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

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. To systematically and comprehensively estimate US spending on per...

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Vydané v:	JAMA : the journal of the American Medical Association Ročník 316; číslo 24; s. 2627
Hlavní autori:	Dieleman, Joseph L, Baral, Ranju, Birger, Maxwell, Bui, Anthony L, Bulchis, Anne, Chapin, Abigail, Hamavid, Hannah, Horst, Cody, Johnson, Elizabeth K, Joseph, Jonathan, Lavado, Rouselle, Lomsadze, Liya, Reynolds, Alex, Squires, Ellen, Campbell, Madeline, DeCenso, Brendan, Dicker, Daniel, Flaxman, Abraham D, Gabert, Rose, Highfill, Tina, Naghavi, Mohsen, Nightingale, Noelle, Templin, Tara, Tobias, Martin I, Vos, Theo, Murray, Christopher J L
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 27.12.2016
Predmet:	Age Distribution Age Factors Disease - classification Disease - economics Drug Costs - statistics & numerical data Drug Costs - trends Federal Government Health Care Costs - statistics & numerical data Health Care Costs - trends Health Expenditures - statistics & numerical data Health Expenditures - trends Humans International Classification of Diseases Personal Health Services - economics Personal Health Services - statistics & numerical data Personal Health Services - trends Public Health - economics Public Health - statistics & numerical data Public Health - trends Sex Distribution Sex Factors United States Wounds and Injuries - economics
ISSN:	1538-3598, 1538-3598
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Abstract	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. 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. 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. Encounter with US health care system. National spending estimates stratified by condition, age and sex group, and type of care. 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%]). 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.
AbstractList	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.ImportanceUS 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.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.ObjectiveTo systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care.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.Design and SettingGovernment 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.Encounter with US health care system.ExposuresEncounter with US health care system.National spending estimates stratified by condition, age and sex group, and type of care.Main Outcomes and MeasuresNational spending estimates stratified by condition, age and sex group, and type of care.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%]).ResultsFrom 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%]).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.Conclusions and RelevanceModeled 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. 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. 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. 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. Encounter with US health care system. National spending estimates stratified by condition, age and sex group, and type of care. 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%]). 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.
Author	Gabert, Rose Bulchis, Anne Joseph, Jonathan Lomsadze, Liya Chapin, Abigail Baral, Ranju Naghavi, Mohsen Reynolds, Alex Flaxman, Abraham D Bui, Anthony L Dicker, Daniel Vos, Theo Johnson, Elizabeth K Murray, Christopher J L Nightingale, Noelle Squires, Ellen Templin, Tara Dieleman, Joseph L Highfill, Tina Lavado, Rouselle Horst, Cody Campbell, Madeline Hamavid, Hannah DeCenso, Brendan Tobias, Martin I Birger, Maxwell
Author_xml	– sequence: 1 givenname: Joseph L surname: Dieleman fullname: Dieleman, Joseph L organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 2 givenname: Ranju surname: Baral fullname: Baral, Ranju organization: Global Health Sciences, University of California, San Francisco, San Francisco – sequence: 3 givenname: Maxwell surname: Birger fullname: Birger, Maxwell organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 4 givenname: Anthony L surname: Bui fullname: Bui, Anthony L organization: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles – sequence: 5 givenname: Anne surname: Bulchis fullname: Bulchis, Anne organization: Global Health Sciences, University of California, San Francisco, San Francisco – sequence: 6 givenname: Abigail surname: Chapin fullname: Chapin, Abigail organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 7 givenname: Hannah surname: Hamavid fullname: Hamavid, Hannah organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 8 givenname: Cody surname: Horst fullname: Horst, Cody organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 9 givenname: Elizabeth K surname: Johnson fullname: Johnson, Elizabeth K organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 10 givenname: Jonathan surname: Joseph fullname: Joseph, Jonathan organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 11 givenname: Rouselle surname: Lavado fullname: Lavado, Rouselle organization: World Bank, Washington, DC – sequence: 12 givenname: Liya surname: Lomsadze fullname: Lomsadze, Liya organization: Northwell Health, New Hyde Park, New York – sequence: 13 givenname: Alex surname: Reynolds fullname: Reynolds, Alex organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 14 givenname: Ellen surname: Squires fullname: Squires, Ellen organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 15 givenname: Madeline surname: Campbell fullname: Campbell, Madeline organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 16 givenname: Brendan surname: DeCenso fullname: DeCenso, Brendan organization: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania – sequence: 17 givenname: Daniel surname: Dicker fullname: Dicker, Daniel organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 18 givenname: Abraham D surname: Flaxman fullname: Flaxman, Abraham D organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 19 givenname: Rose surname: Gabert fullname: Gabert, Rose organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 20 givenname: Tina surname: Highfill fullname: Highfill, Tina organization: US Bureau of Economic Analysis, Washington, DC – sequence: 21 givenname: Mohsen surname: Naghavi fullname: Naghavi, Mohsen organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 22 givenname: Noelle surname: Nightingale fullname: Nightingale, Noelle organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 23 givenname: Tara surname: Templin fullname: Templin, Tara organization: Department of Statistics, Stanford University, Palo Alto, California – sequence: 24 givenname: Martin I surname: Tobias fullname: Tobias, Martin I organization: New Zealand Ministry of Health, Wellington, New Zealand – sequence: 25 givenname: Theo surname: Vos fullname: Vos, Theo organization: Institute for Health Metrics and Evaluation, Seattle, Washington – sequence: 26 givenname: Christopher J L surname: Murray fullname: Murray, Christopher J L organization: Institute for Health Metrics and Evaluation, Seattle, Washington
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Snippet	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...
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SubjectTerms	Age Distribution Age Factors Disease - classification Disease - economics Drug Costs - statistics & numerical data Drug Costs - trends Federal Government Health Care Costs - statistics & numerical data Health Care Costs - trends Health Expenditures - statistics & numerical data Health Expenditures - trends Humans International Classification of Diseases Personal Health Services - economics Personal Health Services - statistics & numerical data Personal Health Services - trends Public Health - economics Public Health - statistics & numerical data Public Health - trends Sex Distribution Sex Factors United States Wounds and Injuries - economics
Title	US Spending on Personal Health Care and Public Health, 1996-2013
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