The DOI matches its Crossref record; 18 of the 19 references it cites were found in a registry or an index; 1 of the 9 sources its claims cite were checked for support.
US Health Care Spending by Payer and Health Condition, 1996-2016
Open accessAbstract
Importance: US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time. Objective: To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016. Design and Setting: Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition. Exposures: Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting. Main Outcomes and Measures: National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016. Results: Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP; $9655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion (95% CI, $122.4-$146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion [95% CI, $116.3-$149.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion]), falls ($87.4 billion [95% CI, $75.0-$100.1 billion]), urinary diseases ($86.0 billion [95% CI, $76.3-$95.9 billion]), skin and subcutaneous diseases ($85.0 billion [95% CI, $80.5-$90.2 billion]), osteoarthritis ($80.0 billion [95% CI, $72.2-$86.1 billion]), dementias ($79.2 billion [95% CI, $67.6-$90.8 billion]), and hypertension ($79.0 billion [95% CI, $72.6-$86.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%). Conclusions and Relevance: Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance. Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.
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102 Own result · 24 Own method · 10 No basis given · 8 Own interpretation · 4 Sources not found · 4 No full text of the sources · 1 Couldn’t confirm · accuracy not yet measured
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“33.7% (95% CI, 30.0%-38.4%) by public insurance”
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · plain
“33.7% (95% CI, 30.0%-38.4%)paid by public insurance”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“urinary diseases ($86.0 billion [95% CI, $76.3-$95.9billion])”
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
“urinary diseases at $86.0 billion (95% CI, $76.3 billion-$95.9billion)”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%)”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“9.4% (95% CI, 9.4%-9.4%)by out-of-pocket payments”
- Also stated in: § Health Care Spending by Payer, Age, and Aggregated Health Condition in 2016 · hedged
“an estimated $255.2 billion (95% CI, $255.0 billion-$255.2billion) or 9.4% (95% CI, 9.4%-9.4%)by out-of-pocket payments”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer, Age, and Aggregated Health Condition in 2016 · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9billion])”
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
“diabetes at $111.2 billion (95% CI, $105.7 billion-$115.9billion)”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“government administration and net cost of insurance programs was 9.8% (range, 8.9%-10.5%) in 2016.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Health Care Spending by Payer, Age, and Aggregated Health Condition in 2016
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“falls ($87.4 billion [95% CI, $75.0-$100.1 billion])”
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · plain
“falls at $87.4 billion (95% CI, $75.0 billion-$100.1 billion)”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance”
- Also stated in: § Health Care Spending by Payer, Age, and Aggregated Health Condition in 2016 · hedged
“In 2016, an estimated $1.3 trillion (95% CI, $1.3 trillion-$1.3trillion) or 48.0%(95% CI, 48.0%-48.0%) of total spending was accounted for by private insurance”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer, Age, and Aggregated Health Condition in 2016 · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“hypertension ($79.0 billion [95% CI, $72.6-$86.8billion])”
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
“hypertension at $79.0 billion (95% CI, $72.6 billion-$86.8billion)”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion])”
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
“ischemic heart disease at $89.3 billion (95% CI, $81.1 billion-$95.5 billion)”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · hedged
- Probably not a substantial claim. 21
- It may state two separate claims as one. 13
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Recent studies suggest that these subsidies accounted for $146 billion of health care costs in 2017.32”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
What the sources say
- Could not verifycites [32] 32. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053): 1545-1602. doi:10.1016/S0140-6736(16)31678-6 sourceExperimental — accuracy not yet measured
The Methods (Data sources; page unavailable) describe insurance claims used to estimate disease prevalence, not the cost of employer-sponsored insurance subsidies. Searches for “$146 billion,” “2017,” and employer-sponsored insurance subsidies found no passage addressing the claimed amount. (LLM, conf=0.78)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Could not verify
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The conditions with the highest spending varied by type of payer, age, sex, type of care, and year.”
