US health expenditure disaggregated by disease, type of care, age, and sex, for the United States, 1996-2013

Although estimates of total health expenditure for the United States are available, comprehensive data on the amount spent on different diseases and by which populations are still lacking. To fill this gap, we estimated annual health expenditure in the US disaggregated by disease or injury as classified by the Global Burden of Disease (GBD) 2013 as well as by age, sex and health care type, from 1996 to 2013.

Government budgets, insurance claims, facility surveys, household surveys, and official US records were collected and combined. In total, 7 sources of microdata were used. For each record, the primary cause of health expenditure was determined and the amount of health spending was extracted, as well as the type of care and age and sex of the patient. Data biases were adjusted using population weights and series adjustments based on linear regression, and by leveraging multiple data sources reporting on the same type of care. Spending estimates were adjusted for inflation and to reflect the cause of illness treated rather than simply the primary cause. Nationally representative data was scaled to reflect the total amount of US spending for each year. Uncertainty intervals were estimated using a statistical bootstrapping method.

In 2013, five causes of health spending made up 17% of $2.8 trillion of health spending. Ischemic heart disease was the largest cause of health expenditure, with the majority of the health expenditure coming from spending on ambulatory care and inpatient care. The second and third most costly causes of health spending in 2013 were hypertension and sense organ diseases, on which $96.1 billion and $93.7 was spent. In per person terms, the 80 to 84 year old age group spent the most on health, at $37,174 thousand per person. Of causes with more than 1,000 prevalent cases in 2013, the most expensive causes of health expenditure per prevalent case are non-melanoma skin cancer, aortic aneurysms, and cervical cancer. These costs include spending on prevention as well as treatment, including public health funds. For each of these causes, more than $230,000 was spent per year per prevalent case. More was spent in 2013 than in 1996 on 140 of the 170 causes of health spending. All 38 age and sex groups and 8 types of care increased health spending between 1996 and 2013 as well. The causes of health spending that increased the most, relative to their 1996 amount were autism spectrum disorders, dengue, and Leishmaniasis which increased by 1,399%, 909%, and 831% respectively. In absolute terms, low back and neck pain and hypertension increased the most between 1996 and 2013, with spending increasing for each by more than $53 billion.

Spending on health care increased substantially since 1996, with more spending on most major causes of illness, and all types of care and age and sex groups. Understanding how spending has changed provides necessary information for those attempting to reduce the increases health spending and increase allocative of resources to improve health.