In 2020, consumers directly paid for 9% of all healthcare spending in the U.S., as compared to 47% in 1960. The rest was paid by governments (55%), private insurance companies (28%), and other entities. Such payers are called "third-parties" because they do not deliver or receive healthcare. In other words, they are not patients or caregivers. Government policies have driven the steep rise of third-party payments over the past half century, and this has been a major factor in the growth of healthcare costs. Per the Encyclopedia of Health Care Management: "Because most medical care is delivered with third-party payments, and the purchaser is in dire need of the services, the typical patient has little interest in price." The U.S. has the fourth lowest rate of out-of-pocket healthcare payments among developed nations.