Statement and Billing Volume Analysis - Finserv and Healthcare

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Part
01

Statement Volume - Health Insurance 4

In 2018, an estimated 3.445 billion health insurance claims were filed in the U.S. In addition, an estimated 2.3 statements are sent per claim in the U.S. We were able to estimate both the number of health insurance claims and the average number of bills/statements sent per claim by health insurance companies annually in the U.S. via triangulated calculations that we formulated based on available data. Those step-by-step calculations, along with the supporting data we found, is all explained in detail below.

Annual Number of Health Insurance Claims

• According to our data-based, triangulated calculation, there are an estimated 3.445 billion health insurance claims in the U.S. annually.
• The most-recent data we could find about the number of health insurance claims in the U.S. was from 2012. However, we were able to estimate how that number has changed between 2012 and 2018, in order to provide the most up-to-date information in light of the available data.
• According to the Council for Affordable Quality Healthcare, it was estimated that 40% of the people in the U.S. with health insurance constituted 1.3 billion health insurance claims in 2012.
• Since the aforementioned number of claims didn't pertain to all people with health insurance, we determined the number of health insurance claims for the entire U.S. population with health insurance through a cross-calculation that we formulated. That calculation was as follows: 1.3 billion is to 40% as X is to 100. Next, we multiplied 1.3 billion by 100 and divided that value by 40 (representing 40%), which equals 3.25 billion (number of claims for entire U.S. population with health insurance).
• To update that 2012 data, we found that there has been a 6% increase in health insurance enrollment between 2012 and 2017. We determined that from the facts that the uninsured percentage was 15% in 2012 and the uninsured percentage was 9% in 2017, so 15% — 9% = 6%.
• Accordingly, we multiplied the estimated number of 2017 health insurance claims in the U.S. (3.25 billion) by 0.06 (representing the aforementioned 6% health insurance enrollment increase between 2012 and 2017), which equals 195 million (estimated increase in the number of health insurance claims).
• We then added 195 million to the estimated number of health insurance claims in 2017 (3.25 billion), which equals 3.445 billion (estimated number of U.S. health insurance claims in 2017).

Average Number of Bills/Statements Sent Per Health Insurance Claim

• According to our data-based, triangulated calculation, U.S. health insurance companies send an average of 2.3 bills/statements per claim (estimated).
• To calculate the average number of bills/statement, we first needed to find the average healthcare spend per person in the U.S., which is \$10,348.
• Next, we needed to calculate the average number of health insurance claims per person in the U.S. To do so, we divided the previously calculated number of U.S. health insurance claims in 2017 (3.445 billion (estimated)) and divided that by the number of people with health insurance in the U.S. (294.6 million in 2017), which equals 11.7 (estimated, average number of health insurance claims per person).
• To calculate the average number of bills/statement sent per claim, we divided the average healthcare spend per person in the U.S. (\$10,348) by 11.7 (estimated, average number of health insurance claims per person), which equals \$884.4 (estimated spend per person per claim, rounded to the nearest tenth).
• Next, we divided \$884.4 by the average monthly claim spend per person in 2018 among people with individual market health insurance (\$392), which equals 2.3 (estimated number of months to pay off a claim, rounded to the nearest tenth). We used the average monthly claim spend among people with individual market health insurance because that was the most-directly applicable data we could find.
• Accordingly, an average of 2.3 bills/statements per claim (estimated) are sent by health insurance companies.

Research Strategy

We began our research by looking for articles about the number of health insurance claims and the average number of bills/statements sent per claim by health insurance companies annually in the U.S. Not one article directly provided that information, and we reviewed many articles published by reputable sources such as Becker's Hospital Review and CNBC, among others, when reserching for that information. Those sources did, however, provide related data points, which we logged throughout our research.

For our second research method, we reviewed several credible reports about health insurance claims, payments, and the health insurance market in general. We thought that perhaps the data requested might have been included therein. While there was a lot of data packed into those reports, the exact data we were looking for wasn't directly stated. An example of one such source that we consulted for those reports was the Kaiser Family Foundation, and we did ultimately cite data from that source in our findings above. Just like with the articles, there were some related insights we found from the report sources that we reviewed, which we also noted.

As a third research method, we turned our efforts to determining the requested data points through triangulated calculations, since the available data alone didn't directly provide the information we were looking for. The data we used for those triangulated calculations came from a combination of reputable sources, which included the Council for Affordable Quality Healthcare for example. All the data we used in our triangulated calculations is specific to the U.S. only.
Part
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Part
02

Statement Volume - Health Insurance 3

While there is no publicly available information on the number of annual marketing offers sent by third-party health insurance companies each year, it was found that the medicare marketing rules have changed for the current year (2019) in terms of the electronic communication policy and marketing through unsolicited contracts. The Centers for Medicare and Medicaid Services (CMS) made agents wait to begin marketing for the next year's plans, until October 1.

Key Insights

• The Medicare Communications and Marketing Guidelines (MCMG) was rewritten by the Centers for Medicare and Medicaid Services (CMS) for the year 2019. Under this new format, changes were made in the sections of the electronic communication policy and marketing through unsolicited contacts, educational events, personal marketing appointments, and required disclaimers.
• Under the new guidelines, the rules placed around unsolicited contact has eased considerably. Brokers can now initiate contact through print media, conventional mail, and email. However, direct unsolicited contact like direct messaging and text via social media and door-to-door solicitation are not permitted.
• CMS has also made agents wait until October 1 to start their marketing plans for the next year and are expected to wait until October 15 to enroll members. The guidelines also state that the "marketing materials are subject to CMS review" while communication materials will not.
• The 2020 Medicare Communications and Marketing Guidelines require agents to ensure their website content for PDP or MAPD plans is approved by the Health Plan Management System (HPMS). Marketing agents are allowed to schedule a sales event right after having an educational event.
• According to the U.S. Census Bureau, in 2018, 8.5% or 27.5 million people had no health insurance that year and over 91.5% of people had health insurance coverage for the entire year. Private health insurance was found to have dominated the insurance market with over 67.3% of the American population opting for third-party health insurance while 34.4% of the population were covered by public health insurance.
• As per the Office of the Actuary at the Centers for Medicare and Medicaid Services, the aggregate health care expenditure in the United States is predicted to grow at a CAGR of 5.8% during the period 2015-2025.

Research Strategy:

We began our search by looking into industry reports from websites such as IBIS World and media reports from websites such as PRNewswire and Businesswire among others to obtain information on the number of annual marketing offers sent by third-party health insurance companies each year in the United States. An exhaustive search through these reports provided no information on the subject. We then scoured through the market-specific websites and blogs such as Excelsior Insurance Brokerage, SHRM, and Ritter Insurance Marketing. Through our search, we were able to identify new marketing guidelines formulated by the CMS with no specific information on the marketing offers sent by private health insurance companies.

We then attempted to triangulate the required information by scouring through case studies, press releases, and media mentions by some top third-party health insurance companies in the United States. We searched for third-party health insurance companies from databases such as NAP.edu and Chron. For each of the companies identified, we looked into their websites, annual reports, investor presentations, and financial documents to find relevant information that could help in triangulating the number of annual marketing offers sent by them. An extensive search through these channels provided information concerning coverage and costs with no supporting information on the marketing offers sent by the health insurance companies each year. We then extended our search further to include government databases such as the U.S. Census Bureau. While the information on how many people have insurance coverage through private health insurance was available, there was no data that pertained to third-party insurance companies and their marketing offers. The lack of information on the subject can be due to the focus laid on the cost than on the volume of marketing offers. It can also be due to the extensive focus laid on maintaining the guidelines and its compliance rather than the volume of the marketing offers sent out. It can be assumed that there is no limit or restrictions on the volume of marketing offers being made as long as they are compliant with the new rules.
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Part
03

Statement Volume - Health Insurance 2

In 2017, the number of health insurance policies was 294.6 million and in 2018 the number of health insurance policies was 299.79 million.

HEALTH INSURANCE POLICIES IN THE UNITED STATES

• In 2017, the number of people with health insurance policies was 294.6 million.
• In 2018, the number of people in the United States with health insurance policies was 91% of the population.
• This is equal to 299.79 million people.

YOUR RESEARCH TEAM APPLIED THE FOLLOWING STRATEGY

We began our research for the number of health insurance policies in existence each year in the United States by reviewing government articles, industry expert reviews, and news articles for information. We discovered on the government census website the exact number of policyholders in 2017. For 2018, they offered only a percentage of US citizens who had coverage — which was 91%. Therefore, we researched for the US population, determining it was 329.45 million people in August 2019, hence, we divided 91% into 329.45 million to conclude that in 2018 the number of Health Insurance policies was 299,79 million.
Part
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Part
04

Statement Volume - Health Insurance 1

There is insufficient information available to the public to determine the number of EOBs (explanation of benefits) sent by health insurance providers each year. A triangulation attempt reveals that unique instances of hospital visits likely triggers over 164,885,177 EOBs. These EOBs are sent out by health insurance providers every year.

NUMBER OF EOBS (EXPLANATION OF BENEFITS)

• Typically, an explanation of benefit (EOB) is sent to people with private insurance coverage.
• Those who have purchased healthcare plans via their employer or those under Medicare also get EOBs sent to them.
• An explanation of benefits (EOB) is sent from the insurance company to a subscriber after a particular visit to a healthcare service provider.
• A triangulation attempt reveals that about 129276278 unique hospital visits are initiated by outpatients with private insurance every year.
• Outpatients initiate about 35,608,899 (calculated) unique hospital visits with Medicaid insurance coverage every year.
• Collectively, Medicaid insured, and privately insured adults account for about 164,885,177 unique hospital visits triggering a minimum of 164,885,177 explanations of benefits. (Assuming that all unique visits require an EOB)

RESEARCH STRATEGY

The research included academic and scholarly publications such as resources of the United States National Library of Medicine, Journal of Adolescent Health, etc. An investigation was conducted to uncover the number of EOBs (explanation of benefits) sent by health insurance providers every year. This information was not published. This strategy further researched instances that trigger the processing and forwarding of an EOB to policyholders. This process revealed that insurance companies typically post an explanation of benefits (EOB) to policyholders whenever care is provided through the plan. Further research showed that many insurance companies process and send EOBs even when they are not required. An investigation to uncover the percentage of EOBs sent but not required did not reveal any helpful insight.

The study also reviewed medical databases and credible blogs such as Med Data for the number of EOBs (explanation of benefits) sent to consumers by health insurance providers each. This number was not made public. The research strategy examined the percentage of health insurance consumers that receive EOBs yearly. This strategy also investigated the number of those that are not satisfied with EOB content or report challenges related to its interpretation. About 74% of health insurance consumers get confused with the content of explanation of benefits (EOBs) as well as medical bills. The research studied the break down into separate statistics for medical bills and EOBs. This detail is not made public.

American census resources were studied to uncover those under insurance coverage. Those with insurance coverage that get EOBs (explanation of benefits) sent by health insurance providers each year were also reviewed. Census demographics revealed the various percentage of people covered by different insurance policies. The percentage of insured people that get EOBs sent to them is not available to the public.

The research also included health information publications such as Very Well Health web, for the various categories of insurance consumers that get EOBs. The study also evaluated the number of people under such insurance coverage. Uncovered insight revealed that an EOB is sent to categories of people who purchase insurance on their own, a health plan through an employer, or Medicare. The study investigated the number of people covered by private insurance, Medicaid insurance plans that receive EOBs yearly. Very Well Health web did not reveal this information.

CALCULATION/ASSUMPTIONS

• The study assumes that all those that have purchased insurance coverage on their own get EOBs. Those who have health plans paid by their employer and those under Medicare also get EOBs.
• This study assumes that an explanation of benefits (EOB) gets sent to a subscriber after a "particular service" or visit to a healthcare service provider.
• In 2017, about 67.2% of Americans had private insurance. The population of adults in the United States as of 2017= 251,564,106, then (251,564,106*67%) = 168547951. This estimate means there are 168547951 adults with private insurance in the United States.
• In 2017, about 19.3% of Americans had Medicaid insurance. The population of adults in the United States as of 2017 = 251,564,106, then (251,564,106*19.3%) = 47797180. This means there are 47797180 adults covered under Medicaid in the United States.
• For all outpatient visits combined, 76.7% of adults with private insurance visit hospitals yearly. Assuming this rate is constant for all years, hospital visits = (Number of adults with private insurance * hospital visit rate) = 168547951*76.7% = 129276278 hospital visits
• For all outpatient visits combined, 74.5% of adults with Medicaid insurance visit hospitals yearly. Assuming this rate is constant for all years, hospital visits = (Number of adults with Medicaid insurance * hospital visit rate) = 47,797,180*74.5% = 35,608,899 hospital visits
• Total visits by individuals with Medicaid and private insurance = 129,276,278+35,608,899 = 164,885,177 unique hospital visits.
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Part
05

Statement Volume - Mental Health

MENTAL HEALTH FACILITIES IN THE UNITED STATES

• The approximate number of annual mental health residents in the United States is between 27 million and 62 million. This number is corroborated with data from this source and this source.
• There are 170,000 residents in mental health facilities in the United States on any given day.
• There are 30 million mental health related physician office visits annually in the United States.
• 19.8 million people with any mental health illness and 7.5 million people with a serious mental health issue received mental health services in 2017.

RESEARCH STRATEGY:

We began the research for the average or approximate number of annual residents in skilled mental health facilities by reviewing expert articles, government publishings and news reports in order to find the exact number. While performing this research we found two credible government sources published within the last 48 months which stated that the last comprehensive analysis of the mental health facilities themselves was in 2014 as well as that "there is no single source of information that documents all psychiatric inpatient capacity across the various types of organizations that are providing these services." This analysis showed that there were on average 170,000 patients in mental health facilities per day in the United States.
170,000 daily patients * 365 days in a year = 62,050,000 residents per year.

