Factors Associated With Increases in U.S. Health Care Spending

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 7, 2017

Media advisory: To contact corresponding author Joseph L. Dieleman, Ph.D., email Kelly Bienhoff at kbien@uw.edu. The full study is available on the For The Media website.

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Bottom Line: Health care spending increased by more than $900 billion from 1996 to 2013. More than half of the spending increase was attributed to increased prices for health care services, with lesser contributions from growth and aging of the U.S. population.

Why The Research Is Interesting: Spending on health care in the United States is higher than in any other country and is increasing. Total health spending in 2015 reached $3.2 trillion and accounted for nearly 18 percent of the U.S. economy. Understanding what drives spending increases could inform future policy initiatives to help control growth.

What and When: Changes in five factors (population size, population aging, disease prevalence or incidence, service utilization, or service price) related to health care spending (exposure); changes in health care spending in the United States from 1996 to 2013 (outcome).

How (Study Design): Data on the five factors for 155 health conditions and six types of care (ambulatory, inpatient, prescriptions acquired in retail settings, nursing facility, emergency departments and dental care) were collected and analyzed from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation’s U.S. Disease Expenditure 2013 project.

Authors: Joseph L. Dieleman, Ph.D., of the Institute for Health Metrics and Evaluation, Seattle, and coauthors

Results: After adjustments for price inflation, annual health care spending on the six types of care increased from $1.2 trillion to $2.1 trillion between 1996 and 2013 with contributions as follows:

Study Limitations: Spending estimates were not separated by payer; data on spending and disease were captured only at the national level.

Study Conclusions: Increases in U.S. health care spending from 1996 through 2013 were largely related to increases in prices for health care services but also related to population growth and aging. Understanding the factors that affect spending and how they vary across health conditions and types of care may inform policy efforts to contain health care spending.

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What The Image Shows: Increases in health care service price and per unit (per visit, per day and night in the hospital, per prescription filled) accounted for most of the increase in health care spending from 1996 to 2013.

Related material:

The following related elements also are available on the For The Media website:

  • The editorial, “Factors Associated With Increased US Health Care Spending,” by Patrick H. Conway, M.D., M.Sc., Blue Cross Blue Shield of North Carolina, Durham.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jama.2017.15927)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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