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · plain
“Spending varied based on type of care, age, and payer.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Health Care Spending by Payer and Health Condition in 2016 · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 3C shows that spending on diabetes occurs later in life than low back and neck pain and other musculoskeletal disorders and is generally financed by public insurance.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Downloaded From: https://jamanetwork.com/ on 08/20/2023
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, there was higher spending for ischemic heart disease among men at younger ages than among women, and higher spending among women at older ages than among men.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Downloaded From: https://jamanetwork.com/ on 08/20/2023
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there was higher spending among men at older ages with a major increase at aged 55 years”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Downloaded From: https://jamanetwork.com/ on 08/20/2023
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 3A shows that private insurance funded most of the modeled health care spending for low back and neck pain, whereas public insurance played a substantive role for the population aged 65 years or older, and out-of-pocket payments were relatively constant across age groups (when measured as a fraction of the total amount of low back and neck pain spending).”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Downloaded From: https://jamanetwork.com/ on 08/20/2023
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Out-of-pocket payments varied much less across age and sex than across public and private insurance, with the highest spending found among individuals older than aged 85 years.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Health Care Spending by Payer, Age, and Aggregated Health Condition in 2016
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Health Care Estimated Spending in 2016 for the 100 Most Expensive Health Conditions of the 154 Health Conditions Analyzed”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Health Care Estimated Spending in 2016 for the 54 Least Expensive of the 154 Health Conditions Analyzed”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“154 Health Conditions Analyzed”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, bootstrapping methods only capture a subset of uncertainty and do not reflect the uncertainty associated with some modeling decisions and processes.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Quantifying Uncertainty
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- The authors state this as an assumption: Bootstrapping methods assume that the empirical distribution of the errors in the sample data approximates the population's distribution.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to these limitations, the 95% CIs should be used as a relative indication of when the measurements are the most precise rather than as exact 95% CIs.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Quantifying Uncertainty
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
- The authors state this as an assumption: Bootstrapping methods assume that the empirical distribution of the errors in the sample data approximates the population's distribution.
In the paper
“Excluded from this study were home health care (2.6% of total health care spending between 1996 and 2016); durable medical equipment and nondurable medical products, which include over-the-counter medicines (3.7%); government public health activities (2.9%); and research and infrastructure investment (5.6%).”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Results
What the sources say
- Not matchedcites [3] 3. Emergency department care F 0 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 Mean spending for 1996-2016, % Public insurance, 48.8 Private insurance, 47.0
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
In the paper
“the health burden (measured using disability-adjusted healthyears) increased by only 1.3% annually.25”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
What the sources say
- Not matchedcites [25] 25. Substance Abuse and Mental Health Services Administration. Results from the 2016 national survey on drug use and health: detailed tables. http://www.samhsa.gov/data/report/results-2016- national-survey-drug-use-and-health-detailed- tables. Published September 7, 2017. Accessed January 23, 2020.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, the point estimate (ie, the reported value) of a percentile interval bootstrap is not based on the observed data but is instead based on the mean of the bootstrap draws and can be skewed in some cases.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Quantifying Uncertainty
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- The authors state this as an assumption: Bootstrapping methods assume that the empirical distribution of the errors in the sample data approximates the population's distribution.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“these estimates are, at the time of publication, 3 years out of date.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the many statistical adjustments and modeling necessary to complete this study are only as strong as the underlying data.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This study assessed health care spending, which for many reasons differs from actual health system costs.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it is unclear if the health condition, age group, and sex distribution for this spending actually reflects regular health care spending paid by public insurance.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“it is estimated that specialty drugs contributed to 43% of net pharmaceutical spending across all health conditions despite only being 2% of the volume in 2016.29”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
What the sources say
- Not checked — no full text of the sourcecites [29] 29. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012;307(18):1934-1940. doi:10.1001/jama.2012.3951 source
hedged- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“First, the data used in this study are imperfect.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
plain- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“this study cannot make any claims regarding the efficiency and effectiveness of these spending amounts and whether the trends are best suited in meeting national objectives to optimize the value of health care spending overall.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This classification aligns with US government accounting in the National Health Expenditure Accounts”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the estimates extend 3 additional years through 2016”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the study did not provide granular and potentially distinct spending trends associated with the 2 major government insurance programs, Medicare and Medicaid”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the MEPS and other data sources exclude active military personnel, incarcerated individuals, and homeless individuals.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the payers with the highest spending for each health condition may have been underrepresented in the survey data due to the infrequency in which these cases occur.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Limitations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These subsidies are indirect contributions from the government and provide further explanation as to why these estimates do not account for the health care system's entire effect on the government.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In the current study, spending was attributed to the entity that managed the spending rather than the originating source of the resources.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper relies on this without support.
Little is known about how spending by each type of payer is divided across health conditions.
