Spending on Personal Health Care, Public Health Increases Substantially

Estimates of U.S. 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, according to a study appearing in the December 27 issue of JAMA.1
Health care spending in the United States is greater than in any other country in the world. According to estimates, spending on health care accounted for more than 17 percent of the U.S. economy in 2014. Between 2013 and 2014 alone, spending on health care increased 5.3 percent. Despite the resources spent on health care, much remains unknown about how much is spent for each condition, or how spending on these conditions differs across ages and time. Understanding how health care spending varies can help health system researchers and policy makers identify which conditions, age and sex groups, and types of care are driving spending increases.
Joseph L. Dieleman, Ph.D., of the Institute for Health Metrics and Evaluation, University of Washington, Seattle, and colleagues estimated U.S. spending on personal health care and public health, according to condition (i.e., disease or health category), age and sex group, and type of care. Government budgets, insurance claims, facility surveys, household surveys, and official U.S. 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 [to divide into parts] into 29 conditions).
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 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion in spending, including 57.6 percent spent on pharmaceuticals and 23.5 percent spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.l billion, and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 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 and $64.4 billion, respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4 percent and 5.6 percent annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8 percent) and nursing facility care (2.5 percent).
The treatment of 2 risk factors, hypertension and hyperlipidemia, were also among the top 20 conditions incurring spending. Spending for these conditions has collectively increased at more than double the rate of total health spending, and together led to an estimated $135.7 billion in spending in 2013.
“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 U.S. health care spending,” the authors write.
“In many walks of life-such as government, business, and even crime-it is always a good idea to ‘follow the money,’ although ‘pursuing the money’ may not be optimal. Dieleman et al have ‘followed’ the health care money, and the trail has led to important findings that could ultimately compel the United States to change how it spends its trillions of dollars in health care,” writes Ezekiel J. Emanuel, M.D., Ph.D., of the University of Pennsylvania, Philadelphia, in an accompanying editorial.2
“At the very least, the data suggest that the United States needs to pay more attention to and provide higher-quality care for behavioral health and management of physical pain (such as low back, hip, and knee pain). There should also be an increased public health focus on lifestyle interventions and injury prevention. Finally, the findings by Dieleman et al suggest that the United States needs better strategies for nursing home care and for control of pharmaceutical costs. Initiatives in all of these areas are both necessary and timely. As the nation engages the quadrennial reexamination of national priorities that occurs with every new administration, these important suggestions will hopefully have the chance to both be considered and, ultimately, influence national policies and practices.”
1. doi:10.1001/jama.2016.16885; 
2. doi:10.1001/jama.2016.16739;