US Spending on Personal Health Care and Public Health, 1996-2013

Abstract

Importance: US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time.

Objective: To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care.

Design and setting: Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis.

Exposures: Encounter with US health care system.

Main outcomes and measures: National spending estimates stratified by condition, age and sex group, and type of care.

Results: From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%-2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]).

Conclusions and relevance: Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure 1. Personal Health Care Spending in the United States by Age Group, Aggregated Condition Category, and Type of Health Care, 2013

DUBE indicates diabetes, urogenital, blood, and endocrine diseases. Reported in 2015 US dollars. Each of the 3 columns sums to the $2.1 trillion of 2013 spending disaggregated in this study. The length of each bar reflects the relative share of the $2.1 trillion attributed to that age group, condition category, or type of care. Communicable diseases included nutrition and maternal disorders. Table 3 lists the aggregated condition category in which each condition was classified.

Figure 2. Personal Health Care Spending in the United States by Age, Sex, and Aggregated Condition Category, 2013

DUBE indicates diabetes, urogenital, blood, and endocrine diseases. Reported in 2015 US dollars. Panel A, illustrates health care spending by age, sex, and aggregated condition category. Panel B, illustrates health care spending per capita. Increases in spending along the x-axis show more spending. Communicable diseases included nutrition and maternal disorders. Table 3 lists the aggregated condition category in which each condition was classified.

Figure 3. 2013 Personal Health Care Spending in the United States and Annualized Growth Rates by Age Groups 0 to 19 Years and 20 to 44 Years, 1996–2013

Each panel illustrates 2013 health care spending (reported in 2015 US dollars) and the annualized rate of change for each condition with at least $1 billion of health care spending, for each age group in 1996.

Figure 4. 2013 Personal Health Care Spending in the United States and Annualized Growth Rates by Age Groups 45 to 64 Years and 65 Years and Older, 1996–2013

Each panel illustrates 2013 health care spending (reported in 2015 US dollars) and the annualized rate of change for each condition with at least $1 billion of health care spending, for each age group in 1996.

Figure 5. Personal Health Care Spending in the United States Across Time for All Conditions and the 7 Conditions With the Greatest Absolute Increases in Annual Spending From 1996–2013

Reported in 2015 US dollars. Y-axis segments shown in blue indicate range from y = $0 billion to y = $30 billion. Shaded areas indicate uncertainty intervals.