US Healthcare Spending in 2013 Dominated by Diabetes and Heart Disease

Healthcare accounts for more than 17% of spending in the US economy, and the rate continues to grow. To develop a comprehensive understanding of US spending on healthcare based on age, gender, disease condition, and type of care, researchers examined healthcare data between 1996 and 2013 and found that 20 conditions accounted for half of all spending in the United States, with diabetes leading the way.

The analysis included data from 183 sources, which included government budgets, insurance claims, facility surveys, household surveys, and official US records between 1996 and 2013—a total of 155 conditions were included, with information on spending, age and gender of the patient, and type of care.

“While it is well known that the US spends more than any other nation on healthcare, very little is known about what diseases drive that spending," Joseph Dieleman, PhD, lead author of the study and assistant professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, said in a statement. "IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively.”

Using the National Health Expenditure Accounts as the source for the spending estimates, personal health spending—accounting for 89.5% of total health spending in 2013—was the focus of the study. Spending categories included hospital care, physician and clinical services, nursing facility care, and prescribed retail pharmaceutical spending, among others. These types of care are not routinely ascribed to specific health conditions.

Of the 155 conditions that accounted for $30.1 trillion in personal healthcare spending between 1996 and 2013, diabetes topped the list at $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion), 57.6% of which was spent on pharmaceuticals and 23.5% on ambulatory care. The second highest spending was on ischemic heart disease at $88.1 billion (UI, $82.7 billion-$92.9 billion), closely followed by low back and neck pain at $87.6 billion (UI, $67.5 billion-$94.1 billion). Other conditions that were costly for the healthcare system included musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome, and rheumatoid arthritis; well-care associated with dental visits; and pregnancy and postpartum care.

Over the 18-year period, 143 conditions saw a rise in spending—diabetes saw the highest increase at $64.4 billion; low back and neck pain was next at $57.2 billion. In terms of the type of care, spending on emergency care (6.4%) and retail pharmaceuticals (5.6%) saw a high annual rate of increase during the same time period. Only 6% of personal health care spending was on well-care, of which nearly a third of the spending was on pregnancy and postpartum care. Public health education and advocacy initiatives, such as anti-tobacco and cancer awareness campaigns, totaled an estimated $77.9 billion in 2013, less than 3% of total health spending.

Gender-based analysis found that women ages 85 and older spent the most per person in 2013 (more than $31,000 per person), about 58% of which occurred in nursing facilities, while 40% was expended on cardiovascular diseases, Alzheimer's disease, and falls. Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a spouse at home to provide care.

According to the director of IHME, Christopher Murray, MD, DPhil, senior author on the study, the findings could provide important lessons to private insurers, health policy experts, and leasers in the government on more effective ways to deliver healthcare services and reign in healthcare spending.

Reference

Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996-2013. JAMA. 2016;316(24):2627-2646. doi:10.1001/jama.2016.16885.