US Health Care Spending by Payer and Health Condition, 1996-2016.

Published on Mar 3, 2020in JAMA45.54
· DOI :10.1001/JAMA.2020.0734
Joseph L Dieleman26
Estimated H-index: 26
Jackie Cao5
Estimated H-index: 5
+ 19 AuthorsChristopher J L Murray220
Estimated H-index: 220
Importance US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time. Objective To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016. Design and Setting Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition. Exposures Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting. Main Outcomes and Measures National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016. Results Total health care spending increased from an estimated 1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; 259 per person) to an estimated 3.1 trillion in 2016 (17.9% of GDP; 655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated 134.5 billion (95% CI, 22.4-146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at 29.8 billion [95% CI, 116.3-49.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at 111.2 billion [95% CI, 05.7-115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease (9.3 billion [95% CI, 81.1-5.5 billion]), falls (87.4 billion [95% CI, 5.0-100.1 billion]), urinary diseases (6.0 billion [95% CI, 76.3-5.9 billion]), skin and subcutaneous diseases (85.0 billion [95% CI, 0.5-90.2 billion]), osteoarthritis (0.0 billion [95% CI, 72.2-6.1 billion]), dementias (79.2 billion [95% CI, 7.6-90.8 billion]), and hypertension (9.0 billion [95% CI, 72.6-6.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%). Conclusions and Relevance Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance. Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.
📖 Papers frequently viewed together
509 Citations
2,363 Citations
2,996 Citations
#1Angela Y. Chang (UW: University of Washington)H-Index: 2
#1Angela Y Chang (UW: University of Washington)H-Index: 10
Last. Joseph L DielemanH-Index: 26
view all 206 authors...
Summary Background Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We...
125 CitationsSource
#1Ellen Squires (UW: University of Washington)H-Index: 6
#2Herbert C. Duber (UW: University of Washington)H-Index: 18
Last. Joseph L Dieleman (UW: University of Washington)H-Index: 26
view all 11 authors...
OBJECTIVE Health care spending on diabetes in the U.S. has increased dramatically over the past several decades. This research describes health care spending on diabetes to quantify how that spending has changed from 1996 to 2013 and to determine what drivers are increasing spending. RESEARCH DESIGN AND METHODS Spending estimates were extracted from the Institute for Health Metrics and Evaluation’s Disease Expenditure 2013 database. Estimates were produced for each year from 1996 to 2013 for eac...
15 CitationsSource
#1Joseph L DielemanH-Index: 26
#2Ellen SquiresH-Index: 6
Last. Christopher J L MurrayH-Index: 220
view all 13 authors...
Importance Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. Objective To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, se...
131 CitationsSource
#1Joseph L DielemanH-Index: 26
#2Ranju Baral (UCSF: University of California, San Francisco)H-Index: 9
Last. Martin Tobias (Wellington Management Company)H-Index: 32
view all 15 authors...
Background One of the major challenges in estimating health care spending spent on each cause of illness is allocating spending for a health care event to a single cause of illness in the presence of comorbidities. Comorbidities, the secondary diagnoses, are common across many causes of illness and often correlate with worse health outcomes and more expensive health care. In this study, we propose a method for measuring the average spending for each cause of illness with and without comorbiditie...
9 CitationsSource
#1Roger ChouH-Index: 84
#2Richard A. DeyoH-Index: 150
Last. Sara Grusing (OHSU: Oregon Health & Science University)H-Index: 16
view all 10 authors...
A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Randomized trials that reported pain, function, or harm...
389 CitationsSource
#1Anthony L. Bui (UCLA: University of California, Los Angeles)H-Index: 10
#2Joseph L DielemanH-Index: 26
Last. Christopher J L MurrayH-Index: 220
view all 11 authors...
Importance Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time. Objective To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care. Evidence Review Health care spending estimates were ext...
74 CitationsSource
#1Joseph L DielemanH-Index: 26
#2Ranju Baral (UCSF: University of California, San Francisco)H-Index: 9
Last. Christopher J L MurrayH-Index: 220
view all 26 authors...
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, househ...
509 CitationsSource
#1Theo Vos (UW: University of Washington)H-Index: 159
#2Christine Allen (UW: University of Washington)H-Index: 15
Last. Christopher J L Murray (UW: University of Washington)H-Index: 220
view all 637 authors...
Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the...
3,180 CitationsSource
#1Hannah Hamavid (UW: University of Washington)H-Index: 10
#2Maxwell Birger (UW: University of Washington)H-Index: 8
Last. Joseph L Dieleman (UW: University of Washington)H-Index: 26
view all 10 authors...
Background In 2013 the United States spent $2.9 trillion on health care, more than in any previous year. Much of the debate around slowing health care spending growth focuses on the complicated pricing system for services. Our investigation contributes to knowledge of health care spending by assessing the relationship between charges and payments in the inpatient hospital setting. In the US, charges and payments differ because of a complex set of incentives that connect health care providers and...
9 CitationsSource
#1Kyle J. Foreman (Imperial College London)H-Index: 61
#2Mohsen Naghavi (UW: University of Washington)H-Index: 142
Last. Majid Ezzati (Imperial College London)H-Index: 138
view all 3 authors...
Background Mortality data are affected by miscertification of the medical cause of death deaths and changes to cause of death classification systems. We present both mappings of ICD9 and ICD10 to a unified list of causes, and a new statistical model for reducing the impact of misclassification of cause of death.
