US Personal Health Care Spending by Payer and Health Condition, 1996-2015

Background: Little is known about what health conditions each of the major health care payers are spending resources on. The objective of this study is to estimate US spending on personal health care, according to payer - public insurance, private insurance, and out-of-pocket - and health condition, age and sex group, and type of care, for 1996 through 2015.

Methods: Government budgets, insurance claims, facility records, household surveys, and official records were collected to estimate spending for 154 health conditions. Information about spending, the age, sex, and health condition of the patient, and the type of care was extracted. The fraction of the spending paid by public insurance, private insurance, and out-of-pocket payments was estimated based on household survey data and was used to estimate health condition spending by payer for each of these categories. Spending growth rates, standardized by population size and age structure, were calculated for each payer and health condition.

Findings: From 1996 through 2015, $39.2 trillion was disaggregated by payer, health conditions, age and sex group, and type of care. Low back and neck pain had the highest spending in 2015, with $127.9 billion (uncertainty interval [UI], $115.9 billion-$140.6 billion) in spending, with 59.5% (UI, 55.9%-63.6%) from private insurance, substantially less spending from public insurance [31.9% (UI, 28.3%-35.3%)] and out-of-pocket [8.6% (UI, 7.6%-9.7%)]. Diabetes mellitus accounted for the second-highest spending in 2015 ($104.7 [UI, $98.6-$111.6] billion) with most (53.5% [UI, 47.6% - 59.5%]) from public insurance, and Alzheimer disease and other dementias accounted for the third-highest amount ($93.4[UI, $68.5-$112] billion), with most spending (58% [UI, 40.3% - 67.2%]) from public insurance. These conditions varied by payer, age, sex, type of care, and year. After adjusting for inflation, population size, and age structure, public insurance, private insurance, and out-of-pocket annual spending grew at an annualized rate of 2.69% (UI, 2.67%-2.7%), 2.27% (UI, 2.25%-2.29%), and 0.67% (UI, 0.65%-0.69%), respectively.

Conclusion: Estimates showed substantial increases from 1996 through 2015, with population adjusted spending by public insurance growing the fastest. While spending on ischemic heart disease, Alzheimer disease and other dementias, and low back and neck pain accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.