“Although the Centers for Medicare & Medicaid Services provides annual estimates of total health care spending for each of these programs, little is known about how spending by each type of payer is divided across health conditions.”
The authors state this as an assumption.
Bootstrapping methods assume that the empirical distribution of the errors in the sample data approximates the population's distribution.
“Bootstrapping methods assume that the empirical distribution of the errors in the sample data approximates the population's distribution.”
The paper relies on this without support.
Women live longer than men on average.
“on average, women live longer than men”
The paper relies on this without support.
Women are less likely to have an in-home informal caregiver (eg, a spouse) than men.
“are less likely to have an in-home informal caregiver (eg, a spouse)”
The paper relies on this without support.
Baby boomers will age into the years most affected by dementia.
“as baby boomers age into the years most affected by the disease”
The paper relies on this without support.
Out-of-pocket payments are not distributed evenly or according to individuals' ability to pay.
“the 9.4% (95% CI, 9.4%-9.4%)that is financed by out-of-pocket payments (in 2016) is not distributed evenly or in accordance to individuals' ability to pay.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Healthcare expenditure has become a significant component of global spending14, and many health systems face challenges to improve efficiency and provide sustainable care15,16.”
From Early prediction of diagnostic-related groups and estimation of hospital cost by processing clinical notes (2021) · cites this paper as [16]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Results
“The data reflected 85.2% of health care spending between 1996 and 2016.”
§ US Health Care Spending by Payer and Health Condition, 1996-2016 > Health Care Spending by Payer, Age, and Aggregated Health Condition in 2016
“During this period, 86.8% of this spending was included in this study.”
Citations
Cites
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Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association
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2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933
Chen, S., Cao, Z. L., Klaus Prettner, A., Kühn, M., Yang, J., Jiao, L., Wang, Z., Li, W., Geldsetzer, P., Bärnighausen, T., et al. (2023) · JAMA Oncology · doi:10.1001/jamaoncol.2022.7826 · Cited by 915
Five insights from the Global Burden of Disease Study 2019
Murray, C. J. L., Abbafati, C., Abbas, K., Abbasi, M., Abbasi‐Kangevari, M., Abd-Allah, F., Abdollahi, M. R., Abedi, P., Abedi, A., Abolhassani, H., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31404-5 · Cited by 695
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Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems
Baryakova, T. H., Pogostin, B. H., Langer, R., & McHugh, K. J. (2023) · Nature Reviews Drug Discovery · doi:10.1038/s41573-023-00670-0 · Cited by 566
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Lumbar Disc Herniation: Diagnosis and Management
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Palaniappan, L. P., Allen, N. B., Almarzooq, Z., Anderson, C. A. M., Arora, P. K., Avery, C. L., Baker-Smith, C. M., Bansal, N., Currie, M. E., Earlie, R. S., et al. (2026) · Circulation · doi:10.1161/cir.0000000000001412 · Cited by 343
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“Health care expenditures are expected to skyrocket, along with economic strain on many sectors of the economy (14,15).”
BackgroundEconomic burden of childhood overweight and obesity: A systematic review and meta‐analysis
Ling, J., Chen, S., Zahry, N. R., & Kao, T. A. (2022) · Obesity Reviews · doi:10.1111/obr.13535 · Cited by 224
“patient, defensive medicine, insurance system, and free rider programs.(53,54) Therefore, the validity of the study's results may be reduced because of the increasing healthcare expenditures and”
BackgroundThe Economic Burden of Multiple Sclerosis in the United States
Bebo, B., Cintina, I., LaRocca, N., Ritter, L., Talente, B., Hartung, D., Ngorsuraches, S., Wallin, M. T., & Yang, G. (2022) · Neurology · doi:10.1212/wnl.0000000000200150 · Cited by 226
Cillekens, B., Lang, M., van Mechelen, W., Verhagen, E. A. L. M., Huysmans, M. A., Holtermann, A., van der Beek, A. J., & Coenen, P. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-102587 · Cited by 203
“Particularly since musculoskeletal disorders, such as (low) back and neck pain, result in considerable healthcare spending, 80 as well as substantial indirect cost due to presen-teeism and absenteeism, 81 and are among the leading causes of disability worldwide.”