Another study for the same years showed that 30 million mental health-related physician office visits were made by adults aged 18 and over with psychiatrists providing 55% of the care, primary care physicians at 32%, and other specialists at 13%.

We increased the scope of the request to include information about mental health patients instead of just the facilities themselves and was able to discover that 19.8 million people with any mental health illness and 7.5 million people with a serious mental health issue received mental health services in 2017. Mental Health Services included people who received inpatient or outpatient treatment and have used prescription medication for problems with emotions, nerves, or mental health.

19.8 million + 7.5 million = 27.3 million residents

We therefore determined the number of residents in the United States is approximately 27-62 million annual mental health facility residents but this was by using out-of-date data.
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Part
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Statement Volume - Hospice

The average number of annual residents in skilled hospice facilities is 1.4 million.

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Part
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Statement Volume - Nursing Homes 1

The average number of annual residents in skilled nursing home facilities in the US, excluding hospice and mental health facilities, ranges between 1.3 to 1.35 million.

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Part
08

Statement Volume - Testing Centers

Currently, a total of 14 billion lab tests are being conducted each year in the U.S. with LabCorp annually performing more than 120 million patients tests.

ANNUAL NUMBER OF PATIENT TESTS

• As of 2015, the total number of laboratory tests performed each year was an estimated 13 billion in the U.S.
• According to the Center for Disease Control and Prevention, 70% of today’s medical decisions depend on 14 billion laboratory tests conducted annually.”
• Therefore, currently, a total of 14 billion lab tests are being conducted each year in the U.S.
• LabCorp encounters about 115 million patients per year and performs 2.5 million patient tests weekly.
• Therefore, LabCorp annually performs more than 120 million patients tests.
• In 2018, the annual revenue of LabCorp was \$11 billion.
• LabCorp sends a bill to its patients approximately once a month until the balance due for services they performed has been paid.

RESEARCH STRATEGY

We began by searching for the number of annual patient tests and the average bills/statements sent per test from testing centers through various media articles from sources like Health I.T. Dashboard, Quest Diagnostics, Scientific American, ACP Online, Los Angeles Times, The New York Times, and others. We hoped to find the desired statistics through these sources as media sources generally discuss these topics billing, among others. This search revealed the number of laboratory establishments, and the number of laboratory tests performed each year in the U.S., but no information was found concerning the number of annual patient tests and the average bills/statements sent per test from testing centers.

2. Our next strategy was to look through the website of LabCorp. Sometimes companies mention these details on their website’s ‘About Us’ or ‘Corporate Profile’ or ‘History’ or ‘Financial facts’ section. While searching through LabCorp’s website and WFMY News, we were able to find that LabCorp annually performs more than 120 million patients tests; however, it did not mention anything on the average bills/statements sent per test from testing centers. The website also provided information on the revenue it generated in 2018. We then tried to search for billing details of LabCorp and found details of how patients receive and pay bills to LabCorp, but no information was available on the average bills/statements sent per test from testing centers. However, under the FAQ section, we found that LabCorp sends a bill to its patients approximately once a month.

Then, we changed our strategy and looked through various medical journals, books, research reports, and other specific medical sources. The idea was that the information on billing might be available in these reports or studies as sometimes even research studies quote these kinds of information in their ‘Introduction’ or ‘Literature review’ section. Some of the sources we looked through include The American Society for Clinical Laboratory Science, Journal of Medicare Medicaid Research, and Ensuring innovation in diagnostics for bacterial infection: Implications for policy, IBIS World report, and others. These sources provided information on the industry revenue, the number of businesses, growth, market share by products & services, volumes and payments for clinical laboratory test codes, medicare. However, again, this did not provide the information on average bills/statements sent per test from testing centers or LabCorp.

Therefore, based on the strategies as mentioned above, we could only provide the information on the number of annual patient tests performed by LabCorp and a few other relevant details. An extensive search using different strategies and a variety of sources could not provide the requested information.
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Part
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Statement Volume - Dentist's Offices 2

After an exhaustive search, data on the number of lab tests conducted by dental offices annually is not available. However, in the course of this research. The research team found that the U.S. has 9,578 dental offices with 47,385 employees. Highlights of useful data points that were found in the course of this research are provided below.

Useful Information

• There are 9,578 dental offices/businesses in the U.S.
• The U.S. dental laboratory industry is projected to generate \$5 billion.
• There are 47,385 employees in the U.S. dental laboratory industry.
• There were 81,500 dental & ophthalmic laboratory technicians and medical appliance technicians in the U.S. They assist dentists in equipment fixing.
• In 2018, there were 34,480 dental laboratory technicians in the U.S.

Research Strategy

To determine the annual number of lab tests conducted by dental offices in the U.S., your research team commenced with an extensive search on credible statistical, health organizations, and government databases to search for pre-existing data. We found data related to the size of the U.S. point of care diagnostics and testing market and the number of workers in the U.S. dental industry. Next, we looked for the number of dental labs in the U.S. and the average number of tests performed by a laboratory in the U.S. We hoped to use these data points to triangulate the requested data. While we found data on the number of dental laboratories in the U.S., there was no information on the number of tests performed in a lab in the U.S.
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Furthermore, we attempted to triangulate related data points. We commenced by searching for the total number of dental employees in the U.S. and the number of lab tests performed by each dentist or technicians. We hoped to use these data points to estimate the requested data. However, we could only find data on the number of employees in the U.S. dental laboratory industry.

After extensive attempts to find or triangulate the requested data points were unsuccessful, the probable reason for the unavailability of the requested data points is likely because such data has not computed, where it has, it has not been made available to the public domain.
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Part
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Statement Volume - Dentist's Offices 1

US dentist's offices receive around 345 million patient visits per year. Below, our calculations have been outlined, followed by an explanation of the research strategies applied in an attempt to locate information on the average number of bills/statements sent per dentist's office visit.

ANNUAL PATIENT VISITS — DENTIST'S OFFICES

• A dentist office will receive an average of 1725 patient visits per year. (calculated)
• Annually, US dentist's offices receive around 345 million patient visits total. (calculated)

RESEARCH STRATEGY

In order to determine the number of annual patient dentist's office visits, we performed a calculation. To perform the calculation, we needed the following two data points: [1] the average number of patient visits per dentist's office and [2] the number of dentists in the US. To find the first data point, we calculated the average number of patient visits per dentist's office between full-time general dentists and "solo" general dentists, as follows:

Full-time dentists — patients treated yearly: 2,100
"Solo" dentists — patients treated yearly: 1,350

Average value: (2,100+1,350)/2
=1725

Then, we multiplied the average number of patient visits per dentist's office with the total number of practicing dentists in the US, as follows:

Number of patient visits per dentist's office per year: 1,725
Number of practicing dentists in the US: 200,000

1725*200000
=345000000

Therefore, the approximate annual number of patient dentist's office visits in the US is 345 million.

We were unable to reliably determine the average number of statements sent per visit to a dentist's office. In an attempt to determine this specific information, the following strategies have been deployed:

First, we scoured through various credible, reputable and industry-specific publications such as USA Today, State News, Huffpost, The New York Times, Dentistry iQ, Area Dentist, among others, hoping to locate this specific information, as these types of sources often discuss the topic of billing and might have mentioned this information in industry-specific reports. Various irrelevant information was uncovered this way, including the number of dentists in the United States, however no information specifically regarding billing statements sent from a dentist's office was found.

Next, we turned to governmental resources and dental associations such as the American Dental Association, Washington State Healthcare Authority, Emergency Dental Care USA and Data USA, among others, confident that this will provide us with desired results, since these types of sources are experts in the industry and likely know this information, possibly disclosing it publicly. Although various irrelevant information, such as the average annual wage for a dentist, was available this way, again, no information was available on the number of dentist office billings per visit.

We also checked various medical journal databases, such as the Journal of Dental Education, Am J Public Health, NIH, since relevant case studies might have been published in these types of databases. Additionally, statistical databases, such as Statista have been consulted. This way, the average yearly amount of money paid for dental services by a customer was found, but it was evident no information specifically pertaining to the number of bills was available.

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Part
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Statement Volume - Doctor's Offices 2

In the United States there were 1.518 billion laboratory tests conducted in doctor's office or physician office laboratory (POLs) centers, as at 31st December 2017. This figure represents 11 percent of the annual (13.8 billion) laboratory tests that were conducted in the U.S. in 2017. Below are more annual statistics relating to POLs in the U.S.

POLS ANNUAL STATISTICS IN THE U.S.

• According to a 2017 report by CDC's Center for Surveillance, Epidemiology, and Laboratory Services, there was a total of 13.8 billion laboratory tests conducted annually in the U.S. Of these tests, physician office laboratories conducted 11 percent or (13.8 billion * 0.11) 1.518 billion laboratory tests annually.
• Based on findings from the U.S. Centers for Medicare and Medicaid (CMS) Online Survey, Certification, and Reporting (OSCAR) database, physician office laboratories conducted a total of 525 million laboratory tests or 8 percent of total annual laboratory tests in 2006.
• Data from the Healthcare Financing Administration indicates that in 1999, physician office laboratories conducted 656.4 million laboratory tests or (11 percent of total annual laboratory tests) in the U.S.
• Statistics from the CLIA (Clinical Laboratory Improvement Advisory Committee ) indicate the number of CLIA-certified physician office laboratory (POLs) centers in the U.S. from 1993 to 2018. POLs in 2018, 2017 and 2016 are 121,404, 122,973 and 121,973 respectively.
• According to a 2019 report by CLIA, POLs constitute 45.94 percent of the total 264,182 approved laboratory centers in the U.S.
Part
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Part
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Statement Volume - Doctor's Offices 1

There were an estimated 883.7 million office-based physician visits in the United States in 2016. Unfortunately, an extensive search was not able to uncover the average number of bills/statements sent per visit.

DOCTOR'S OFFICE VISITS

• A report published by the Centers for Disease Control & Prevention (CDC) in January 2019, estimated that the total number of physician office visits in 2016 in the United States was 883.7 million.

AVERAGE BILLS PER VISIT

• Information on the average number of bills/statements sent per visit from doctor’s offices in the United States was not publicly available. To help understand why this is the case, details on the billing process are being provided.
• Single provider medical billing typically refers to bills that come out of a doctor's office, as opposed to a hospital or medical clinic.
• The billing process generally works as follows: (1) when the visit is complete, the doctor's office codes the visit according to codes agreed upon with the insurance companies; (2) if the patient has insurance, the coded claim is sent to the insurance company; otherwise, the patient is billed directly; (3) the insurance company decides whether they will pay all, or a portion, of the bill and sends that information back to the doctor's office with payment; (4) the doctor's office bills the patient for any remaining balance; (5) if the patient does not pay the bill, additional bills may have to be sent until payment is received.
• Based on the above process, it appears there would be a minimum of one bill if a patient did not have insurance and paid the bill upon receipt; there would be a minimum of two bills if the patient was insured (one to the insurer and one to the patient), and there would be a minimum of three bills if the patient did not pay the original bill. Since there was no data on how many fall into each of these categories, it is not possible to make a reasonable estimate.
• The medical billing outsourcing market size in the United States is expected to be \$7.8 billion by 2026.

RESEARCH STRATEGY

We began our search for the average number of bills/statements sent per visit from doctor's office on government sites, health organizations, and media sites such as the CDC, the Health Care Cost Institute, and The Washington Post, as these types of resources often publish statistics related to health care. Although we did find statistics on how Physicians Assistants and Nurse Practitioners bill patients, there were no details on the number of bills that are sent out from a typical office visit.

Since the data we needed was not publicly available, we decided to search for information on the total number of bills that are sent from doctor's offices each year in the United States. Since we already had data on the total number of office visits, if we found data on the total number of bills, we would be able to estimate the average number of bills per visit. To find this data we looked on websites of healthcare organizations (The Commonwealth Fund), healthcare service providers (MedData), and national media (The Atlantic). This research allowed us to find data on where America's healthcare spending goes, as well as the fact that 65% of people who file for medical bankruptcy contribute it to doctor's visits, but there was no data on the number of bills that are sent from doctor's offices each year.

As a final strategy, we looked for data on how the billing process works for a visit to a doctor's office. We hoped that if we could understand how the process worked, it may provide some insight into how many bills are sent. We were able to find a detailed description of how the billing process worked which we describe above. However, this data alone was not enough to make any type of reasonable triangulations on the number of medical bills sent per year. Further details on the data we found, and how we attempted to use it to estimate the answer, are provided in the key findings above.

We concluded that the data on the average number of bills sent per visit from doctor's offices is not publicly available and can't be estimated. This is likely because each doctor's office and insurer has their own policies regarding billing, so it is not possible to determine an average.

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Part
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Statement Volume - Urgent Care 2

The number of lab tests conducted by retail and standalone urgent care centers annually in the US could not be determined after a detailed and wide-reaching research. It was however estimated from data older than 2 years that there are about 26.67 million lab tests performed each year by retail and standalone urgent care centers in the US.

USEFUL INSIGHTS

• Between 2011 and 2018, the retail clinic industry was forecast to grow at a Compound Annual Growth Rate (CAGR) of 11.2%, and the number of retail clinics was forecast to reach 2,854 by 2018.
• As of 2107, it was estimated that retail health clinics would have 25 million annual visits.
• As of 2013, freestanding/standalone Urgent Care Centers (UCC) accounted for 32% of all UCCs in the US.
• On average, urgent care centers in the US receive 160 million visits per year.
• According to a 2016 study, 35% of medical encounters/visits result in the performance of at least 1 lab test.

