Source of Increased Health Care Spending in the United States

Adam I. Biener, PhD1; Sandra L. Decker, PhD2; Fredrick Rohde, MA2

Author Affiliations Article Information

JAMA. 2019;321(12):1147. doi:10.1001/jama.2019.0679

In 2015, five health conditions—heart disease, mental disorders, diabetes, osteoarthritis, and cancer—accounted for nearly one-third of all medical care spending in the United States. More than $100 billion was spent to treat heart disease alone. Expenditures associated with heart disease and cancer have not increased significantly between 1996 and 2015. Although the percent of people being treated increased 1.2- to 1.5-fold, average per capita expenditures decreased for these conditions. In contrast, the treated prevalence and spending for diabetes, osteoarthritis, and mental disorders more than doubled between 1996 and 2015. The average per capita expenditure associated with treating diabetes also significantly increased during this period, up from $2309 to $3402. The share of spending on inpatient care has decreased for all 5 of the costliest conditions. However, the proportion of spending on ambulatory care and prescription drugs increased for diabetes, osteoarthritis, and mental disorders.