Pedroza, P., Miller-Petrie, M. K., Chen, C., Chakrabarti, S., Chapin, A., Hay, S., Tsakalos, G., Wimo, A., & Dieleman, J. L. (2022) · eClinicalMedicine · doi:10.1016/j.eclinm.2022.101337 · Cited by 177
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Osteoarthritis year in review 2020: epidemiology & therapy
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“Within the US, expenditures on CVD and DM healthcare have reached $89.3billion and $111.2bil-lion respectively, ranking as the fourth and third highest healthcare costs and exerting considerable pressure on health care resources [2].”
BackgroundBirger, M. L., Kaldjian, A. S., Roth, G. A., Moran, A. E., Dieleman, J. L., & Bellows, B. K. (2021) · Circulation · doi:10.1161/circulationaha.120.053216 · Cited by 157
Self-citationSandal, L. F., Bach, K., Øverås, C. K., Svendsen, M. J., Dalager, T., Jensen, J. S. D., Kongsvold, A., Nordstoga, A. L., Bardal, E. M., Ashikhmin, I., et al. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.4097 · Cited by 160
Chou, R. (2021) · Annals of Internal Medicine · doi:10.7326/aitc202108170 · Cited by 166
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“26 Subsequently, we estimate a correction factor (country-specific spending ratio) by using the ratio of total healthcare expenditures of each country to that of the USA (as a reference).”
MethodShin, D. W., Shin, J. I., Koyanagi, A., Jacob, L., Smith, L., Lee, H., Chang, Y., & Song, T. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.955367 · Cited by 120
Gresham, R. C. H., Bahney, C. S., & Leach, J. K. (2020) · Bioactive Materials · doi:10.1016/j.bioactmat.2020.12.012 · Cited by 117
Cashin, A. G., Folly, T., Bagg, M. K., Wewege, M. A., Jones, M. D., Ferraro, M. C., Leake, H. B., Rizzo, R. R. N., Schabrun, S. M., Gustin, S. M., et al. (2021) · BMJ · doi:10.1136/bmj.n1446 · Cited by 124
Briggs, A. M., Shiffman, J., Shawar, Y. R., Åkesson, K., Ali, N., & Woolf, A. D. (2020) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2020.101549 · Cited by 104
Volgman, A. S., Benjamin, E. J., Curtis, A. B., Fang, M. C., Lindley, K. J., Naccarelli, G. V., Pepine, C. J., Quesada, O., Vaseghi, M., Waldo, A. L., et al. (2020) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.14838 · Cited by 114
“8) billion in 2016.(2) Also troubling is the prediction that the incidence of AF is expected to con-”
BackgroundWallwork, S. B., BRAITHWAITE, F., O’Keeffe, M., Travers, M. J., Summers, S. J., Lange, B. S., Hince, D., Costa, L. O. P., Costa, L. D. C. M., Chiera, B., et al. (2024) · Canadian Medical Association Journal · doi:10.1503/cmaj.230542 · Cited by 108
Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews
Cashin, A. G., Wand, B. M., O'Connell, N. E., Lee, H., Rizzo, R. R. N., Bagg, M. K., O’Hagan, E. T., Maher, C. G., Furlan, A. D., van Tulder, M. W., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013815.pub2 · Cited by 116
Delitto, A., Patterson, C. G., Stevans, J. M., Freburger, J. K., Khoja, S. S., Schneider, M., Greco, C. M., Freel, J. A., Sowa, G., Wasan, A. D., et al. (2020) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.100795 · Cited by 99
“In terms of cost, spinal pain represents the most costly health care condition in the US with estimates exceeding $134 billion [7].”
US Health Care Spending by Race and Ethnicity, 2002-2016
Dieleman, J. L., Chen, C., Crosby, S. W., Liu, A., McCracken, D., Pollock, I. A., Sahu, M., Tsakalos, G., Dwyer‐Lindgren, L., Haakenstad, A., et al. (2021) · JAMA · doi:10.1001/jama.2021.9937 · Cited by 94
Self-citationBussières, A., Hancock, M. J., Elklit, A., Ferreira, M. L., Ferreira, P. H., Stone, L. S., Wideman, T. H., Boruff, J. T., Zoubi, F. A., Chaudhry, F., et al. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2284025 · Cited by 108
“Our fi ndings suggest ACE exposure is associated with the most common and costly chronic pain conditions, including back and neck pain and other MSDs, which account for the highest total health care spending compared to other health conditions (Dieleman et al., 2020).”