RESEARCH STRATEGY

Your research team commenced by consulting industry research providers such as Statista, IBISWorld, MarketWatch, and GrandViewResearch. This approach was taken with hopes of finding already existing/compiled reports, market and industry studies or publications that could provide the number of lab tests carried out by retail and stand-alone urgent care centers annually, in the US. However, the results obtained could only provide information on things such as the industry market report on diagnostic and medical laboratories industry in the US.
Secondly, we went on to search through the websites and records of authoritative and regulatory agencies such as UC Health, MedLine, and the American Clinical Laboratory Association (ACLA). Unfortunately, this attempt only yielded results such as this report on retail clinics and urgent care centers, and was unable to yield any information on the required number of lab tests carried out by retail and standalone urgent care centers, nor could it yield any insight that we could leverage for better results.
Furthermore, we consulted news media such as US News, academic healthcare publications such as those from DovePress and Mayo Clinic for any insight that we could use to calculate an estimate for the required number but this attempt could only yield results such as the Compound Annual Growth Rate (CAGR) of retail clinics from 2011 through 2018, which did not provide adequate data for an estimation of the required answer.
Upon the prevailing unavailability of data regarding the number of lab tests that retail and urgent care centers in the US perform annually, we expanded the scope of the research to include sources and publications that were published earlier than 2017. Doing so, we found that as of 2013, freestanding/standalone Urgent Care Centers (UCC) accounted for 32% of all UCCs in the US, and on average, urgent care centers in the US receive 160 million visits per year. Also, we found that according to a 2016 study, 35% of medical encounters/visits result in the performance of at least 1 lab test. By using these findings and making some assumptions, we were able to estimate the number of lab tests conducted by retail care and standalone urgent care centers annually, as shown under.

CALCULATIONS AND ASSUMPTIONS

Number of annual visitors to retail clinics = 25 million. Number of annual visitors to retail clinics = 160 million, and 32% of all UCCs are freestanding/standalone. We assumed that the percentage shares of the different types of UCCs are proportional to the number of visitors they receive, that is, the number of annual visitors received by freestanding/standalone UCCs = 32% of the total annual UCC visits in the US. That is, freestanding/standalone UCCs receive 32% of 160 million visitors = 0.32 * 160 million = 51.2 million.
The total number of annual visitors received by both retail care centers and freestanding/standalone UCCs = 25 million + 51.2 million = 76.2 million. However, 35% of medical encounters/visits result in the performance of at least 1 lab test. Therefore, the annual number of lab tests performed by both retail care centers and freestanding/standalone UCCs = 35% of 76.2 million = 0.35 * 76.2 million = 26.67 million lab tests.
Part
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Part
14

Statement Volume - Urgent Care 1

Retail and stand-alone urgent care centers handle around 89 million visits per year, and information on the average number of bills/statements sent per visit was not publicly available.

VISITS PER YEAR

• Retail and stand-alone urgent care centers in the United States handle around 89 million visits per year.

NUMBER OF BILLS/STATEMENTS PER VISIT

• Information on the average number of bills/statements sent per visit from retail and stand-alone urgent care centers in the United States was not publicly available. Details on the billing process are provided to help understand this case.
• The billing process depends on the preference of the patient and different circumstances. There are many options, such as direct payment, insurance co-pay, insurance deductible, Urgent care visits during work, etc.
• The billing may also differ when it comes to office hour visits and visits outside office hours. If the patient chooses to pay the full amount, probably around one bill will be issued.
• If the patient chooses an installment method or any insurance method mentioned above, more than one bill will be issued based on the payment preference. Therefore, it is not possible to make a reasonable estimate.
• The average cost per visit to Retail and stand-alone urgent care centers range from \$100 — 150.

RESEARCH STRATEGY

We started our search for the average number of bills/statements sent per visit from urgent care centers on government sites, health organizations, and media sites such as the CDC, NIH, and The Washington Post, as these types of resources often publish statistics related to health care. Even though these sources had information and statistics on the number of visits per year, average cost on visits, they did not contain details on the average number of bills that were sent per visit.

Our next strategy was to search for data on the total number of bills issued from urgent care centers per year in the United States. Since information on the total number of visits per year was available, we aimed to estimate the average number of bills with this information. To find this data, we looked at healthcare websites such as MedData, and Healthdata, and we were able to find information on the general costs related to medical centers, Overall statistics such as the number of urgent care centers, etc. But there was no data on the number of bills that are sent from doctor's offices each year.

Our final strategy was to look for data on how the billing process works for a visit to an urgent care center. We hoped that if we could understand how the process works, it may provide some insight into the number of bills per visit. We were able to find a detailed description of the billing process, which we have described above. However, these findings were not enough to make a reasonable triangulations on the number of medical bills sent per year. Further, details on the data we found, and how we attempted to use it to estimate the answer, are provided in the key findings above.

We concluded that the data on the average number of bills sent per visit is not publicly available and can't be estimated. This is likely because each urgent care center and insurer has their own policies regarding billing, so it is not possible to determine an average.

Part
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Part
15

Statement Volume - Dialysis 2

After an exhaustive search, it appears that there is not sufficient information available in the public domain to determine the number of lab tests conducted by kidney dialysis centers annually in the United States.

Useful Findings

• The prevalence of chronic kidney disease within the U.S. general population is around 14%.
• Over 661,000 people in the United States have kidney failure. Out of this figure, about 468,000 people are on dialysis, while 193,000 currently live with an operational kidney transplant.
• In the United States, one in two of those living with severely reduced kidney function and do not receive dialysis are unaware that they suffer from chronic kidney disease.
• Around one in seven adults in the United States live with chronic kidney disease.
• According to Centers for Disease Control and Prevention, "1 of 2 adults aged 30-64 is expected to develop chronic kidney disease in his or her lifetime."
• The American Society of Nephrology claims that there are more than 3 million patients suffering from chronic kidney disease.
• According to First Research, the combined revenue generated by centers in the U.S. kidney dialysis industry amounts to \$23 billion annually. The industry has about 7,500 centers in the country.
• Around 500,000 people in the nation attain treatment for ESRD (end-stage renal disease) in dialysis centers.
• In 2019, the U.S. dialysis centers industry is projected to generate \$26 billion in revenue. The industry employs an estimated 140,787 individuals and includes about 12,369 businesses.

Data for Others years

• In 2016, about 6,871 dialysis facilities were situated in the United States. That year, a reported 493,550 patients were given dialysis.
• In 2017, around 30 million individuals in the Unted States, or roughly 15% of its adult population, were estimated to suffer from chronic kidney disease.

Research Strategy:

Our research began by combing through statistical databases, including Statista, to find data to help us determine the number of lab tests conducted by kidney dialysis centers in the United States. We found statistics showing the leading dialysis providers in the country as of 2018, by number of patients, but this was not useful for this request. We tried using statistical databases in the United States containing data related to kidney dialysis centers and came across the CDC, which did not provide relevant information. The CDC offered data on the point prevalent counts of dialysis facilities and patients treated by dialysis in the United States. The Medicare website also did not contain relevant data, instead providing a list of kidney dialysis centers in the United States, which was not helpful to us.
Nevertheless, we unearthed the number of businesses within the dialysis centers industry in the United States. Conducting further research for the average number of tests performed by a laboratory in the country, we attempted to employ a triangulation approach, which led us to the University Kidney Research Organization. Here, we searched for existing data to assist us in triangulating an answer, but there was no useful data available, as the source contained kidney disease statistics with no relationship to the specified topic.
We then explored global organizations and publications to locate information on the number of lab tests conducted by kidney dialysis centers annually in the United States, but we could not find suitable data. Instead, we found a publication from the National Institutes of Diabetes and Digestive and Kidney Disease addressing the number of Americans with kidney failures, which would be unhelpful in triangulating an answer.
Afterward, we narrowed our research by looking for the total number of kidney dialysis experts in the United States, and from there, we could search for the number of lab test performed by each individual kidney dialysis expert to triangulate an answer. We were able to find data on the employment size in the kidney dialysis industry, but the information did not clearly state if they were only dialysis experts. Hence, we could not use the reports for an analysis.
Finally, we expanded the time frame to see if we could find any useful details, including past data, regarding the number of lab tests conducted by kidney dialysis centers annually in the United States, or related data and projections to help us calculate an answer. However, there was no data available that could assist us in computing the required data. Instead, we found information on the point prevalent counts of dialysis facilities and patients treated, by year, along with a fact sheet on chronic kidney disease nationally. There was no specific data to depend on for analysis.

Due to the lack of available information, we were unable to provide the number of lab test conducted by kidney dialysis centers annually.
Part
16
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Part
16

Statement Volume - Dialysis 1

There are between 1,500,000 and 2,250,000 annual patients visits in the United States annually. These patients receive a bill per dialysis session per visit.

ANNUAL PATIENT VISITS

• Patients with kidney failure must receive dialysis treatments three times a week to survive.
• Dialysis treatment is not optional, without it, they will die.
• Over 500,000 patients had received dialysis treatment in 2016. More than 240 people on dialysis die every day.
• This number will keep increasing as the number of patients in the United States diagnosed with end-stage renal disease, which affects almost 750,000 people per year, is increasing by 5% year-on-year. Patients will have to be on dialysis treatment until they find a kidney donor for transplantation.
• From the above findings, the number of annual patients visits would be between 1,500,000 and 2,250,000 per year.

AVERAGE BILLS PER VISIT

• DaVita Inc and Fresenius Medical Care AG are the two big players in the United States. Together, they operate more than five thousand dialysis clinics and controls 70% of the market.
• Patients are billed per dialysis session.
• As reported by a recent patient, without insurance or medicare, the bill, which consists of the dialysis treatment, medications, drugs, and administration cost, came close to \$14,000 per session.

RESEARCH STRATEGY

To get the number of annual patients visit. The research team multiply the number of patients with the number of visits needed per patient per year:
3 x 500,000 = 1,500,000 annually
3 x 750,000 = 2,250,000 annually
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Part
17

Statement Volume - Rehab 2

After an extensive search through credible sources, details about the number of lab tests conducted by rehab and therapy (physical) centers annually in the United States do not appear to be available in the public domain. However, the research team was able to gather other valuable insights as presented below, together with the team's research strategies to find the required information.

Relevant Insights on Lab Tests Conducted by Rehab and Therapy (Physical) Centers

• The number of drug screening tests conducted in the United States is around 10 million but not specific to lab tests conducted by rehab and therapy (physical) centers.
• The common test performed by drug and alcohol rehabilitation centers is urine drug test.
• The number of physical therapy rehabilitation centers in the US is 63,082.
• Around 23.5 million people in the US have drug abuse or alcohol problem and around 2.1 million people got the assistance.

• The number of licensed physical therapists in the US is 209,000.
• In FY 2017, the number of lab tests conducted in the US is 13.8 billion.

Research Strategy:

We initially scoured all the statistical reports, surveys, and articles related to rehab and therapy (physical) centers to determine the number of lab tests conducted by these centers annually across various rehab and therapy associations, media releases such as MyPTsolutions, Commission on Accreditation of Rehabilitation, MedlinePlus, Addiction Center, Healthline, etc. We hoped to find the desired statistics through these sources as they would discuss lab tests conducted by rehab and therapy centers; however, most of the information was on type of common lab tests performed for drug abusers but nothing specific to the number of lab tests conducted.

As there is no precompiled figures of the number of lab tests conducted by rehab and therapy centers, we tried looking for information on average number of tests performed per rehab and therapy center and statistics on the number of available rehab and therapy centers in the US to derive at the total number of lab tests conducted by them annually in the US. We checked this information across various business reports such as IBIS World, Euromonitor, Kessler Rehabilitation Center, Lee Health, etc. We hoped to find the desired statistics through these sources as rehabilitation centers and physical therapy centers may quote the details on the number of lab tests performed. Through this approach, we were only able to locate that there are around 63,082 physical therapy rehabilitation centers in the US and that the number of drug screening tests in the US is 10 million, but not segmented by place of lab test and no details on average number of test performed by a rehab and therapy center.

Further, we took a different approach and looked for percentage market share of lab tests conducted by rehab and therapy centers annually out of the total lab tests conducted in the US to get the number of lab tests they have conducted annually. We looked through various clinical lab test articles and surveys from sources such as CDC, Statista, Johns Hopkins Medicine, Quest Diagnostics, etc and only found that in FY 2017, the number of lab tests conducted in the US is 13.8 billion and 11% of them are conducted in physician offices but nothing specific to the percentage market share of lab tests conducted by rehab and therapy centers to calculate further.

As our last resort, we tried looking for the information on the number of physical therapists in the US and average number of time they prescribe lab tests across various physical therapists associations and journals such as APTA, NCBI, Science Direct, Market Research, etc and only found that the number of licensed physical therapists in the US is 209,000 but details on the average number of time they prescribe lab tests are not published in the public domain to calculate further. Also, we looked into details on the number of drug abusers who faced lab tests and who visited rehab and therapy centers to calculate the number of lab tests they have conducted across various drug/alcohol reports such as OHS Inc, Addiction Center, LuxuryRehab, Health Net Pulse, Cardio Brief, etc and could only locate details on the number of people with drug abuse or alcohol problem, but no other details to derive further. In the absence of this information, we pulled together other relevant insights and presented them above.
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Part
18

Statement Volume - Rehab 1

After scouring through multiple resources, it appears that information available in the public domain is not sufficient to determine the number of annual patient visits and the average number of bills/statements sent per visit from rehab and physical therapy centers. Nevertheless, the average number of weighted procedures per visit at physical therapy centers is 3.4, indicating that patients may or may not be billed per procedure.

