The past 35 years have seen U.S. consumers pay for a steadily growing portion of their own healthcare. In fact they’ve ponied up roughly $40 to $50 more each year, driving the average annual out-of-pocket expense from $250 in 1980 to $1,300 in 2015.

Look for the trajectory to proceed apace or even accelerate as the population ages, cutbacks continue in both public and private health coverage, and premiums outpace both price increases and workers’ earnings.

The forecast comes from medical market researcher Kalorama Information, which has released a new report detailing the movement of consumers paying for their own care with credit cards, loans, health savings accounts, medical financing programs and, yes, cold hard cash.  

Many private plans now set limits on payments for certain products or services, leaving participants to self-fund further expenditures after those limits are met, Kalorama noted in a promotional page presenting its new report. “Thus, direct (consumer-to-provider) payments may be made by both uninsured and insured persons. For both groups, however, the size of direct payments for healthcare continues to rise.”

The materials on the promo page didn’t make specific reference to high-deductible health plans, but those are certainly playing a role in pushing out-of-pocket expenses skyward. Employers are pushing HDHPs, and consumers are choosing them to save on premiums—even though, as patients, they’re less than thrilled with what they’re getting in return.