Find reason for decline in out-of-pocket spending

Regarding “Analysis finds slow progress improving outcomes, big jumps in chronic disease since 1980”:

What if you peeled back a few more onion layers on the comment “The report highlighted a number of surprises, including a steady decline in personal out-of-pocket healthcare spending since 1980”?

What is the cause of that decline? My experience suggests it's not that the patient portion itself is on decline; it's that people don't have the money to pay their patient portions and therefore are forgoing treatment, or they are simply walking out on their bills.

I think a follow-up article looking into what is behind that “decline in personal out-of-pocket spending” would be informative.

Jan E. Johnson