AVERAGE NUMBER OF BILLS/STATEMENTS

• The average number of weighted procedures per visit at physical therapy centers is 3.4, suggesting that patients may or may not be billed per procedure, which is also dependent on the CPT code used by the physical therapist to compute the patient's bill.
• If these weighted procedures include both initial and re-evaluations, patients are likely to be billed for them as separate procedures (even if one bill is generated) in order to comply with the CMS tiered physical therapy evaluation and re-evaluation CPT Codes for billing.
• Patients may observe separate prices for the services/procedures due to insurance policy stipulation for them to be able to make a claim and for physical therapists to be paid.

PATIENT VISITS

• A 2011 Science Daily report showed that 63,000 out-patient visits were occurred between 2003 and 2007.

• The average number of visits per patient for rehab and physical therapy centers in 2007 was 9.6 at \$130 per visit.
• Approximately 11.7 million adults in 2011 visited a therapy center, which represented merely 9.58% of the individuals actually needing the service.
• In 2012, there were 24,342 physical therapy companies in the U.S.
• In 2016, a study examined self-referrals for patients being administered total knee arthroplasty who sought physical therapy in Medicare's 2007 – 2009 records.
• It revealed that each patient that completed self-referrals made 15.51 visits on average, while those that did not make self-referrals visited 7.19 times on average.
• Since 2019, there are 38,800 rehab and physical therapy centers in the U.S., with an annual number of receipts amounting to an average of \$886,000.
• Patients receive at least one bill per visit for initial evaluation and at least two if a re-evaluation is required.

Research Strategy:

We were unable to find the number of annual patient visits for Rehab and Therapy (physical) centers. We consulted sources such as the American Physical Therapy Association (APTA), WebPT, among others, but we were not able to gather any specific data about patient visits. However, we found some useful information about how physical therapists may provide patients with one bill for the initial evaluation but two or more for re-evaluations.

Next, we searched for the number of hospital admissions with the hope of finding a breakdown that presented or indicated information about physical therapy centers as well. We consulted sources such as CDC health reports, but there was no information for physical therapy in the breakdown. We changed our approach and searched for the total number of physical therapy referrals in sources such as PT in Motion (APTA news) with the hope of discovering the total patient visits on an annual basis. We found that there was a decline in the number of patient referrals from 2003 to 2014 for musculoskeletal-related therapy, which dropped from "94.4 per 1,000 visits, to just 42.9." Unfortunately, this was still not specific to what we needed.

Afterward, we searched for the number of out-patient/in-patient physical therapy visits, as well as billing information for these visits. We consulted sources such as CMS, APTA, Market Research, and Science Daily, but were only able to find information about the average visit per patient based on self-referral, number of rehab centers, and the annual number of receipts for services amounting to \$886,000. We also discovered that 63,000 out-patient visits occurred between 2003 and 2007. Information specific to the number of annual patient visits for Rehab and Therapy (physical) centers was unavailable. Judging from the limited information available and the date ranges, it appears that this information may not have been compiled or made accessible yet.

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Part
19

Statement Volume - ASC 2

An extensive search in the public domain reveals that information on the number of lab tests conducted by ambulatory surgery centers annually in the USA is non-existent, and media coverage on the specified topic is scarce. The most relevant media mention on the topic is: More than 7 billion medical/clinical lab tests are performed in the U.S. each year. Below are the helpful findings and detailed methodology on the topic.

RESARCH STRATEGY

During our search, we could not find the number of lab tests conducted by ambulatory surgery centers annually in the USA. We used the following strategies, trying to find this missing information.

We began our search by going through various medical-related sources such as NCBI, Med Pac, CDC Gov, AHRQ Gov, Medline Plus, among others. Here, we were hoping to find the lab tests conducted by ambulatory surgery centers monthly and/or annually because these sources usually contain information pertaining to hospitals, surgeries, medical/clinical lab tests, among other medical-related information. However, after a deep search, we could not find any relevant information regarding the number of lab tests conducted by ASCs in the United States. Most of these sources only provide information on the number of ASCs in the USA, the number of surgical procedures performed by ASCs per year, among other irrelevant information.

Next, we expanded our search to databases and bodies that compile medical journals and articles. We went through websites such as Free Medical Journals, Geneva Foundation for Medical Education and Research, Research Gate, OMICS International, American Laboratory Association, Surgery Encyclopedia, among others. Here, we looked for any research paper or article that could provide relevant information pertaining to the research criteria. In these sources, we could only find the number of medical/clinical lab tests performed in the US per year. However, we could not find information on the number of lab tests conducted by ambulatory surgery centers monthly and/or annually in the USA.

Finally, we tried a triangulation approach. Since we had already found the total number of medical/clinical lab tests conducted in the USA per year in the second strategy; We tried searching for the percentage that ASCs lab tests represent from this total number (the number of clinical/medical lab tests conducted in the USA) to help us calculate the number of lab tests conducted by ambulatory surgery centers annually in the USA. However, after an extensive search in credible sources, we could not find the percentage of ASCs lab tests to help us answer the research question. Further, we tried to use a proxy method. Here, we searched for the top five ASCs in the USA and looked for the number of the lab tests each of them has conducted monthly and/or annually. Our aim was to find the number of lab tests these centers have conducted individually, add the numbers up and divide by five, and use the final number as a proxy to answer the research criteria. However, we could not find the information relating to the number of lab tests conducted by these ASCs.

Part
20
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Part
20

Statement Volume - ASC 1

54.57 million bills are sent to ASC patients for 12.9 million visits to ambulatory surgery centers (ASCs) per year.

STATEMENT VOLUME — ASCs

• According to the National Hospital Ambulatory Medical Care Survey (NHAMCS) published in 2017 that collected and analyzed data for 1992 to 2010 regarding outpatient department and emergency department services, annual national estimates state that there is an average of 12.9 million visits to ambulatory surgery centers (ASCs) per year.
• The average number of bills sent to a patient per visit to a medical center, including hospitals and ASCs, is 4.23.
• The minimum for any visit to a medical center in the US, regardless whether it is a hospital or an outpatient department, is at least 2 bills per visit.

RESEARCH METHODOLOGY

Considering there are, on average, 12.9 million visits to ambulatory surgery centers (ASCs) per year, and there are, on average, 4.23 bills sent per visit to patients, we calculated the amount of bills sent to ASC patients per year as follows:
• 12.9 million x 4.23 = 54.57 million
• 54.57 million bills are sent to ASC patients for 12.9 million visits to ambulatory surgery centers (ASCs) per year.
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21
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Part
21

Statement Volume - Hospitals 2

Fourteen billion laboratory tests are conducted annually in the United States. However, in 1999, 5.7 billion laboratory tests were conducted annually in the U.S. Below are annual laboratory tests statistics for various years in the U.S.

U.S. ANNUAL LABORATORY TESTS STATISTICS

• CDC currently estimates that 14 billion laboratory tests are conducted in approximately 260,000 CLIA-certified laboratories, annually in the United States.
• Data from the 2014 Department of Health and Human Services' Federal Register indicates that there was a total of 12.8 billion laboratory tests that were conducted annually in the U.S. by 234,756 laboratories.
• A 2008 report by CDC's Clinical Laboratory Improvement Advisory Committee estimated that there were over 200,000 CLIA-certified (Clinical Laboratory Improvement Amendment) laboratories in the U.S. which conducted approximately 8 billion tests annually.
• According to data from Centers for Medicare and Medicaid (CMS) Online Survey, Certification, and Reporting (OSCAR) database, CDC estimates that in 2007, a total of 6.8 billion laboratory tests were conducted in the U.S. The laboratory testing market was worth \$52 billion in the same year.
• According to findings from the Healthcare Financing Administration, in 1999, there was a total of 5.7 billion laboratory tests that were conducted by 170,101 laboratories in the United States. The following is a breakdown of these tests: hospital laboratories — 52 percent (2,958.2 million), independent laboratories — 26 percent (1,514.2 million), physician office laboratories — 11 percent (656.4 million), and others — 10 percent (597.1 million).
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Part
22

Statement Volume - Hospitals 1

There were over 35 million hospital visits in 2016, with an average of 4.23 bills sent to patients per visit.

STATEMENT VOLUMES FOR HOSPITALS

• Based on the report published by the Center for Disease Control (CDC) data, 5% of the total population in the US had one or more hospital stays in 2016, which is the last surveyed year on a national level (with the study published in 2018).
• According to the same report, 2.1% of the population had 2 or more hospital stays.
• The study by the CDC reported that there were 35,061,000 hospital admissions in 2016.
• Out of that number, 877,000 were federal hospital visits, 33,260,000 were community hospital visits, with 23,886,000 visits to non-profit community hospitals.
• The average number of bills sent to a patient per visit to a hospital is 4.23, with the minimum being at least 2 bills per visit.
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Part
23

Statement Volume - Asset Managers 3

An extensive search in the public domain reveals that information on notices of annual purchases and sales of securities sent to customers either on a monthly or yearly basis by Asset Managers is non-existent, and media coverage on the specified topic is scarce. Helpful findings have been highlighted below.

USEFUL FINDINGS

• The annual purchases of equities from 1999 to 2001 was estimated to be \$142 billion in the United States.
• Private equity firms in the US invested more than \$500 billion "in the US-based companies in 2017", by the end of 2018 this investment was estimated at \$713 billion.
• In 2017, \$84 billion was invested in the United States.
• In 2016, long-term conventional assets that were under management by the US asset managers were estimated at \$51 trillion.
• In 2018, 33% of the money in the United States was in passive investments.

RESEARCH STRATEGY

We were unable to reliably determine the number of notices of annual purchases and sales of securities sent to customers either on a monthly or yearly basis by asset managers. The following strategies have been deployed in an attempt to find, calculate or triangulate this data.

We started the research by searching for pre-compiled data on the notices of annual purchases and sales of securities sent to customers either on a monthly or yearly basis by asset managers. We searched through reliable sources in the finance industry such as Forbes, Delloite, Fortune, CNBC, The Balance, The Office of Financial Research, among others. This strategy failed to give us the information we wanted, information found was mainly about investment type and volume.

Our next strategy was to search for this information on the customer part by searching for the number of notices they receive from their asset managers. We searched through news articles and research reports sites such as Market Insights, Mordor Intelligence, PRNews, and Business Insider. We hoped to find the number of notices on annual purchases and sales of securities, customers receive. This strategy was unsuccessful because we could not find relevant information on the subject, most of these sites had data on the amount of investments.

We then tried to look for this information on asset managers' sites. We searched through annual reports, official websites, and FAQs. We hoped to find any data on notices they send to customers and use this data to find the number of notices of annual purchases and sales of securities send to customers in a month/year. This strategy was also fruitless because we could not find information relevant to the subject, the information available was mainly on services offered.

Our next approach was to try to triangulate this data by searching for the average number of annual purchases, and the number of sales of securities done in a year/ month. We hoped to use this data to triangulate the number of notices sent to customers. This strategy was not successful because we were not able to find enough data for triangulation. After all our efforts, we concluded that the information about notices of annual purchases and sales of securities is not publicly available.
Part
24
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Part
24

Statement Volume - Asset Managers 2

Due to lack of available data, the number of annual shareholder proxy statements and annual reports sent to customers by Asset Managers couldn't be determined. Still, relevant shareholder insights have been gathered for some of the biggest asset management companies. Below, research strategies deployed in an attempt to obtain the requested information have been outlined.

RESEARCH STRATEGY

The research team was unable to determine the number of annual proxy statements and reports sent to shareholders by asset management companies, even after applying the following exhaustive research strategies:

To start the search, we directly searched for pre-compiled information on this topic. Sources we scanned include Motley Fool, Guru Focus, CNBC, among others. This approach was taken because these publications provide commentary on companies that are in the stock market, and therefore they are likely to discuss an asset management company that is on the stock market (e.g. BlackRock), and might compare the number of shareholder proxies and annual reports a particular company has sent with the total amount sent in the industry. Press releases and reports from the U.S. Securities and Exchange Commission were also scanned with intent to locate relevant information, since the governmental entity might know this information and disclose it publicly.
Information specifically surrounding annual reports and shareholder proxies sent by the companies in the asset management space was scarce. Even though extensive reports surrounding particular companies in the field existed, the reports focused on information such as company acquirements and mergers, rather than company statements.

Our next plan was to locate the following data points: [1] the number of shareholder proxies and annual reports sent to stakeholders by companies in the financial industry in general, and [2] the amount of the financial services industry asset management companies take up. The idea was to assume that the proportion of annual reports sent by companies in the asset management industry compared to companies in the financial services industry overall equals the market share of asset management within the financial services industry in general. This strategy produced no results because no information was available on the number of annual reports sent by companies in the financial industry in general. Available information described the best practices and strategies specific companies in the financial industry apply when it comes to proxy announcements, rather than specific data.

Finally, we resorted to manually searching press releases and annual reports of the biggest asset management companies. Our assumption was that, since the biggest companies in the field take up the majority of the market, it would make sense to present the total number of shareholder proxies and annual reports sent by the biggest companies as a rough estimate of the number of proxies and reports sent to shareholders by asset managers in the US.
We used this list to identify the biggest US asset management companies. Then, we examined their annual and operational reports, as well as press releases from the year 2018. Apart from this, we examined interviews with CEO's from each of the companies, but determined these are mostly focused on company promotions, rather than information on number of company shareholders or the number of proxies sent. Our goal was to find statements directly from the companies regarding reports sent, or at least the number of shareholders a company has, which we could then use as a proxy for the number of annual reports sent (assuming that each shareholder receives an annual report).
Ultimately, this strategy didn't succeed in providing desired results, as information on the number of proxies sent or the number of shareholders was not available in company press releases, annual reports and CEO interviews. Instead, for some companies, information on number of shareholders was available. Still, this wasn't enough to determine the number of annual reports sent, because for several companies, including some of the biggest in the field of asset management, there was no information on the number of shareholders. The available shareholder information has been provided as helpful findings.
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25
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Part
25

Statement Volume - Asset Managers 1

5,765,295 US trust accounts were active in December 2018, according to the FDIC. Below, helpful findings have been highlighted, followed by an explanation of why the requested information couldn't be determined.

