Finding One: Out-of-pocket healthcare spending grew between 2013 and 2016, but remained a relatively constant share of take-home income.

Families spent on average $714 or 1.6 percent of their take-home income on out-of-pocket healthcare spending in 2016. Out-of-pocket healthcare spending grew by an average annual rate of 4.3 percent.

Finding Two: The financial burden of out-of-pocket healthcare spending was highest for older, lower-income, and female account holders and increased in 2016 for low-income account holders.

Finding Three: Doctor, dental, and hospital payments accounted for more than half of observed healthcare spending. Dental and hospital payments were less common but larger in magnitude.

Finding Four: Out-of-pocket healthcare spending was highly concentrated among a few families—often the same families year-over-year. The top 10 percent spent 9 percent of their take-home income on out-of-pocket healthcare expenses.

The top 10 percent of families in terms of healthcare burden spent 9 percent of their take-home income on out-of-pocket healthcare expenses—as much as a typical family spends on all combined utility and cell phone bills in a year—and 48 percent of them did so again the following year.

Finding Five: Families made larger healthcare payments in the months and the years when they had a higher ability to pay. Elevated dental and hospital payments primarily contributed to high healthcare spending.

Monthly out-of-pocket healthcare spending was highly correlated with monthly take-home income. In each year during 2013-2016, families had the highest out-of-pocket healthcare spending in months of elevated income: March and April (tax refund season), October, and December.

Finding Six: There was dramatic variation in out-of-pocket healthcare spending across and within our 23 states. Families in Colorado spent the most on healthcare, while families in Louisiana spent the highest fraction of their gross income on healthcare.


From a universe of 37 million checking account holders, we assembled a de-identified sample of approximately 2.3 million Chase customers. We offer a family perspective on out-of-pocket healthcare spending among adults aged 18 to 64.


The JPMorgan Chase Institute Healthcare Out-of-pocket Spending Panel (JPMCI HOSP) offers several key insights as we evaluate proposed changes to our healthcare policies. First, out-of-pocket healthcare expenses represent a stable share of household income in aggregate, but are a source of financial strain for certain families. Healthcare reform should take into consideration the impact on households who are more financially burdened by healthcare expenses—specifically older, low-income, and female account holders. Second, healthcare spending may be large, unexpected, and concentrated in the months and years when families have a higher ability to pay. As such, consumers would benefit from more transparent pricing and payment options to better manage healthcare expenses. Third, cost containment measures, including value-based care, could have meaningful impacts on costs borne by families, not just by insurers and healthcare providers. Finally, wide variation in levels and burden of healthcare spending across geographies underscores the importance of healthcare as a state and local policy issue.


Diana Farrell

Founding and Former President & CEO

Fiona Greig

Former Co-President