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Cited by 1,313Healthcare Policy and ManagementGlobal Health Care IssuesHealthcare Systems and Reforms

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 access
Dieleman, Joseph L., Cao, Jackie, Chapin, Abby, Chen, Carina, Li, Zhiyin, Liu, Angela, Horst, Cody, Kaldjian, Alexander, Matyasz, Taylor, Scott, Kirstin Woody, Bui, Anthony L., Campbell, Madeline, Duber, Herbert C., Dunn, Abe C., Flaxman, Abraham D., Fitzmaurice, Christina, Naghavi, Mohsen, Sadat, Nafis, Shieh, Peter, Squires, Ellen, Yeung, Kai, Murray, Christopher J. L.·2020·JAMA
DOI 10.1001/jama.2020.0734PMC PMC7054840
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Abstract

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.

Overview

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Registry

Crossref · 10.1001/jama.2020.0734

Cites

18 of 18 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

1 of 9 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

Show all 122 claims

  • Probably not a substantial claim. 21
  • It may state two separate claims as one. 13
31 of 31

  • 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.”
6 of 6

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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.

  • Study coverage is reported as both 85.2% and 86.8%

    Minor

    The paper gives two different percentages for the share of health care spending included in the study over 1996-2016.

1 of 1

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Research works printed but not linked: 2

  1. Morrisey, Health Insurance, 1
  2. CurrieJ, HoK, KellyBR, KuziemkoI. Who will be our moral conscience now? a tribute to Uwe Reinhardt. https://www.healthaffairs.org/do/10.1377/hblog20190805.922868/full/. Accessed February 4, 2020. · DOI

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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
DOI
10.1001/jama.2020.0734
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
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

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