RESEARCH STRATEGY

The research team was unable to reliably determine the number of unique asset management accounts per year or month. The following strategies have been deployed in an attempt to find, calculate or triangulate this data.

To start the search, we searched directly for pre-compiled data on this topic. Sources searched include reliable industry-specific sources such as CNBC, Fortune, The Balance, The Office of Financial Research, among others. The Federal Deposit Insurance Corporation was also searched in hope of locating relevant information, since all US asset management companies report the number of their accounts using the "Schedule RC-T" form. Thus, the government entity likely knows this information and might have disclosed it publicly. This way, a list providing data on number of asset management accounts per each asset management type was found. This list, however, couldn't be used to reliably answer the query because it exclusively addressed trust services.
Next, we took a triangulation approach to answer the query. We searched for information on the following two data points: [1] the average number of accounts per asset management company and [2] the number of asset management companies in the US. Since we had already found relevant data on trust companies, we focused on finding this information specifically on brokers and custodian asset managers, but we struggled to find information on both the data points, which is why this strategy has failed. The available information was irrelevant and focused on trends in the asset management space, along with analyses of specific companies.

We then decided to focus our search specifically on asset management customers. In order to triangulate an answer to the query, we searched for the following data points: [1] the average number of asset management accounts per US person and [2] the population of the US. We have also searched for [1] the number of people in the US who use asset management services and [2] the average number of asset management accounts per an individual who uses asset management services, specifically. We weren't able to move forward with this triangulation because information on the number of people in the US who use asset management services, the average number of asset management accounts per an individual who uses asset management services and the average number of asset management accounts per a US person were not available in the public domain. Instead, available information focused on irrelevant things such as asset management market sizes in US dollars and future predictions.

In an attempt to calculate the number of unique accounts asset managers have, we searched for a comprehensive list of asset management companies in the US to search each of their operational reports to find the number of accounts held by each company yearly, to add together to get the total number of accounts. This calculation attempt has failed because no comprehensive lists of companies in the asset management business were found. Instead, only the biggest asset management companies were listed on the public domain. After looking through their annual reports, it was evident that most of them didn't provide information specifically on the number of accounts they have and most of them didn't provide account information pertaining to the US, which is why the answer couldn't be reliably estimated using data from the biggest players in the field. Still, we provided available account data for some companies as helpful findings.

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Statement Volume - Insurance 3

In 2018, an estimated 600 billion claims were sent by insurance agencies (excluding health insurance but including life, car and home insurance) in the UnitedStates. An average of 1.1 bills/statements per claim (estimated) are sent by insurance agencies excluding health agencies.

Annual Number of Insurance agencies Claims

• The total of 70 million homes were insured in the U. S in the year 2017.
• According to ISO, in 2017, 6 percent of insured homes had a claim.
• We multiplied the total number of insured homes to the percentage of insured homes with claim to find the total of homeowners Insurance Claims (70,000,000 * .06 = 4,200,000)
• The total number of cars Insured in the US in 2016 was 202.68 million.
• The total Losses on Claims is \$173,258,486 and average Loss on Claims is \$438. Therefore, to calculate the number of Claims on car insured, we divided the total loss on claims to the average loss on claims (173,258,486/438 = 395,567).
• Life Insurance Claims about 52% of 1.2 trillion (600 billion) and approximately 59% of Americans have life insurance.
• Therefore, the total number of claims that insurance agencies (excluding health insurance) send yearly is the summation of life, car and home insurance (4200000+395567+ 600,000,000,000= 600004595567).
• In 2017, about 2,813,503 Americans died. Assuming 59% of those deaths were insured (2,813,503 * .59 = 1,659,967 insured deaths

Average Number of Bills/Statements Sent Per life, car and home Insurance Claim

• To calculate the average number of bills/statement, we first needed to find the average life, car and home insurance per person in the U.S., which is \$2,150, \$1,502 and \$1,083 (\$4735)respectively
• Next, we needed to calculate the average number of life, car and home insurance claims per person in the U.S. To do so, we divided the previously calculated number of U.S. life, car and home insurance claims in 2017 (600 billion (estimated)) and divided that by the number of people with life, car and home insurance in the U.S. which is 3090, 279 and 857 (4221) respectively
• To calculate the average number of bills/statement sent per claim, we divided the average life, car and home insurance per person in the U.S. (\$4735) by 4221) (estimated, average number of 1.1 insurance claims per person)
• Accordingly, an average of 1.1 bills/statements per claim (estimated) are sent by insurance agencies excluding health agencies.

Research strategy

We began our research by looking for articles about the number of claims insurance agencies (excluding health insurance)send either on a monthly or yearly basis in the U.S. Not one article directly provided that information, and we reviewed many articles published by reputable sources such as statista, ISO among others, when researching for that information. Those sources did, however, provide related data points, which we logged throughout our research.
For our second research method, we reviewed several credible reports about life, cars and home insurance claims market in general. We thought that perhaps the data requested might have been included therein. While there was a lot of data packed into those reports, the exact data we were looking for wasn't directly stated. Just like with the articles, there were some related insights we found from the report sources that we reviewed, which we also noted.
As a third research method, we turned our efforts to determining the requested data points through triangulated calculations, since the available data alone didn't directly provide the information we were looking for. The data we used for those triangulated calculations came from a combination of reputable sources, which included statista, ISO and many more. All the data we used in our triangulated calculations is specific to the U.S. only.

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Statement Volume - Insurance 2

The research team could not find data in the public domain to determine the average or the approximate number of marketing offers that insurance agencies (excluding health insurance) send either on a monthly or yearly basis in the US. We have, however, provided some useful insights below.

• Insurance companies adapt to marketing automation, which is the most useful and effective method to keep in touch with existing clients via mails and promoting personalized and customized offers.
• The more an insurance company spends on marketing, the bigger its return will be and the greater will be the chance for revenue growth.
• According to a survey by Velocify, insurance companies that spent more than 15% of their total revenues on marketing were much more likely to experience significant growth.
E-MAIL MARKETING- THE MOST EFFECTIVE
USEFUL STATISTICS OF THE COMPANY

RESEARCH STRATEGY

There is no data in the public domain to determine the average or the approximate number of marketing offers that insurance agencies (excluding health insurance) in the US send either on a monthly or yearly basis. The unavailability of data may be due to the fact that this industry is wide with various types of insurance policies and various channels such as agents, brokers, or direct sales.

The research team started by scouring through various research platforms, industry reports, credible media/press releases or articles by insurance as well as marketing agencies. IBISWorld, Deloitte, Leadsurance, among others. There is no pre-compiled data or studies conducted relevant to marketing offers by insurance agencies.
However, it was evident that most of the insurance companies use automation marketing tactics, and e-mail is the most popular marketing technique used in modern-day to connect with clients.

The assumption was made that every marketing offers sent by insurance agencies uses e-mail as one of the combined modes or the only mode of marketing technique with more supporting sources. Next, the research was directed to determine the average number of e-mails sent by an agent/company for marketing purpose in the US. We intended to multiply the number of insurance agents in the US with the average number of marketing e-mails sent by a particular agent per month or year. Research websites and surveys were explored, but this strategy was not fruitful as most closely relevant data which could be found were on the number of e-mails sent by companies. This number could not be utilized as it does not specify the type of mail, whether marketing e-mails or updates on general communication.

Finally, we tried to identify the key players in the agents/brokers industry of insurance by using the number of marketing offers sent by one of these key players as a proxy and then multiplying this number by the total number of agencies in the US. The key players are identified as Marsh & McLennan Companies Inc., Aon Corporation, Willis Towers Watson and Arthur J. Gallagher & Co., but the number of marketing offers sent could not be determined by any of these agencies. Their official websites, annual reports, press releases were all used in this strategy.
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Statement Volume - Insurance 1

The total number of insurance policies in the US reached 659 million at the end of 2018.

LIFE INSURANCE
LONG-TERM DISABILITY COVERAGE
• There are 8.1 million disability policies in the United States.
• Long term care insurance is more popular with individuals that are over 55 years old.
• 69% of people over 65 have long-term care insurance.
HOMEOWNERS INSURACE
• There are 79 million owned homes in the United States.
• Of these, 95% have homeowners insurance. As such, we were able to calculate that there are 75 million home insurance policies in the United States as of the end of 2018.
RENTERS INSURANCE
• 43 million household units in the United States are rented.
• Of these, only 40% have renters insurance. As such, we were able to calculate that there are 17.2 million renters insurance policies in the United States.
AUTO INSURANCE
IDENTITY THEFT PROTECTION
• The top writers of heath insurance policies by amount of premiums written within the United States are Chubb, American International Group, XL Group, Travelers Companies, AXIS, Beazley Insurance, CNA Financial, BCS Financial, Liberty Mutual, and Zurich Insurnace Group.
• These companies account for 69% of all the identity theft protection policies within the Unted States.
• 3 million identity theft claims were processed in 2018.

Research Strategy:

We began our research to determine the number of unique policies that insurance agencies write on a monthly or a yearly basis by reviewing trusted sources such as SEC filings and trusted industry reports. We were able to identify that the most common types of insurance available in the United States are life insurance, long term disability coverage, homeowners insurance, renters insurance, and identity theft protection. In order to determine the total amount of policies that insurance agencies write per year, we added the number of active policies for each type of insurance.

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Statement Volume - Credit Reporting 3

After an extensive search through credible sources, details about the average or the approximate number of credit inquiry notice that credit reporting agencies send either on a monthly or yearly basis do not appear to be available in the public domain or cannot be triangulated accurately using the available data. However, the research team was able to gather other valuable insights about the subject. Details have been presented below, together with the team's research strategies to find the required information.

• Under the Fair Credit Reporting Act, consumers have the right to receive notification if any financial institution submits, or plans to submit, negative information to a credit reporting agency. They also have the right to know when their credit report is being used for any denials.
• Consumers must receive notice when their credit is denied, known as an “adverse action” notice or when credit is granted, but under less favorable conditions, known as a “risk-based pricing” notice. Both circumstances require the consumer to be informed about the credit reporting agency used and the right of a free copy of their report.
• The National Foundation for Credit Counseling or NFCC reported that 44% of adults have not received their credit score for the last 12 months, as of March 2016.
• As of 2018, Americans are applying for fewer credit lines overall. According to the FICO report, the percentage of the population with one or more hard inquiries hit a four-year low of 42.2% in April compared with 43.7% in April 2014.
• Credit scores: The U.S. population in 2016 was 323 million people, out of those, 77% or 249 million were 18 and over (or adults), therefore, there were 139 million free credit reports emitted in 2016.
• Hard inquiries: The adult population in the United States was 253 million people as of 2018. Out of which, 42.2% had one or more hard inquiries, accounting for at least 106 million hard inquiries.
• In 2003, Colorado credit report agencies sent 2.6 million negative information notices to consumers.

Research Strategy:

We were not able to find the number of credit inquiry notices that credit reporting agencies send monthly or yearly. The following strategies were used in our search for this information:

We began our search by looking for publicly available reports that would indicate how many of the said notices these agencies are sending each year/month. We searched for this information in reputable financial sites, such as the Business Insider, Financial Times, and Forbes, among others; and sites related to the subject like the National Foundation for Credit Counseling and the Federal Trade Commission. We located the regulations pertaining to credit inquiries, as well as the different types of inquiries (which was later used for a more narrow approach), and other interesting, but not relevant information.

Next, we expected that the main credit reporting agencies could provide more information about the topic, so we performed extensive research on the annual reports, official websites, FAQs, as well as looking into third-party information from Equifax, Experian and TransUnion, hoping the agencies would provide how many of those notices they send or at least any number that would provide enough grounds for triangulation. The numbers were not available, but by examining their FAQs, we discovered that credit agencies are mostly reactive organizations, meaning, they usually only provide information when requested. Regarding inquiries, the three agencies guided the consumers to check their credit reports to discover inquiries being made and in no point mentioned any type of notice for this sort of information. We went back to the sources about regulations previously found and in fact, lenders, or other parties requesting inquiries, are the ones obliged to notify consumers and get their agreements (for hard inquiries). Under the Fair Credit Reporting Act, the lender must request the agreement for hard inquiries from the consumer and then send the consumer the final result of the inquiry, including the agency used. The consumer may then get in touch with the agency and request the credit report used for the inquiry and dispute, if necessary. The same goes for inquiries made by employers, with the exception that employers may arrange to have the CRA provide pre-adverse action notices directly to consumers, but the employer is still liable if the agency fails to do so. It is important to notice that the information presented here is regarding federal laws. Inquiries can be found in credit reports, which consumers have the right to request, every 12 months, for free.

Still hoping to provide some answers, we shifted our focus to consumers by looking for how many are receiving such notices and with what frequency. We scoured through several news articles and reports, hoping to find a breakdown of the type of credit notices consumers receive and who is sending those, expecting to at least find what notices the agencies are sending. The only information we found with this approach was an estimation of how many consumers are asking for their credit reports, which we triangulated to discover how many credit reports were issued in the U.S. in 2016.

Next, we divided our research into the type of inquiry, with the information we found from previous sources, in soft and hard inquiries. Here, we found the number of Americans who had at least one hard inquiry in 2018, which we triangulate to discover the minimum number of hard inquiries made in the US in 2018.

