Tracking US Health Care Spending by Health Condition and County.
Level 3 - non-randomized controlled study
Observational longitudinal claims and records analysis (design analogy for health economics)
PubMed 39951281 · doi:10.1001/jama.2024.26790
What was done
Researchers conducted an observational analysis of more than 40 billion insurance claims and nearly 1 billion facility records to estimate US healthcare spending and utilization from 2010 to 2019. The analysis tracked spending across 3,110 US counties, 4 payers (Medicare, Medicaid, private insurance, and out-of-pocket payments), 148 health conditions, 38 age/sex groups, and 7 care types (ambulatory, dental, emergency department, home health, inpatient, nursing facility, and retail pharmaceuticals).
What was found
The dataset captured 76.6% of US personal healthcare spending between 2010 and 2019. The largest condition-specific spending went to type 2 diabetes ($143.9 billion [95% CI, $140.0B-$147.2B]), followed by musculoskeletal disorders ($108.6 billion [95% CI, $106.4B-$110.3B]), oral disorders ($93.0 billion [95% CI, $92.7B-$93.3B]), and ischemic heart disease ($80.7 billion [95% CI, $79.0B-$82.4B]). By care setting, ambulatory care accounted for 42.2% of spending, hospital inpatient care accounted for 23.8%, and retail pharmaceuticals accounted for 13.7%. Age-standardized per capita spending varied nearly fourfold across counties, ranging from $3,410 (95% CI, $3,281-$3,529) in Clark County, Idaho, to $13,332 (95% CI, $13,177-$13,489) in Nassau County, New York. Out-of-pocket spending showed the greatest geographic variation, and cross-county differences were driven more by utilization rates than by price and care intensity.
Why it matters
This study provides granular condition- and county-level mapping of US healthcare expenditures, demonstrating that wide geographic cost disparities are primarily fueled by differences in care utilization rather than price variations alone.
Limits
The analysis captured 76.6% of total personal healthcare spending, leaving nearly a quarter of spending unaccounted for. Data relied on administrative claims and facility records, which are subject to coding practices and missing data. Trends post-2019 (including the impact of the COVID-19 pandemic) were not evaluated.
Cited by
- context Healthcare spending in the United States totals 3.6 trillion dollars annually, with 75% of that spending directed toward chronic metabolic diseases.