The real cost of healthcare

In addition to actual out-of-pocket spending on medical goods and health-related services, significant costs are incurred by people who are giving "supervisory care", that is care for sick relatives or friends in the form of imputed costs captured by the care-giving time that could otherwise be used profitably and productively.

The research finds that these additional annual costs amounted to $363 billion in 2009, or roughly 14.7% of overall annual health care spending of $2.83 trillion. For instance, the $55 billion that is spent on nutritionals/supplements by consumers is not included in official estimates. And neither is the imputed cost of supervisory care, amounting to $199 billion. 

This cost is concentrated on poorer and two-person households, as well as among seniors. Put another way, the annual per-capita out-of-pocket costs of US health care to consumers essentially double to around $1,900 (from $904) once supervisory care and other items not included in the official estimates are taken into consideration.

And, demonstrating the significance of the amount consumers now spend on health care, the additional costs captured in the study support an increase in consumer discretionary spending on health care from 16.2 percent - for items traditionally reported by the government - to 19.9 percent, which surpasses housing and utility costs at 18.8 percent.

These findings matter on several levels. First, think about the US economy. Costs that are incurred through health care represent either lost dollars (earnings that are foregone while giving care) or real dollars that are spent out-of-pocket and are therefore unavailable to other sectors, including financial services. 

Our study suggests that consumers have significantly less discretionary spending power as a consequence of health-related costs, meaning that there is less slack for debt repayment or for the servicing of new debt taken on in the form of consumer credit. If they spend hundreds of additional dollars on health, that money cannot purchase a new or upgraded automobile; nor can it purchase the credit to buy said vehicle. There is potential downside risk to the economy here.

Further, overall health spending is growing quickly, including the out-of-pocket spending we have tracked. As broader health reforms kick in, there is going to be more pressure on the economy, not less. The US health system employs roughly 15m people, so it has a huge influence on the economy. 

More efficient service delivery could help to reduce the pressure on consumer's pockets, but that is likely to take time and is anyway uncertain. Arguably more challenging is whether the supply of health care services can be maintained or actually grown to meet future demand as more people are insured.

Looked at from the perspective of US business, the out-of-pocket health spending revealed in our research is clearly important, but is only one part of a much bigger strategic challenge facing firms as a consequence of reform and overhaul of US health care. Financial services firms are particularly affected.

They are consumers of health care themselves through insurance and other health-related programs (for example, health savings plans) and are thus directly influenced by rising costs and alternative methods of delivery to their employees.

But financial firms are also deeply enmeshed in the health care industry. Insurers are major direct participants as providers and as asset managers. Private equity and real estate firms are major participants in the health care system as restructuring and construction of new hospitals and facilities shape provision in the future. 

Banks and other payment processors are also vital parts of the system and face daunting competitive challenges as technology brings new methods for handling consumers' medical records and new opportunities for non-banks to deliver mobile electronic payments at the point of service or sale.

And the relationship goes both ways. Like it or not, rising medical costs are high among the causes of financial stress for millions of Americans whose credit standing has fallen since the onset of the recession. Many consumers have struggled to pay medical bills on time, either becoming delinquent or juggling obligations using credit cards and other loans - a trick that has become much harder for many now that banks have tightened credit standards.

Both the health care and financial industries are at different stages of major regulatory and structural change and they are inextricably tied together. Consumers sit between them as users and purchasers of services. 

Now that we have a better idea of what it is really costing consumers on the health side of the equation, we might expect a more informed debate across the board, including a better understanding of the potential impact on the US economy.

*FN: "The Hidden Costs of U.S. Healthcare for Consumers: A Comprehensive Analysis," Deloitte, March 2011

Paul H. Keckley, Ph.D., is Executive Director for the Deloitte Center for Health Solutions (the Center), the health care research arm of Deloitte LLP. Andrew Freeman is the Executive Director of the Deloitte Center for Financial Services. 

The full study as well as Deliotte's breakdown can be found here.