Finally, we completely broadened our research to include any type of notice sent by CRAs and expanded the age scope, hoping to at least provide the total amount of notices sent by the said agencies. By removing the date scope standard of 2 years, we found a book saying that over a typical one-year period in Colorado, CRAs on average sent 2.6 million negative information notices to consumers. The date of the information, plus differences in population, state financial conditions, and consumer behavior after the last financial crisis would make a triangulation using that number possibly too inaccurate to include in our official findings. But we can look into it here: The population of Colorado in 2003 was 4.59 million, with 2.6 million notices sent, that would mean that, approximately, for every citizen in Colorado, 0.5 notices were sent, or one notice for every 2 citizens (we ignored for both calculations the number of people receiving more than one notice, as the proportion population/notice was the focus). If we applied the same proportion to the entire population of the United States in 2003, which is 290 million, that would lead us to roughly 145 million negative information notices in 2003. Applying to the current population of 327 million would mean 163 million negative notices. But again, this number is hardly accurate and it is based on a possible proportion from 2003. We tried to discover more recent information for other states, such as California, New York, Florida, Colorado, and Texas, but it was not publicly available.

After all our efforts, we concluded that the information about notices sent is not publicly available, but some estimates that might provide some clarity into the subject are. In 2016, there were 139 million credit reports issued (56% of 249 million), and in 2018, at least 108 million hard inquiries were made (42.2% of 253 million).
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Statement Volume - Credit Reporting 2

After an extensive search through credible sources, details about the average or the approximate number of marketing offers that credit reporting agencies send either on a monthly or yearly basis do not appear to be available in the public domain or cannot be triangulated accurately using the available data. Details of some valuable insights on the subject have been presented below.

USEFUL FINDINGS

• The estimated number of credit reports released by credit bureaus is 3 billion annually.
• The updates made to consumer files by credit bureaus are more than 36 billion from an estimate of 18,000 sources.
• The estimated average FICO credit score in the United States is 704.
• The three main credit reporting agencies, Experian, Equifax, and TransUnion maintains files on at least 200,000,000 Americans.
• About 38.1% of Americans have a "639 or lower credit score".
• The Fair and Accurate Credit Transactions Act (FACTA) permits individuals to be furnished with free credit reports from the three major bureaus at least once per year.

RESEARCH STRATEGY

We were not able to find the number of marketing offers that credit reporting agencies send monthly or yearly. The following strategies were used in our search for this information:
We commenced the search by searching through reputable financial sites, such as the Financial Times, MarketWatch, Forbes, among others. We hoped to find precompiled information on marketing offers that credit reporting agencies send either on a monthly or yearly basis. Although we were able to locate major credit reporting agencies and the number of consumers, we were unable to find relevant information using this strategy.
Our next strategy was to try to find the number of marketing offers received by consumers from credit reporting agencies. We searched through news articles and research reports sites such as Market Insights, PRNews, and Business Insider. This strategy was unsuccessful because we could not find relevant information on the subject, most of these sites had data on credit scores.
Our next approach was to look for this information on sites of bodies that regulate credit. We searched through sites such as the National Foundation for Credit Counseling and the Federal Trade Commission. We hoped to find any useful insights on marketing offers that credit reporting agencies send. This strategy was also fruitless because we could not find information relevant to the subject, the information available was mainly on credit scores and credit cards.
Our next approach was to perform an extensive search on annual reports, official websites, FAQs, as well as looking into third-party information from Equifax, Experian, and TransUnion. We expected that the main credit reporting agencies could provide more information about the topic. We hoped that the agencies would provide the number of marketing offers they send and that these would provide enough grounds for triangulation. This strategy failed because the numbers were not available. After all our efforts, we concluded that the information about marketing offers sent is not publicly available.

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Statement Volume - Credit Reporting 1

Credit Reporting Agencies have approximately 200 million personal accounts for consumers in the US and about 18,000 lender accounts.

Overview

• Credit Reporting Agencies (CRA's) collect personal and financial data from organizations about people; create accounts for entities (individuals or small companies), and then sell the information back to lenders along with a credit score so that lenders can assess risk.
• There are three major credit agencies in the United States: Equifax, Experian, and TransUnion.
• Most of the data gathered for this report came from the 2010 census, which was the last year this information was collected.
• The Consumer Financial Protection Bureau (CFPB) combined data from the 2010 census and some further data gathering on their part to produce some information shown below.

Consumer Accounts

• Equifax, Experian, and TransUnion retain information on more than 200 million Americans.
• "Approximately 19 million people, or 8.3 percent of the adult population, had "unscorable" credit records."
• In 2011, consumers reached out to the credit reporting companies roughly 8 million times, resulting in disputes of 32 to 38 million items in their credit files.

Lending Company Accounts

• Every year, credit bureaus collectively make over 36 billion updates to consumer files using data from about 18,000 sources.

Source of Information

• The percentage and the total number of sources in each category are shown below.
• General Credit Cards lenders provide 40% of 18,000, which equals 7,200 general credit card sources.
• Retail Credit Cards lenders provide 18% of 18,000, which equals 3,240 retail credit card sources.
• Auto Lenders provide 4% of 18,000, which equals 720 Auto Lenders sources.
• Mortgage Lenders provide 7% of 18,000, which equals 1,260 mortgage lender sources.
• Other lenders provide 31% of 18,000, which equals 5,580 other lender sources.
• Most information contained in credit files comes from a few large banks and other financial institutions.
• "The top 10 data furnishers provide 57 percent of the trade lines coming into the credit reporting companies. The top 50 data furnishers provide 72 percent. The top 100 data furnishers provide 76 percent." That translates to .005% of the information comes from 76 percent of the sources.

Calculations

BREAKDOWN OF LENDERS BY TYPE
• 40% x 18,000 = 7,200 general credit card lenders
• 18% x 18,000 = 3,240 retail credit card lenders
• 4% x 18,000 = 720 auto loan lenders
• 7% x 18,000 = 1,260 mortgage lenders
• 31% x 18,000 = 5,580 other sources of information.

PERCENTAGE OF INFORMATION FROM SOURCES
• 100 top sources / 18,000 = .005% of sources

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Statement Volume - Credit Cards 3

After an exhaustive search, information on the average number of annual leveraged purchase notices that credit card providers send either on a monthly or yearly basis is not available and could not be estimated. However, in the course of this research, the research team gathered useful information which has been provided below.

USEFUL FINDINGS

• The American Banking Association reported that there were 364 million open credit card accounts in the U.S. as of the end of 2017.
• The total number of credit card transactions in the U.S. was 40.8 billion in 2017. Therefore, the average annual number of transactions per credit card in the U.S. was 40.8 billion/364 million = 112 in 2017.
• On average, U.S. smartphone users receive 46 app push notifications per day.
• The cut-off point for push notifications in the banking, financial services, and insurance (BFSI) is 5. That is to say that BFSI can get away with five push notifications before faced with a sharp increase in unsubscribes.
• In 2017, nearly 4 in 10 consumers in the U.S. say they have received alerts from banks that falsely flagged legitimate purchases. 31% of U.S. adults reported getting a fraud alert about a credit card transaction in the same year.
• In 2017, 87% of banks use alerts and notifications for fraud, deposits made, and low balances.
• While over 35% of mobile bankers in the U.S. check their banking app once a day or more, 84% check it just once a week or more.
• Between 2018 – 2019, 56% of respondents used mobile banking primarily to receive an alert.
• As of 2015, 9 of the top 20 financial institutions in the U.S. were already using push notifications. However, only 14% of consumers were getting push notifications from a financial institution.

Research Strategy

To determine the average number of annual leveraged purchase notices that credit card providers send either on a monthly or yearly basis, your research team commenced with a thorough search for publications and articles from credit card issuer companies. We adopted this approach hoping to find pre-compiled data released by such companies but no relevant data was available. Next, we searched for reports published by the regulating authorities active in the domain of credit card transactions or banking hoping to determine if these authorities had set any regulation on the types of notices that the credit card companies could send. While there was some information relating to the number of transactions that banking authorities could provide within a certain amount of fees, there was no specific information on the annual leveraged purchase notices sent by credit card providers.

Furthermore, we searched for relevant data on reputable statistical databases, publications by experts in the financial industries, and credible blog sites relevant to the financial technology industry. We hope to find relevant data from research reports and articles published by experts in this industry. Although there was information available on push notifications sent by banking institutions, as well as fraud alerts sent by credit card providers, information about annual leveraged purchase notices that credit card providers send either on a monthly or yearly basis could not be found. After exhaustive research, we concluded that data on the average number of annual leveraged purchase notices that credit card providers send is largely unavailable. Where such an analysis has been conducted by any financial or independent organization, they have not made such data available to the public domain.
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Statement Volume - Credit Cards 2

It is estimated that 3.994 million direct mail credit card offers and 3.994 million digital credit card offers were sent in 2018, for a total number of credit card offers/marketing offers of 7.988 billion.

DIRECT MAIL CREDIT CARD OFFERS

• Mintel Comperemedia estimated the number of direct mail credit card offers sent in the U.S. was 295 million in June 2018, 295 million in July 2018, 343 million in August 2018, 316 million in September 2018, 354 million in October 2018, and 391 million in November 2018.
• The total estimated offers sent for the 6-month period from June to November 2018 was 1,997 million (calculation below). This can also be represented as 1.997 billion.
• If an assumption is made that the pieces of direct mail were the same for the other 6 months of 2018, then the total direct mail credit card offers sent in the U.S. in 2018 can be estimated to be 3.994 billion (calculation below).
• In 2015-2016, the number of direct mail credit offers peaked at about 7.5 billion. The number was about 3.6 billion in 2017.

DIGITAL CREDIT CARD OFFERS

• In 2018, about 50% of credit card offers were made digitally. That means if there were about 3.994 billion (estimated) direct mail offers in 2018, there were also about 3.994 billion (estimated) digital offers.

TOTAL CREDIT CARD OFFERS

• If there were an estimated 3.994 billion (estimated) direct mail credit card offers and 3.994 billion (estimated) digital credit card offers made in 2018, there were approximately 7.988 billion (calculation below) total credit card offers sent in 2018.

RESEARCH STRATEGY

Although data on the number of credit care offers/marketing pieces was readily available, the data for 2018 was not presented on an annual basis. Therefore, some calculations were necessary to present the data in the desired format.

The total number of direct mail offers sent from June to November 2018 was calculated by adding the offers for each of the 6 months:

To estimate the total number of direct mail pieces for 2018, the number of offers for the 6-month period from June to November 2018 was doubled:
1.997 billion *2=3.994 billion

To estimate the total credit card offers sent in 2018, we added the number of digital offers to the number of direct mail offers:
3.994 billion+3.994 billion=7.988 billion
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Statement Volume - Credit Cards 1

In 2018, there were 479 million credit card accounts and at the end of quarter 2 of 2019, there are 486 million credit card accounts.

UNIQUE CREDIT CARD ACCOUNTS

• In 2017, there were \$469 million credit card accounts.
• In 2018, there were \$479 million credit card accounts.
• At the end of quarter 2 of 2019, there are \$486 million credit card accounts.
• The number of unique credit card accounts has been steadily increasing between 2017 and 2019, and it is projected to reach \$500 million.

YOUR RESEARCH TEAM APPLIED THE FOLLOWING STRATEGY

We began our research for the stated volume of credit card, as well as the average or approximate number of unique accounts that credit card providers have monthly/annually, by reviewing credible sources, such as NASDAQ and other government sources, qualified articles written by experts and also news sources. We backed up the data with the government publishing from the federal reserve which shows the active credit card accounts in the United States from 2003 to 2019.
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Statement Volume - Specialty Lenders 3

Specialty lending is any financing activity that takes place outside the traditional banking system by non-bank lenders and targets commercial and consumer borrowers that are not adequately served by traditional banking channels due to their poor credit score or low documentation.

US Specialty Auto Lending

• As per the data from the New York Fed’s latest Quarterly Report on Household Debt and Credit, lenders originated \$139 billion in auto loans and leases in Q1'2019, including new and used vehicles, representing an increase of 6.3% YoY.
• The auto loans provided to consumers with credit scores below 620 (the cutoff for subprime) and mainly provided by specialty lenders, accounted for 20.1% of the total auto loans in Q1'2019, up by 18.9% from last year.
• The auto loans to borrowers in the highest credit-score category, 760 and above, accounted for 33% of auto loan and lease originations in Q1'19, almost flat from 33.3% a year ago while the loans to borrowers in the range of 620 to 659 credit-score accounted for 12.2% of the total, up from 11.5% in Q1'18.
• Serious delinquencies, defined by the New York Fed as 90 or more days late, accounted for 4.69% of the outstanding overall automotive balance in Q1'19, up from 4.26% a year ago. Thus, these loan accounts had the highest probability of notices being sent by lenders.
• Specialty lenders who are primarily PE firms have together plowed around \$3 billion into the subprime auto loan financing and about 25% of the auto loans written are subprime with new cars forming 20% of the same.
• Specialized lenders have faced constant losses in auto lending leading to numerous bankruptcy announcements over the past years. Examples include Summit Financial Corp, Spring Tree Lending, Pelican Auto Finance, etc.
• The Fitch's index of subprime auto loan Annualized Net Losses (ANL) has continued to reign close to all-time peak level of 9.8% in 2018.

