US SICK Care Spending Swells to $2.1 Trillion


US health care spending has ballooned to $2.1 trillion – making up almost 18% of the US economy, and marking a $933.5 billion increase since 1996, according to a new report published in the JAMA Network.

Study authors, led by Joseph L Dieleman, PhD, of the Institute for Health Metrics and Evaluation in

Seattle, Washington, quantified changes in US health care spending associated with 5 fundamental factors: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity.

50%, or roughly $583.5 billion of the increase was related to changes in service price and intensity. Population changes, including overall population growth ($269.5 billion) and an aging population ($135.7 billion) accounted for a combined additional 34.7% spending growth. Changes in service utilization were not associated with a statistically significant change in spending.

On the other hand, changes in disease prevalence or incidence were associated with spending reductions of 2.4%, or $28.2 billion. However, study authors acknowledged that the influence of this factor (and all factors measured in the study) varied by health condition and type of care. For example, decreases in prevalence of cardiovascular diseases were associated with 20.7% reduction in spending, but annual diabetes spending grew by $64.4 billion, with $44.4 billion of that growth coming from pharmaceutical spending.

Across all health conditions, the greatest annualized growth rates were in retail pharmaceutical spending and emergency department care, at 5.6% and 6.4%, respectively. The condition with the greatest absolute increase in spending was diabetes, which increased at an annualized rate of 6.1%. Low back and neck pain had the second-largest increase in health care spending, increasing at an annualized rate of 6.5%, or $57.2 billion. In absolute terms, this increase was concentrated in ambulatory care and inpatient care.

Spending increases on the treatment of hypertension ($47.6 billion), the treatment of hyperlipidemia ($41.9 billion), and depressive disorders ($30.8 billion), were also notable, authors wrote.

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