Healthcare Spending by Inpatient Care and Others

In the December 27, 2016 issue of JAMA there was an article on US Spending on health care and how it now represents approximately 17% of the US economy.  Yes, another article and research.  Because it’s JAMA and given the interest in price and value, it’s probably important to take a look at it.  It likely will get cited someplace.  By the numbers this report looked at more than 180 sources of data to estimate spending for more than 155 conditions — including cancer — between 1996 and 2013.  The data came from government budgets, insurance claism, facility surveys, household surveys and US records.  So what did it find?  Substantial increases in spending with the biggest areas being diabetes, ischemic heart disease, and low back and neck pain.  In effect, the study was looking at US spending estimates based on age, condition, sex  and type of care.

As I’m not an epidemiologist or a statistician I won’t detail the methodology other than to say a good portion of the upfront on this article was devoted to that.  What I can offer is that of the myriad of conditions and diseases the greatest spending was against cardiovascular disease coming in at B$231.1.  But the breakdown in care was even more interesting. For CVD, the the biggest percentage of spending by the kind of care was inpatient care (hospital care) at nearly 60%.  Nursing Care came in at around 15% and pharmaceuticals was closer to the bottom at 6.2% of care.  And most of the cost (+65%) hit people over 65 years old.

Diabetes and other endocrine conditions was the second largest group — B$224.6.  In this group, both ambulatory care and pharmaceuticals account for approximately 31% while inpatient care was at 23%.  And a good chunk (42%) impacted those people over 65.   Neoplasms as indicated on this chart — or cancers — accounted for B$115.4 — 11th on this top 14 list of personal healthcare spending.  Inpatient care was at 51%, while ambulatory care came in at 42% and pharmaceuticals at 1%!  And less than 50% were over 65.

In all these categories however, there are a list of inclusions and exclusions so it’s really important to understand these data and segregate what they represent but what is interesting is the breakdown in kinds of care.

Some more interesting statistics:

  • The greatest spending was between 50 and 74 years. After this the population decreases and so does spending
  • Greatest absolute difference between spending for men versus women (per person) was ischemic heart disease (IHD):  men spend more
  • Women spend more on depressive disorders, and Alezheimer’s diseaes and other dementias
  • Public health spending focused mostly on infectious diseases (e.g., HIV/AIDS, lower respiratory tract infections, and diarrheal
    diseases) For personal health care spending,  noncommunicable diseases represent the majority of spending
  • Public health spending remains a small part of total health spending at 2.8% or B$77.9

As with all research, it needs to be reviewed carefully, but what was interesting was the breakdown in costs by kind of care and age.  As evaluations of cost cutting measures takes place, it’s important to consider this.  If interested, this research appeared in JAMA December 27, 2016 Volume 316, Number 24, pages 2627-2645.

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