National Trends in Out-of-Pocket Costs Among U.S. Adults With Diabetes Aged 18-64 Years: 2001-2017

Abstract

Objective: To assess national trends in out-of-pocket (OOP) costs among adults aged 18-64 years with diabetes in the U.S.

Research design and methods: Using data from the 2001-2017 Medical Expenditure Panel Survey, we estimated total per person annual OOP costs (insurance premiums, prescription drug costs, inpatient and outpatient deductibles, copays, and other payments not covered by insurance) and high OOP cost rate, defined as the percentage of people with OOP spending >10% of their family's pretax income. We examined trends overall, by subgroup (insurance type, income level, insulin use, size of patient's employer, and whether the patient was enrolled in a high deductible health plan), and by type of service. Changes in trends were identified using joinpoint analysis; costs were adjusted to 2017 U.S. dollars.

Results: From 2001 to 2017, OOP costs decreased 4.3%, from $4,328 to $4,139, and the high OOP cost rate fell 32%, from 28 to 19% (P < 0.001). Changes in the high OOP cost rate varied by subgroup, declining among those with public or no insurance and those with an income <200% of the federal poverty level (P < 0.001) but remaining stable among those with private insurance and higher income. Drug prescription OOP costs decreased among all subgroups (P < 0.001). Decreases in total (-$58 vs. -$37, P < 0.001) and prescription (-$79 vs. -$68, P < 0.001) OOP costs were higher among insulin users than noninsulin users.

Conclusions: OOP costs among U.S. nonelderly adults with diabetes declined, especially among those least able to afford them. Future studies may explore factors contributing to the decline in OOP costs and the impact on the quality of diabetes care and complication rates.

Figure 1—

Total OOP costs and high OOP cost rate among U.S. adults with diagnosed diabetes, 2001–2017. High OOP cost rate: percentage of patients living in a family of OOP cost >10% of family income.

Figure 2—

Trend in OOP costs among U.S. adults with diagnosed diabetes by services type, 2001–2017.

Figure 3—

High OOP cost rate among U.S. adults with diagnosed diabetes, by insurance type, 2001–2017. High OOP cost rate: percentage of patients living in a family with OOP costs >10% of family income.

Figure 4—

High OOP cost rate among U.S. adults with diagnosed diabetes, by income level, 2001–2017 High OOP cost rate: percentage of patients living in a family with OOP costs >10% of family income.