Today's Managing Health Care Costs Number is $3.2 trillion
Medical Spending for Women by Age
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| Source for all graphics |
Happy 2017 - and I'm back blogging after a week of rest and contemplation. I'm sure we're all in for an interesting year of health care policy -and I'll be blogging on Republican efforts to repeal the Affordable Care Act over the coming days too.
JAMA published a blockbuster description of where medical dollars are spent in the United States- using data from various federal surveys, Truven's MarketScan database, and Medicare claims. The analysis divides cost up by age/gender cell as well as by disease category. It does not specify what payer is responsible for costs, but does split out those over 64 (largely covered by Medicare) and those under 20 (usually inexpensive -and often covered by Medicaid) - so you can get a sense from this of employer spending as well. The researchers also reviewed where public health dollars are spent. No surprise - there is a low correlation with where health care treatment dollars are spent.
General findings.
- Chronic diseases rule. Ten of the 14 top conditions are chronic conditions - led by cardiovascular disease, diabetes, other noncommunicable disease, mental health disorders and musculoskeletal disorders. Taken together, these represent about a trillion dollars in spending.
- Women have higher medical costs than men (even excluding pregnancy related costs
- With the exception of (sick) newborns, we spend progressively more money on Americans as they get older.
- There are a few conditions, like hypertension, where generic drugs have led to a dramatic decrease in pharmaceutical costs for treatment. There are others, like diabetes, where the drug spending continues to escalate.
Ezekiel Emanuel penned an accompanying editorial .
In 2015, the United States spent roughly $3.2 trillion on health care. That is a staggering, almost unimaginable amount. Indeed, this level of spending makes the US health care system the fifth largest economy in the world, behind only the US, Chinese, Japanese, and German national economies.
Emanuel notes the large spending on mental health care (despite evidence that treatment is now terrible), the serious cost of pain, and the mismatch of public health spending and medical costs. He notes that almost 22% of dollars spent on those over 65 are spent at skilled nursing facilities - again without evidence that the care is of high quality, and that expenditures for drugs keep on going up.
The effort to collate this data is enormous (there are 26 coauthors of this article) - but knowing where we are spending dollars helps us know where to look for potential savings. The costs of noncommunicable diseases also loom large -and societal efforts to decrease risk factors are bound to create more value than treatment of existing disease.
Note how drug spending has increased substantially for diabetes -which is dominated by brand name and single source medications, but it has diminished for hypertension, where most drug classes are available as generics. Source
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