Kasch, R., Truthmann, J., Hancock, M. J., Maher, C. G., Otto, M., Nell, C., Reichwein, N., Bülow, R., Chenot, J., Hofer, A., et al. (2021) · Spine · doi:10.1097/brs.0000000000004198 · Cited by 96
Chen, N., Fong, D., & Wong, J. Y. H. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.50674 · Cited by 98
Grogans, S. E., Bliss‐Moreau, E., Buss, K. A., Clark, L. A., Fox, A. S., Keltner, D. J., Cowen, A., Kim, J. J., Kragel, P. A., MacLeod, C., et al. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105237 · Cited by 135
“…States alone, nearly 1 in 3 individuals will experience an anxiety disorder in their lifetime, diagnoses and service utilization are surging among young people, and direct health care costs exceed $40 billion annually (Binkley and Fenn, 2019; Dieleman et al., 2020; NCS-R, 2007; Vos et al., 2016).”
BackgroundEconomic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults
Peterson, C., Aslam, M. V., Niolon, P. H., Bacon, S., Bellis, M. A., Mercy, J. A., & Florence, C. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.46323 · Cited by 91
Healthcare spending for non-fatal falls among older adults, USA
Haddad, Y. K., Miller, G. F., Kakara, R. S., et al. (2024) · Injury Prevention · doi:10.1136/ip-2023-045023 · Cited by 87
The Amygdala and Depression: A Sober Reconsideration
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Trends in U.S. Health Care Spending on Inflammatory Bowel Diseases, 1996-2016
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COVID-19 and the Opioid Epidemic: Two Public Health Emergencies That Intersect With Chronic Pain
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Epidural Steroid Injections for Low Back Pain: A Narrative Review
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Allocation of National Institutes of Health Funding by Disease Category in 2008 and 2019
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Health Care Spending on Respiratory Diseases in the United States, 1996–2016
Duan, K. I., Birger, M. L., Au, D. H., Spece, L. J., Feemster, L. C., & Dieleman, J. L. (2022) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202202-0294oc · Cited by 70
Self-citationResearch Priorities in Atrial Fibrillation Screening
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Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries
Chow, R. D.-W., Bradley, E. H., & Gross, C. P. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.1229 · Cited by 61
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Molecular Biomarkers for Cardiometabolic Disease: Risk Assessment in Young Individuals
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Pharmaceutical supply chain reliability and effects on drug shortages
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Intervertebral disc degeneration and regeneration: a motion segment perspective
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MethodRoseen, E. J., Smith, C., Essien, U. R., Cozier, Y. C., Joyce, C. T., Morone, N. E., Phillips, R. S., Barnett, K. G., Patterson, C. G., Wegener, S. T., et al. (2022) · Pain Medicine · doi:10.1093/pm/pnac193 · Cited by 47
Metadata
- Authors
- Dieleman, J. L., Cao, J., Chapin, A., Chen, C., Li, Z., Liu, A., Horst, C., Kaldjian, A., Matyasz, T., Scott, K. W., Bui, A. L., Campbell, M., Duber, H. C., Dunn, A. C., Flaxman, A. D., Fitzmaurice, C., Naghavi, M., Sadat, N., Shieh, P., Squires, E., Yeung, K., & Murray, C. J. L.
- Affiliations
- Institute for Health Metrics and Evaluation (US)
- Harvard University (US)
- Seattle Children's Hospital (US)
- Meta (United States) (US)
- University of Washington (US)
- Bureau of Economic Analysis (US)
- Microsoft (United States) (US)
- The Improve Group, St Paul, Minnesota
- Kaiser Permanente Washington Health Research Institute (US)
- Corresponding author
- Dieleman, Joseph L.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2020-03-03
- Volume
- 323
- Issue
- 9
- Pages
- 863
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC7054840
- OpenAlex
- W3010268726
- Cited by
- 1,313
- References
- 19
- Citations by year
- 2026: 171 · 2025: 269 · 2024: 284 · 2023: 221 · 2022: 160 · 2021: 139 · 2020: 69
- FWCI
- 125.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (P30AG047845)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Keywords
- health care spending, public insurance, private insurance, out-of-pocket costs, Medicare, Medicaid, health conditions, outpatient care, inpatient care, nursing facilities, emergency department care, dental care, prescription drug spending, health care costs
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Disease, Health Expenditures, Female, Health Status, Humans, Infant, Insurance, Health, Male, Middle Aged, United States, Age Distribution, Sex Distribution, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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