US Spending on Personal Health Care and Public Health, 1996-2013 | Health Care Economics, Insurance, Payment | JAMA | JAMA Network
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World Health Organization.  The data repository. Accessed December 16, 2015.
Centers for Medicare & Medicaid Services.  National health expenditure data: historical. Accessed December 16, 2015.
National Health Expenditure Accounts.  National Health Expenditure Accounts: methodology paper, 2014: definitions, sources, and methods. Accessed November 15, 2015.
Agency for Healthcare Research and Quality.  United States Medical Expenditure Panel Survey 1996-2013. Accessed November 15, 2016.
Roehrig  C. Mental disorders top the list of the most costly conditions in the united states: $201 billion.  Health Aff (Millwood). 2016;35(6):1130-1135. PubMedGoogle Scholar
Murray  CJL, Barber  RM, Foreman  KJ,  et al; GBD 2013 DALYs and HALE Collaborators.  Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.  Lancet. 2015;386(10009):2145-2191.PubMedGoogle ScholarCrossref
Rosen  AB, Cutler  DM.  Challenges in building disease-based national health accounts.  Med Care. 2009;47(7)(suppl 1):S7-S13.PubMedGoogle ScholarCrossref
Naghavi  M, Makela  S, Foreman  K, O’Brien  J, Pourmalek  F, Lozano  R.  Algorithms for enhancing public health utility of national causes-of-death data.  Popul Health Metr. 2010;8(1):9.PubMedGoogle ScholarCrossref
Hodgson  TA, Cohen  AJ.  Medical care expenditures for diabetes, its chronic complications, and its comorbidities.  Prev Med. 1999;29(3):173-186. PubMedGoogle ScholarCrossref
Fortin  M, Soubhi  H, Hudon  C, Bayliss  EA, van den Akker  M.  Multimorbidity’s many challenges.  BMJ. 2007;334(7602):1016-1017.PubMedGoogle ScholarCrossref
Wolff  JL, Starfield  B, Anderson  G.  Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.  Arch Intern Med. 2002;162(20):2269-2276.PubMedGoogle ScholarCrossref
Roehrig  C, Miller  G, Lake  C, Bryant  J.  National health spending by medical condition, 1996-2005.  Health Aff (Millwood). 2009;28(2):w358-w367.PubMedGoogle ScholarCrossref
Roehrig  CS, Rousseau  DM.  The growth in cost per case explains far more of US health spending increases than rising disease prevalence.  Health Aff (Millwood). 2011;30(9):1657-1663.PubMedGoogle ScholarCrossref
Agency for Healthcare Research and Quality.  United States Nationwide Inpatient Sample, 1996-2013. Accessed November 15, 2016.
Hamavid  H, Birger  M, Bulchis  AG,  et al.  Assessing the complex and evolving relationship between charges and payments in US hospitals: 1996-2012.  PLoS One. 2016;11(7):e0157912.PubMedGoogle ScholarCrossref
Substance Abuse and Mental Health Services Administration.  National Expenditures for Mental Health Services & Substance Abuse Treatment: 1986-2009. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.
Centers for Medicare & Medicaid Services.  United States Medicare Skilled Nursing Facility Limited Data Set 1999-2016. Accessed November 15, 2016.
Centers for Disease Control and Prevention.  United States National Nursing Home Survey, 1997, 1999, 2004. Accessed November 15, 2016.
Highfill  T, Johnson  D.  Measuring nursing home price growth between 2000-2009. Accessed November 15, 2016.
National Center for Biotechnology Information.  PyMC: Bayesian Stochastic Modelling in Python. Accessed November 28, 2016.
Foster  JT.  Bspline. Accessed June 11, 2016.
Patil  A, Fonnesbeck  C, Huard  D, Salvatier  J.  PyMC2. Accessed May 15, 2016.
Yamamoto  DH.  Health care costs—from birth to death. Accessed November 15, 2016.
Feigin  VL, Roth  GA, Naghavi  M,  et al; Global Burden of Diseases, Injuries and Risk Factors Study 2013 and Stroke Experts Writing Group.  Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet Neurol. 2016;15(9):913-924.PubMedGoogle ScholarCrossref
Finkelstein  EA, Trogdon  JG, Cohen  JW, Dietz  W.  Annual medical spending attributable to obesity: payer-and service-specific estimates.  Health Aff (Millwood). 2009;28(5):w822-w831.PubMedGoogle ScholarCrossref
Hurd  MD, Martorell  P, Delavande  A, Mullen  KJ, Langa  KM.  Monetary costs of dementia in the United States.  N Engl J Med. 2013;368(14):1326-1334. PubMedGoogle ScholarCrossref
Yabroff  KR, Lund  J, Kepka  D, Mariotto  A.  Economic burden of cancer in the United States: estimates, projections, and future research.  Cancer Epidemiol Biomarkers Prev. 2011;20(10):2006-2014.PubMedGoogle ScholarCrossref
Thorpe  KE, Florence  CS, Joski  P.  Which medical conditions account for the rise in health care spending?  Health Aff (Millwood). 2004;suppl web exclusives:W4-437-45.PubMedGoogle Scholar
Dunn  A, Rittmueller  L, Whitmire  B.  Health care spending slowdown from 2000 to 2010 was driven by lower growth in cost per case, according to a new data source.  Health Aff (Millwood). 2016;35(1):132-140.PubMedGoogle ScholarCrossref
Lassman  D, Hartman  M, Washington  B, Andrews  K, Catlin  A.  US health spending trends by age and gender: selected years 2002-10.  Health Aff (Millwood). 2014;33(5):815-822.PubMedGoogle ScholarCrossref
Sing  M, Banthin  JS, Selden  TM, Cowan  CA, Keehan  SP.  Reconciling medical expenditure estimates from the MEPS and NHEA, 2002.  Health Care Financ Rev. 2006;28(1):25-40.PubMedGoogle Scholar
Aizcorbe  A, Liebman  E, Pack  S, Cutler  DM, Chernew  ME, Rosen  AB.  Measuring health care costs of individuals with employer-sponsored health insurance in the US: a comparison of survey and claims data.  Stat J IAOS. 2012;28(1-2):43-51.PubMedGoogle Scholar
Bernard  D, Cowan  C, Selden  T, Cai  L, Catlin  A, Heffler  S.  Reconciling medical expenditure estimates from the MEPS and NHEA, 2007.  Medicare Medicaid Res Rev. 2012;2(4):mmrr.002.04.a09.PubMedGoogle ScholarCrossref
Original Investigation
December 27, 2016

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

Author Affiliations
  • 1Institute for Health Metrics and Evaluation, Seattle, Washington
  • 2Global Health Sciences, University of California, San Francisco, San Francisco
  • 3David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
  • 4World Bank, Washington, DC
  • 5Northwell Health, New Hyde Park, New York
  • 6University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 7US Bureau of Economic Analysis, Washington, DC
  • 8Department of Statistics, Stanford University, Palo Alto, California
  • 9New Zealand Ministry of Health, Wellington, New Zealand
JAMA. 2016;316(24):2627-2646. doi:10.1001/jama.2016.16885

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.