Expert Commentary

Survey dissects U.S. healthcare spending over the decades

Diabetes, heart disease and back pain are the priciest ailments in the United States, a new survey has found. And the cost of healthcare is rising far faster than inflation.

Diabetes, heart disease and back pain are the priciest ailments in the United States, a new survey has found. And the cost of healthcare is rising faster than inflation.

The issue: Americans spend more on healthcare per capita than any other nation — roughly 10 times the global average, says the World Health Organization. The amount is growing. According to U.S. government figures, healthcare spending leapt 5.8 percent in 2015 – as the Affordable Care Act expanded coverage – to reach $3.2 trillion or an average of $9,990 per person. All told, healthcare accounts for 17.8 percent of the economy.

But little is known about exactly how the money is spent. A new survey seeks to shed light on the outlays, to determine how spending is changing over time, and to identify the most expensive ailments. Such information could help drive investments in new cures and help policymakers understand where to focus attention.

An academic study worth reading: “U.S. Spending on Personal Health Care and Public Health, 1996-2013,” in JAMA, December 2016.

Study summary: A team led by Joseph Dieleman of the University of Washington looked at 183 sources of nationally representative data (including government budgets, insurance claims, a variety of national surveys and the government’s National Health Expenditure Data) to examine spending on 155 conditions, including 29 types of cancer, from 1996 to 2013. They sought to comprehensively estimate personal and public healthcare spending by condition, age and gender, and type of care.

Dieleman and colleagues grouped spending into six categories: inpatient care, ambulatory care (visits to a doctor’s office and outpatient treatment at hospitals), emergency care, nursing facilities, dentistry and prescriptions. Other spending included over-the-counter medicines, medical devices and house calls.

For public health spending by the government, the researchers examined audited appropriations for the “four primary federal agencies providing public health funding: the Health Resources and Services Administration, the Centers for Disease Control and Prevention [CDC], the Substance Abuse and Mental Health Services Administration, and the U.S. Food and Drug Administration [FDA].”


  • The costliest illness in 2013 was diabetes. Spending on diabetes totaled an estimated $101.4 billion. Roughly 57.6 percent of this figure was spent on prescription pharmaceuticals. Between 1996 and 2013, spending on diabetes increased by 6.1 percent per year.
  • The second-costliest condition was heart disease, at $88.1 billion. About 56.5 percent of this spending was on inpatient care; 61.2 percent was spent on adults aged 65 years or older. Between 1996 and 2013, spending on heart disease increased an average of 0.2 percent annually.
  • Low back and neck pain was the third-highest category, at an estimated $87.6 billion – largely on ambulatory (outpatient/walk-in) care.
  • Of all conditions, those with the fastest increase in spending were autistic spectrum disorders (17.6 percent), Vitamin A deficiency (14.7 percent), high cholesterol (10.3 percent) and obesity (9.9 percent).
  • Personal health spending (money spent on individual care) in 2013 totaled $2.1 trillion.
  • The costliest cancers were colon and rectum cancers, at $18.5 billion. The cost increased by 2 percent per year between 1996 and 2013.
  • Females spent 24.6 percent more than males overall in 2013. Spending on females was greater than males for ages 15 to 64 and above age 74.
  • Excluding infants, spending per person generally increases with age.
  • Between 1996 and 2013 healthcare spending increased between 3 percent and 4 percent per year; spending on pharmaceuticals increased, on average, by 5.6 percent annually. (By comparison, average inflation during that period was 4 percent, according to the Federal Reserve Bank of Minneapolis.)
  • Personal health spending increased for 143 of 155 conditions between 1996 and 2013.
  • Personal health spending comprised 89.5 percent of total health spending in 2013. Other spending was largely federal support for organizations like the CDC and the FDA.
  • The three conditions that received the most federal health spending were HIV/AIDS ($3.5 billion), lower respiratory tract infections ($1.8 billion), and diarrheal diseases ($0.9 billion).

The authors’ table with data for all surveyed conditions can be found here.

Helpful resources:

A number of government and multilateral organizations publish data on health spending in the U.S., including the World Health Organization, the federal Centers for Medicare and Medicaid Services, the National Institutes of Health, the CDC’s National Center for Health Statistics, and the Department of Health and Human Services, which operates the Agency for Healthcare Research and Quality.

Other research:

Journalist’s Resource has profiled a range of papers on healthcare spending, including spending by the elderly, who pays for opioids, and why Americans pay so much more than people in countries with similar economies like Canada and the United Kingdom. For more, see our healthcare archives.

We also have a syllabus on healthcare reporting for journalists.


Keywords: hospitals, doctors, Obamacare, Medicaid, Medicare, health insurance, ER, emergency room

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