30 CitationsSource
Cited By104
#1Aidan G Cashin (UNSW: University of New South Wales)H-Index: 6
#2Rodrigo R N Rizzo (UNSW: University of New South Wales)H-Index: 3
Last. Maurits W. van Tulder (VU: VU University Amsterdam)H-Index: 100
view all 0 authors...
#1Joseph L Dieleman (Institute for Health Metrics and Evaluation)H-Index: 26
#2Carina Chen (Institute for Health Metrics and Evaluation)H-Index: 2
Last. Annie Haakenstad (Institute for Health Metrics and Evaluation)H-Index: 18
view all 0 authors...
Importance null Measuring health care spending by race and ethnicity is important for understanding patterns in utilization and treatment. null Objective null To estimate, identify, and account for differences in health care spending by race and ethnicity from 2002 through 2016 in the US. null Design, Setting, and Participants null This exploratory study included data from 7.3 million health system visits, admissions, or prescriptions captured in the Medical Expenditure Panel Survey (2002-2016) ...
1 CitationsSource
#1Shiwani Mahajan (Yale University)H-Index: 8
#2Cesar Caraballo (Yale University)H-Index: 7
Last. Oyere Onuma (Yale University)H-Index: 1
view all 0 authors...
Importance The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. Objective To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. Design, Setting, and Participants Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that i...
#1Aidan G Cashin (UNSW: University of New South Wales)H-Index: 6
#2Hopin Lee (University of Newcastle)H-Index: 18
Last. James H. McAuley (UNSW: University of New South Wales)H-Index: 57
view all 8 authors...
ABSTRACT null null Patient education is recommended as first-line care for low back pain (LBP), although its efficacy for providing clinically meaningful reductions in disability has been questioned. One way to improve treatment effects is to identify and improve targeting of treatment mechanisms. We conducted a pre-planned causal mediation analysis of a randomized, placebo-controlled trial investigating the effectiveness of patient education for patients with acute LBP. 202 patients who had few...
#1Lester Tsai (UCSD: University of California, San Diego)H-Index: 1
#2Nghia Nguyen (UCSD: University of California, San Diego)H-Index: 23
Last. Siddharth Singh (UCSD: University of California, San Diego)H-Index: 67
view all 6 authors...
BACKGROUND AND AIMS Inflammatory bowel diseases (IBD) lead to high morbidity and unplanned healthcare utilization. We conducted a systematic review with meta-analysis to estimate the cumulative incidence of IBD-related (and all-cause) hospitalization in patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS Through a systematic review to September 3, 2019, we identified population-based inception cohort studies in patients with IBD that reported patient-level cumulative incidenc...
#1Emelia J. Benjamin (BU: Boston University)H-Index: 158
#2Sana M. Al-Khatib (Duke University)H-Index: 76
Last. Paulus KirchhofH-Index: 108
view all 24 authors...
There has been sustained focus on the secondary prevention of coronary heart disease and heart failure; yet, apart from stroke prevention, the evidence base for the secondary prevention of atrial fibrillation (AF) recurrence, AF progression, and AF-related complications is modest. Although there are multiple observational studies, there are few large, robust, randomized trials providing definitive effective approaches for the secondary prevention of AF. Given the increasing incidence and prevale...
#1Brian R Anderson (Palmer College of Chiropractic)
Last. Cynthia R. Long (Palmer College of Chiropractic)H-Index: 24
view all 3 authors...
Objective null The purpose of this study was to evaluate the relationship between treatment escalation and spinal manipulation in a retrospective cohort of people diagnosed with musculoskeletal disorders of the cervical spine. null Methods null We used retrospective analysis of insurance claims data (2012-2018) from a single Fortune 500 company. After isolating the first episode of care, we categorized 58 147 claims into 7951 unique patient episodes. Treatment escalation included claims where im...
Intervertebral disc degeneration (IDD) is one of the main causes of low back pain (LBP), which severely reduces the quality of life and imposes a heavy financial burden on the families of affected individuals. Current research suggests that IDD is a complex cell-mediated process. Inflammation, oxidative stress, mitochondrial dysfunction, abnormal mechanical load, telomere shortening, DNA damage, and nutrient deprivation contribute to intervertebral disc cell senescence and changes in matrix meta...
#1Louise Fleng Sandal (University of Southern Denmark)H-Index: 5
#2Kerstin Bach (NTNU: Norwegian University of Science and Technology)H-Index: 11
Last. Ilya Ashikhmin (NTNU: Norwegian University of Science and Technology)
view all 23 authors...
Importance: Lower back pain (LBP) is a prevalent and challenging condition in primary care. The effectiveness of an individually tailored self-management support tool delivered via a smartphone app has not been rigorously tested. Objective: To investigate the effectiveness of selfBACK, an evidence-based, individually tailored self-management support system delivered through an app as an adjunct to usual care for adults with LBP-related disability. Design, Setting, and Participants: This randomiz...
#1Jessica Favero Butts (Penn State Milton S. Hershey Medical Center)H-Index: 2
#2Kathryn H. SchmitzH-Index: 78
Last. Matthew SilvisH-Index: 14
view all 4 authors...
ABSTRACT: Ten percent of all premature deaths and 117 billion dollars in annual health care costs are attributable to physical inactivity in America. The positive impact exercise can have on overall health is irrefutable. While it is the responsibility of health care providers to assess and counsel for exercise, there are logistical, structural, and educational barriers preventing this counseling. A physical activity consultation clinic led by primary care sports medicine physicians would allow ...