US Specialty Home/Mortgage Lending

• Nearly \$34 billion of unconventional mortgages were originated by lenders in the first three quarters of 2018, a 24% increase from the same period a year earlier. Such mortgages are primarily provided to people with low credit scores and not having the standard proofs of income and are primarily catered to by specialty lenders.
• Many specialty lenders pack these unconventional mortgages into residential mortgage-backed securities and sell them as bonds to deleverage their balance sheets. There was \$12.3 billion of such residential-mortgage-backed securities sold in 2018, nearly quadrupled from a year earlier.
• As of January 2019, American households owed a total of \$9.12 trillion in mortgage debt and including mortgage debt from all sources, comprising for-profit businesses and financial institutions, the total mortgage debt was \$15.12 trillion. The national average mortgage in 2017 was \$201,811 which was nearly 10% higher than the average in 2007, \$183,469.
• Two of the top 10 non-bank specialty mortgage lenders, Quicken Loans and Loan Depot, generated \$86 billion and \$29.91 billion respectively in 2017.
• In aggregate, the top 10 non-bank specialty mortgage lenders originated \$198 billion in mortgage loans as compared to \$245 billion by mortgage bank lenders.

RESEARCH STRATEGY

Despite an extensive search, we were unable to identify information regarding the average or the approximate number of annual leveraged purchase notices that specialty lenders (i.e. auto or home) send either on a monthly or yearly basis in the United States. All the information found catered around the general mortgage and auto lending in the US, the size of the specialty lending in these sectors, the losses and delinquencies faced by the specialty lenders, the growth they have witnessed in the loan originations in these sectors, and the overall trends in specialty lending. The primary reason for the information to be missing can be due to its niche nature and lack of disclosures by individual lenders at such a granular level due to which no research reports or regulatory databases have any compiled info apropos of the same. Below is a deep dive into the various strategies that we deployed to find the information.
Our first strategy was to check various research reports, academic articles, and white papers on the US specialty finance sector from Deloitte, Business Insider, McKinsey, IBIS World, Market Radar, Academia.edu, Fern University, etc. After a thorough search, no useful information pertaining to the number of annual leveraged purchase notices sent by specialty lenders could be located. All the information found catered around the overall lending in the US subprime auto market which is mainly provided by specialty lenders and the overall auto loan originations that has been completed by the US lenders along with the percentage of subprime, prime and near-prime loans.
Next, we scanned government and statutory organizations such as Federal Reserve, FDIC, Depository and Financial Institutions Payments (DFIP), The Consumer Financial Protection Bureau (CFPB), SEC, etc. All these are potential sources that regulate the various specialty lenders or the related sectors (auto and home) in one way or the other. Therefore, the idea was to check if there are any mandatory or voluntary information filed by lenders around the number of annual leveraged purchase notices sent. However, no relevant information could be located and all the information found centered around the general loan guidelines and regulations to be adhered to while providing finance to consumers and corporate entities. Also, macro-level data on mortgage and auto loan originations from the New York Federal Reserve was available.
Subsequently, we checked media articles on Forbes, WSJ, Business Insider, Bloomberg, Live Mint etc., surveys from Pew Research, Deloitte, Nielsen etc., statistical websites such as Statista, and financial and payment information related blogs such as 'Planet Money', 'Securion Pay', 'Pymnts.com', 'Fiserv' etc. Here, we tried to check if any of these sources have reported any data around the number of annual leveraged purchase notices sent by specialty lenders in the US. However, all the data found dealt with the broad trends in non-bank specialty lending in the US and the losses and delinquencies in the mortgage and subprime auto lending by specialty lenders.
Further, we decided to triangulate the information using individual specialty lenders such as American Mortgage, Quicken Loans, Loan Depot, etc. The idea was to check for the required notices data sent by some of these individual players and use their loan origination market share to triangulate the number of notices sent by specialty lenders overall. For example, if the top 4-5 players had sent X number of average notices and hold Y% of the loan origination market combined, the overall number of notices could be triangulated as (X/Y*100). The primary assumption here is that players holding majority market share will originate maximum notices and smaller players will do so in some proportion. While we were able to locate the top specialty lending players and their origination volumes, no data concerning the number of annual leveraged purchase notices sent by these specialty lenders individually on a monthly or yearly basis could be found.
Finally, we decided to find alternated data points to triangulate the information. For this, we endeavored to locate past surveys or research done around the topic which we can use as a proxy. The idea was to use the past research highlighting data around the number of annual leveraged purchase notices sent by specialty lenders on a monthly or yearly basis in the US and then leverage the loan originations growth rate by these specialty lenders to extrapolate the current number of notices sent by them. The primary assumption here is that the number of notices sent would be directly proportional to the loan originations made by the specialty lenders. While we were able to find the growth number of the overall auto and mortgage loan originations in the US, past data concerning the number of annual leveraged purchase notices sent by specialty lenders on a monthly or yearly basis could not be found.
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36

Statement Volume - Specialty Lenders 2

Housing loan originations in the United States have benefited from rising demand among millennials, steady immigration, as well as a gradual shift from renting to owning. About 21.1% of small banks prioritize marketing to existing customers.

USEFUL INSIGHTS

• Chase launched a customer-driven digital mortgage experience for a faster, more transparent home loan process and to promote it; they turned to their social media channels.
• Optimization of mobile website, using email marketing, marketing to millennials with direct mail are some of the ideas for marketing home loans in the United States.
• About 21.1% of small banks prioritize marketing to existing customers that rely on strong connections to the community.
• The auto lending industry in the United States continues to see value growth, despite tightening lending requirements as creditworthy consumers remain favored by lenders, with the majority of auto loans being disbursed to consumers with Prime (661-780) and Super Prime (781-850) credit scores.
• Housing loan originations in the United States have benefited from rising demand among millennials, steady immigration, as well as a gradual shift from renting to owning.
• In 2018, the annual auto loan originations hit \$584 billion.
• About 25% of banks reported a drop in demand for auto loans in 2018.

RESEARCH STRATEGY

Information on the average or the approximate number of marketing offers that specialty lenders (auto or home) send on a monthly or yearly basis is not available.
The research team began by searching for reports or publications on the U.S. specialty lending sector by various banking associations. The idea here was to find pre-compiled information on the number of marketing offers that specialty lenders send on a yearly or monthly basis that includes home or auto lenders in the industry. We looked for information on sites like the American Bankers Association, National Bankers Association, Consumer Bankers Association, among others; however, no such information was readily available.

Next, we combed through government databases and statutory organizations such as Federal Reserve, FDIC, DFIP, SEC. We searched for reports, publications on these sites and found a small business lending survey report which provided some stats on the marketing activities, however, no relevant information could be located on the number of marketing offers sent by either home or auto lenders. We had thought that this strategy might work as they are potential sources which regulate the various specialty lenders or the related sectors (auto and home) in one way or the other and hence, the idea was to check if there are any mandatory or voluntary information filed by lenders around the number of marketing offers sent in a year.

Additional, we searched through media articles and news publications for articles that could be used to address the request. We looked for information on site like autonews, housingwire, autofinancenews, among others. The idea was to find any comments made by industry experts or banking marketing professionals, company spokesperson on the number of marketing offers sent by home/auto lenders. However, most of the articles published only provided general information on marketing strategies, trends in marketing. We thought that this strategy might work as sites like these are leading sources in the auto/home news industry and would have published such information.

At last resort, we tried to triangulate the information by finding some of the data points as below. We first tried to identify the key players in the home/auto lending industry and then tried to find the number of marketing offers sent by one of these key players. We searched for reports, press releases, media publications for players like WellsFargo, Chase, Bank of America, among others. However, such information could not be located. The aim behind this strategy was to look for information for some of the top players and provide this information as a proxy by multiplying the number for a company by the number of home/auto lenders in the United States.

One of the probable reasons for the unavailability of such information could be that since the number of marketing offers sent by home or auto lenders would differ among numerous banks in the United States. It could also be possible that banks in the United States do not disclose information related to marketing efforts due to competitive reasons.

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Statement Volume - Specialty Lenders 1

The specialty market is defined in this case study, as the U.S. auto loan industry, which covers the number of unique accounts for specialty lenders in the auto industry, from 2012 through 2017.

Research Strategy

In the course of our research, we were able to uncover findings from relevant sources regarding the number of unique accounts that specialty lenders have yearly. Though, while the research criteria requested findings for either auto or home, we were only able to discover a report for specialty auto loan market and not for home.
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Statement Volume - Banks and Credit Unions 4

While there is no publicly available information on the average number of annual leveraged purchase notices that banks and credit unions send on a monthly or yearly basis, it was found that leverage ratios on private deals have been increasing because of the rising competition among the United States banks for private equity loans.

Insights on Leveraged Lending

• According to Forbes, the CEOs of the seven largest banks in the United States claimed that their top focus was on leveraged lending. The report also revealed that leveraged lending is unscrutinized, unregulated, and obscured.
• In 2018, banks were still the country's largest leveraged loan underwriters. Leverage ratios on equity-backed private deals have been increasing steadily primarily because of the rise in competition among banks and credit unions for private equity loans. This was observed after the leveraged lending guidelines were relaxed in 2018.
• Some of the largest banks in the United States are JPMorgan Chase & Co., Bank of America, Citigroup Inc., Wells Fargo & Co., Goldman Sachs Group, Morgan Stanley, U.S. Bancorp, PNC Financial Services Group, TD Group US Holdings LLC, and Capital One Financial Corp.
• Some of the largest credit unions in the United States are Alliant Credit Union, Star One Credit Union, Quorum Federal Credit Union, Boeing Employees Credit Union, Delta Community Credit Union, VyStar Credit Union, Bethpage Federal Credit Union, Navy Federal Credit Union, Randolph-Brooks Federal Credit Union, and American Airlines Federal Credit Union.

Research Strategy:

We began our search by looking into research reports published by various banking associations related to annual leveraged purchase notices. The idea here was to find any direct information on the number of leveraged purchase notices sent by banks annually or any lower or upper threshold set in the industry by such organizations. However, after searching through various banking associations including but not limited to American Bankers Association, National Bankers Association, and Consumer Bankers Association, no information was found on the average or an approximate number of annual leveraged purchase notices that banks and credit unions send either on a monthly or yearly basis. We also looked into reports published by research firms such as Value Penguin and Spark Post. After an exhaustive search, we found that these channels only provided information on how banks interact with its customers and how they communicate and found no information on the number of annual leveraged purchase notices that banks and credit unions send out.

We then expanded our search to include industry-specific reports from websites such as Bank Rate and media websites such as the Financial Times, Forbes, and Reuters. A thorough search through these channels provided no information on the number of annual leveraged purchase notices that banks and credit unions send. We then attempted to triangulate the required information by first determining the largest banks and credit unions in the country and then individually researching these institutions to calculate the number of annual leveraged purchase notices they send out. However, most of the banks and credit unions such as Bank of America only provide general information related to bank account statements sent by the banks with no specific information on leveraged purchase notices. One of the probable reasons for the unavailability of such information could be that banks and credit unions in the United States do not disclose information related to customer communications for privacy purposes.

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Statement Volume - Banks & Credit Unions 3

An extensive search in the public domain reveals that information on marketing offers that banks and credit unions send either on a monthly or yearly basis is non-existent, and media coverage on the specified topic is scarce. Helpful findings have been highlighted below.

USEFUL FINDINGS

• According to International Digital Hub, banks (65%) are utilizing software for marketing material reports, storage, and manage approval.
• By 2018 banks and credit unions' digital marketing investments were on the rise.
• According to The Financial Brand, in 2017, only 2% of banks and credit unions are putting aside over "50% of their marketing budget to mobile".
• In 2017, banks and credit unions committed less than 40% to mobile marketing.
• In 2017, \$20.2 billion was spent on digital transformation by financial institutions.

RESEARCH STRATEGY

We were not able to find the number of marketing offers that banks and credit unions send monthly or yearly. The following strategies were used in our search for this information:
We started by searching through reputable financial sites, such as the Business Insider, The Financial Brand, Financial Times, MarketWatch, among others. We hoped to find precompiled information on marketing offers that banks and credit unions send either on a monthly or yearly basis. Although we were able to locate trends in financial marketing, we were unable to find relevant information for our research using this strategy.

Our next approach was to try to find the number of marketing offers received by consumers from banks and credit unions. We hoped to find research reports and articles on marketing offers received by consumers, specifically from banks and credit unions. We searched through news articles and research reports from sites such as Market Insights, PRNews, and Forbes. This strategy was unsuccessful because we could not find relevant information on the subject, most of these sites had data on consumers' preferred communication methods with their banks.

We then searched for this information on major banks and credit unions. We hoped that this information would give us insights into the number of marketing offers they send. We searched through annual reports, official websites, and FAQs. This strategy was also fruitless because we could not find information relevant to the subject, the information available was mainly on marketing channels they use.

Our next approach was to try to triangulate this data by searching for the average number of marketing offers sent in different channels such as social media and digital, we also searched for marketing offers that banks send and then that of credit unions separately. We hoped to use this data to triangulate the average number of marketing offers sent to customers. This strategy was not successful because we were not able to find enough data for triangulation. After all our efforts, we concluded that the information about marketing offers is not publicly available.

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Statement Volume - Banks & Credit Unions 2

The estimated number of overdraft notices sent out by banks and credit unions in 2017 in the United States is in the range of 10.53 million to 980 million. The estimated average number of overdraft notices that were sent by banks and credit unions in 2017 is 495.26 million.

