Mark S. Freeland

An Overview of the NHEA With Implications for Cost Analysis Researchers

Background/Objective:The National Health Expenditure Accounts (NHEA) are the official government estimates of aggregate US health care spending. We summarize the data sources, methods, strengths, limitations, and applications of the NHEA. Methods:To compile this article, we provide background on the NHEA, a description of the data sources and methods used to produce them, some recent findings that the NHEA produced, as well a discussion of their strengths, limitations, and applications drawn from several different sources, both internal and external to Centers for Medicare and Medicaid Services. Results:The NHEA have a multitude of applications, including comparison with other economic data such as the Gross Domestic Product, reconciliation with other health spending data sources, and use in predictive and analytic models. The NHEA adhere to national income accounting standards and are comprehensive, mutually exclusive, multidimensional, and consistent over time. The NHEA do not contain microlevel detailed data and are subject to both sampling and nonsampling errors during the interim census years, although this is the case for all available data sources. Conclusions:Determining the correct method for measuring health care costs depends on one’s purpose, and analysis of health care cost data that requires aggregate-level statistics should consider use of the NHEA.