Lower-income households shoulder the largest economic burden to pay for their healthcare, which researchers say speaks to the regressive nature of how the nation's health system is financed.
A new study by the RAND Corp. found the bottom fifth of households by income paid an average of $3,093 per person for healthcare in 2015 compared with $22,161 among the top fifth of household incomes.
But households with the lowest incomes paid a disproportionately higher share toward healthcare services compared with more affluent families. The bottom fifth of household incomes paid an average of 34% of their income in 2015 toward healthcare while the top fifth paid 16% of their income for healthcare services.
Other households paid between 20% and 23% of their income toward healthcare.
The findings were published Monday in the online journal Health Services Research.
Lead study author Katherine Carman, a senior economist at RAND, said the analysis looked at how much people really pay for healthcare, the burden it places, and the relationship between who pays for care and who receives care.
"Healthcare is really obscure," Carman said. "You can't see what you're paying in taxes, you can't see how much your employer is paying toward health insurance—so to see that percentage is really illuminating."
Researchers analyzed tax payments, insurance premium contributions made by individuals and their employers, in addition to out-of-pocket expenses.
Overall payments made to finance healthcare services totaled $9,393 per capita in 2015, accounting for 18% of the country's gross domestic product.
The study found the poorest families paid 12% of their income in out-of-pocket healthcare costs compared with just 0.7% among the highest-earning households.
"It's not just the lowest-income households, it's the sickest lowest-income households," Carman said. "Those are people who are really in poor health and need a lot of healthcare but are ending up having to pay those (disproportionate) costs."
Individuals covered by Medicare and Medicaid on average paid the lowest share of their income for healthcare at 13.6% each, while households covered by employer-based plans paid the largest share at 20%. Households with individual market health plans paid 19.7% of their income for healthcare services while those who were uninsured paid 18%.
Previous studies have shown the U.S. pays more per capita than other wealthy nations for healthcare but ranks well below those countries in several key health indicators, including life expectancy and maternal and infant mortality.
The RAND study highlights the growing financial barriers many Americans face in trying to access healthcare. A December Gallup survey found 25% of Americans said they delayed receiving treatment for serious medical conditions over the past year due to costs, compared with 19% in 2018 who reported putting off treatment.