Annual Overdrafts Notices

• There were over 4,909 Federal Deposit Insurance Corporation (FDIC) insured commercial banks in the United States, in 2017. According to the National Credit Union Administration, in 2017, there were 5,737 credit unions in the country.
• American Banker reported that each year, over 39 million Americans are overdrafters and pay about \$35 every time they overdraw.
• In 2018, the median overdraft fee or the non-sufficient fund (NSF) was \$30 at credit unions and \$32 at banks. Based on the information published by the FDIC, 10 of the largest banks in the United States collected over \$11.45 billion in overdraft and NSF fees in 2017. This figure is an increase of \$10 million from the previous year (2016). Over \$34.3 billion was collected in overdraft fees from banks and credit unions throughout the country.
• Pew Charitable Trusts reports that banks are not notifying their customers adequately about the fees charged for ATM and debit overdrafts. Banks have been required to obtain consent from customers for heavily overdrafting them before they are charged with fees for ATM overdrafts, since 2010.
• It was found that only 27% of all overdrafters in the United States were able to discuss their issues with their banks, in 2017.
• The maximum possible number of overdraft notices that could have been sent by banks and credit unions in 2017 can be calculated as follows,
• Maximum number of overdraft notices = Total amount collected in overdraft fee / average overdraft fee per overdrawing attempt
• Maximum number of overdraft notices = \$34.3 billion / \$35 = 980 million
• The minimum possible number of overdraft notices that could have been sent by banks and credit unions in 2017 can be calculated as follows,
• Minimum number of overdraft notices = 27% of the total number of overdrafters
• Minimum number of overdraft notices = 27% of 39 million = 10.53 million
• Therefore, the number of overdraft notices that have been sent out by banks and credit unions in 2017 has been estimated to lie within the range of 10.53 million to 980 million.
• The estimated average number of overdraft notices that banks and credit unions sent in 2017 is calculated as follows,
• Average number of overdraft notices = [(Maximum number + minimum number) / 2]
• Average number of overdraft notices = [(980 million + 10.53 million)/ 2] = 495.26 million

Research Strategy:

We began our search by looking into industry-specific reports from websites such as the American Banker, market reports from websites such as Pew Trusts, media reports from websites such as Forbes, and government databases such as the United States Census Bureau to obtain information on the average number of overdraft notices that banks and credit unions send either on a monthly or yearly basis. An exhaustive search through these channels provided no direct information on the number of overdraft notices sent by banks and credit unions each year but provided background information on the subject. With the available facts, we were able to triangulate the required data for 2017 as a range.
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41

Statement Volume - Banks & Credit Unions 1

There is not enough publicly available data to determine the approximate number of unique accounts that banks and credit unions have. Still, the research team found that 111 million Americans are members of a credit union, as of 2017. Below is an overview of helpful findings, followed by an explanation why the approximate number of unique accounts couldn't be determined.

RESEARCH FINDINGS

We were unable to find the approximate number of unique accounts that banks and credit unions have. The following strategies were deployed in an attempt to answer the query .First, we examined reliable banking and financial industry publications, confident we will find the desired information, since sources such as Nerd Wallet, CNBC, Value Penguin often publish comprehensive statistics and data surrounding banks and the banking industry. What we hoped to find in these types of sources was either the number of bank accounts active in a specific year, or the number of bank and credit union statements issued monthly in the US. What we ended up finding instead was irrelevant data, such as the number of active credit cards and the general banking industry information such as trends.

Next, we moved on to approach the query from a different angle. We decided to focus on customers who use banking and credit union services to determine the number of unique bank and credit union accounts. We checked the DataBank, since this source provides the number of bank accounts per 1000 inhabitants of a country, but no data was available for the United States. Subsequently, we decided to search for the following information: [1] percentage of the US adult population who owned a bank account in a given year, and [2] the average amount of bank accounts owned by US bank customers. These two data points would then be used to estimate the total number of bank accounts for a given year. The strategy wasn’t fruitful because all we were able to find was the average number of credit cards Americans own and the average American checking account balance. No information was available specifically on either the average number of bank accounts per individual, or the percentage of the population who own a bank account, although outdated information on the percentage of US households who are unbanked was available.

We applied the same strategy to find out the number of credit union accounts, but again, all we were able to find was information on the number of American credit union members, while information on the average number of credit union accounts held by person wasn't available. Subsequently, we decided to identify the largest banks and credit unions in the United States by market share and search their 2018 annual reports in order to find number of accounts each bank has had and add the numbers together to get the total number. Our reasoning behind this strategy was that the 10 largest US banks and credit unions hold the vast majority of the market and thus, their information could be used to estimate the approximate total number of accounts. After using Statista and MX Data to identify the biggest players in the industries, we carefully examined each of their annual and operational reports, but determined the banks and credit unions have not disclosed the number of accounts they have, either on the US or the global level. Because of this, we were unable to move forward with the search.

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Financial Service Volume (WrapUp)

The findings from the Financial Services statement and bill volume research have been entered into the attached spreadsheet for ease of review.

Among those findings are the following statistics:
• There are 486 million unique credit card accounts in the United States.
• Approximately 7.99 million marketing offers sent by credit card companies.
• Credit reporting agencies have approximately 200 million unique accounts.
• There are approximately 600 billion insurance (life, health, and auto) claims each year.
• On average, 1.1 bills are sent for every insurance claim.
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Healthcare Volume (WrapUp)

Findings from the healthcare statement and bill volume research have been compiled in the attached spreadsheet for ease of review.

Among those findings are:
• Patients visit hospitals approximately 35 million times each year.
• Ambulatory surgery centers have about 12.9 million annual patient visits.
• Skilled nursing facilities have approximately 1.35 million patients per year.
• About 3.45 billion health insurance claims are processed each year.
• Each health insurance claim generates an average of 2.3 statements.

Sources
Sources

Quotes
• "There are four main types of documents you'll receive. You will receive the first two -- the summary of benefits and coverage, and the uniform glossary -- when you sign up for a health plan and each year when you renew your plan. The second two -- an explanation of benefits, or EOB, and medical bills -- you receive when you use your insurance."
Quotes
• "Paper is hurting all healthcare stakeholders 86% of consumers receive paper medical bills 88% of providers report receiving paper checks and Explanation of Payment (EOPs) from one or more of their payers"
• "74% of consumers are confused by Explanation of Benefits (EOBs) and medical bills"
Quotes
• "Urbas recommends patients always look at their explanation of benefits (EOB) to make sure that the services listed are correct."
Quotes
• "In 2017, private health insurance coverage continued to be more prevalent than government coverage, at 67.2 percent and 37.7 percent, respectively. Of the subtypes of health insurance coverage, employer-based insurance was the most common, covering 56.0 percent of the population for some or all of the calendar year, followed by Medicaid (19.3 percent), Medicare (17.2 percent), direct-purchase coverage (16.0 percent), and military coverage (4.8 percent)."
Quotes
• "You should get an EOB if you have insurance you purchased on your own, a health plan from your employer, or Medicare."
Quotes
• "Various policies, including those related to explanation of benefits sent to a plan policy holder outlining services received, may affect the receipt of confidential healthcare by young adults."
Quotes
• "Insurance companies typically send an explanation of benefits (EOB) to the policyholder whenever care is provided under the plan. EOBs typically include the patient name, provider name, a description or code for the service, amounts paid by the insurance company, and amounts due [4]. About half of states require insurance companies to send EOBs, and many insurance companies send them even when not required"
Quotes
• "Figure 7. Percent distribution of long-term care services providers, by sector and number of people served daily: United States, 2016 "
• "Table V. Long-term care services providers, by geographical and organizational characteristics and sector: United States, 2015–2016"
Quotes
• "Analysis of all tables shows that 100% of nursing homes in all states except Michigan and New Mexico, provide skilled nursing services. "
Quotes
• "The total annual test volume for all labs reporting volume (in any one of four possible fields) was 13.8 billion tests."
Quotes
• "Drug and alcohol rehabilitation centers test residents on a regular basis. This helps ensure that people receiving treatment for drug or alcohol abuse stay sober."
Quotes
• "23.5 million people have an illicit drug abuse or alcohol problem 11.2 % of them (2.1 million people) got the help they needed"
Quotes
• "In 1999, 170,102 laboratories conducted 5.7 billion laboratory tests for both inpatients and outpatients in the United States."
Quotes
• "The CMS Online Survey, Certification, and Reporting (OSCAR) database indicates that there are a total of 234,756 laboratories which provide approximately 12,805,702,719 tests annually (see Table 5) in the United States."
Quotes
• "Based on 2007 data from the Centers for Medicare and Medicaid (CMS) Online Survey, Certification, and Reporting (OSCAR) database, CDC estimates that approximately 6.8 billion laboratory tests are performed annually in the U.S. "
Quotes
• "Insurance companies using marketing automation sell 20% more policies per producer, and 10% more per household, and companies using lead management drove 43% more policies per producer, and 13% more policies per household."
• "This should make it clear that technology is a major factor in driving insurance sales, and that’s why a significant part of most insurance companies’ marketing spend is allocated toward technology."
Quotes
• " But if an insurer combined the platform with a new process in which it employed campaign logic, it could send out several automated, personalized email campaigns each week."
• ""
Quotes
• " Email marketing technology has the highest adoption. It is used by 82% of companies. – Ascend2 “Marketing Technology Strategy” (August 2015)"
• "Marketing automation Email and CRM are the most effective types of technology use for marketing purposes, according to 53% of marketing influencers. – Ascend2 “Marketing Technology Utilization Survey” (2019)"
Quotes
• "At 1.47 million emails sent per month, US companies send more emails than the global average of 1.38 million. – MarketingLand"
• "Armed with these email marketing statistics, you know that email marketing is as relevant as ever, especially when marketers tap into the best practices proven to drive conversions, encourage customer loyalty, and increase brand awareness. Though it seems like every year sees the advent of some new technology heralding the end of email marketing, it’s still one of the highest performing channels available to marketers."
Quotes
• " In 2017, there were approximately 1.1 million insurance agents, brokers and service employees in the United States"
Quotes
• "According to data released April 26, 2018, by the American Banking Association, there were 364 million open credit card accounts in the United States as of the end of 2017. "
Quotes
• "There were some 41 billion U.S. general purpose credit card transactions in 2018 (based on cards issued by the four major networks – Visa, Mastercard, American Express, and Discover), accounting for about \$3.8 trillion in dollar volume.2General purpose credit card payments value had grown from \$3 trillion in 2016 to \$3.32 trillion in 2017."
• "And the total number of credit card transactions in the U.S. was 40.8 billion in 2017, up from 37.3 billion in 2016, according to the 2013 Federal Reserve Payments Study."
Quotes
• "A Javelin report in April 2015 found that 9 of the top 20 financial institutions in the U.S. were already using push notifications, along with many smaller ones. The report predicted that in five years, all 20 top banks would be sending notifications, and that notifications would surpass text messages as the No. 2 form of financial alert by 2019. (Email is No. 1.)"
• "However, the Javelin study found that only 14 percent of consumers are currently getting push notifications from a financial institution, even though 45 percent said they would be useful. "
Quotes
• "Among survey respondents that primarily used mobile banking over the past 12 months, major uses included checking an account balance or recent transactions (94% of respondents), transferring money between bank accounts (58% of respondents), receiving an alert (56% of respondents), depositing a check using mobile camera (48%), paying a bill (47% of respondents) and locating the closest in-network ATM or branch for their bank (36% of respondents)."
Quotes
• "Eighty-seven percent of mobile banking customers use alerts and notifications for fraud, deposits made and low balances. "
• "The majority (54 percent) of consumers say they use a mobile banking app, up from 48 percent in 2015. More than a third (35 percent) check their banking app once a day or more, but the majority of consumers (84 percent) check it once a week or more. Forty-one percent of consumers say having constant access to their finances decreases their daily level of stress."
Quotes
• "Fraud alerts on credit card transactions have surged, and nearly 4 in 10 consumers say they have received alerts from banks that falsely flagged legitimate purchases, according to a new poll by CreditCards.com. "
• "This year, 31 percent of U.S. adults reported getting a fraud alert about a credit card transaction, and 25 percent received a fraud alert about a debit card transaction. That represents a 15 percent increase since we last asked the question in 2015."
• "More than half of the contacts (53 percent) came by a phone call. Consumers also found out by text message (14 percent), by email (12 percent) and by having a purchase blocked at the point of sale (15 percent)."
• "This year’s poll found 37 percent of those contacted said every one of the blocked charges was actually a legitimate purchase. Another 15 percent who received an alert said most of the blocked charges were legitimate. Just 1 in 4 cardholders (24 percent) said the bank got it right every time and only blocked fraudulent charges."
Quotes
• "Purchase alerts are a better customer experience than the phone calls,” says Ben Knieff, a senior analyst with Aite Group, a financial industry research company. “And it ends up reducing costs in the call center."
• "Visa has found that alert programs have led to a 40 percent decline in subsequent fraud losses."
• "Four in 10 consumers (45 million Americans) received notifications from a bank via email, text or push in 2014, according to a 2015 report by Javelin Strategy & Research. That number is expected to climb to 52 percent by 2019."
• "Issuers of Visa cards and Mastercards in North America now have purchase alert programs in place to comply with the mandate. For issuers that haven’t created their own alert systems, Visa rolled out its Purchase Transaction Alerts Program in April 2016. It offers text messaging, emails and push notification capabilities. Mastercard’s In Control program offers similar services. “People really want and need this,” says Jill Bugh, vice president for Mastercard’s In Control."
Quotes
• "Average US smartphone user receives 46 app push notifications per day"
• "40% of web push notification senders belong to either the ecommerce or media, publishing & blogging sectors"
• "PushCrew find a slightly higher cut-off point for five key push sending industries. Results vary across them. Recipients of software & SAAS pushes consistently unsubscribe at the highest rate, and see a real spike in unsubscribes at the 11-15 per day mark. Senders of ecommerce and media, publishing & blogging push notifications enjoy the greatest levels of tolerance, while BFSI can get away with five before faced with a sharp increase in unsubscribes."
• "PushCrew find a marked positive effect when it comes to segmentation. Media, publishing & blogging, BFSI, and digital marketing agency push notification senders profit the most from segmentation."