Estimates of health care expenses for the U.S. civilian noninstitutionalized (community) population are critical to policymakers and others concerned with access to medical care and the cost and sources of payment for that care. In 2011, health care expenses among the U.S. community population totaled $1.33 trillion. Medical care expenses, however, are highly concentrated among a relatively small proportion of individuals in the community population. As previously reported in 1996, the top 1 percent of the U.S. population accounted for 28 percent of the total health care expenditures and the top 5 percent for more than half. More recent data have revealed that over time there has been some decrease in the extent of this concentration at the upper end of the expenditure distribution. In 2011, nearly 14 percent of health care expenditures in the community population for direct payments for medical care (which excludes expenses for insurance premiums) were paid out of pocket ($185 billion). In addition, the distribution of health care expenditures paid out of pocket is also concentrated among a relatively small proportion of individuals.
Using information from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) for 2011, this Brief provides detailed estimates of the concentration in the level of out-of-pocket health care expenditures for the nation, further distinguished by specific population subgroups. Studies that examine the concentration of health care expenditures, their magnitude, and their respective differentials among specific population subgroups are essential to help discern the factors most likely to drive health care spending and the characteristics of the individuals who incur them. The MEPS-HC data is particularly well suited for measuring the population's distribution of health care expenditures because it contains nationally representative data on individuals' expenditures for health care by source. All differences between estimates discussed in the text are statistically significant at the 0.05 level unless otherwise noted.