Abigail Chapin

US Spending on Personal Health Care and Public Health, 1996-2013

Importance US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. Objective To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. Design and Setting Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. Exposures Encounter with US health care system. Main Outcomes and Measures National spending estimates stratified by condition, age and sex group, and type of care. Results From 1996 through 2013,

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30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated

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101.4 billion (uncertainty interval [UI],

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96.7 billion-

Spending on Children’s Personal Health Care in the United States, 1996-2013

106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of

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88.1 billion (UI,

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82.7 billion-

The US Provided

92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of

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87.6 billion (UI,

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67.5 billion-