US Health Care Spending by Payer and Health Condition, 1996-2016
US Health Care Spending by Payer and Health Condition, 1996-2016
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DOI：
10.1001/jama.2020.0734
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发表时间：
2020-03-03
影响因子：
120.7
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Dieleman, Joseph L.;Cao, Jackie;Murray, Christopher J. L.
重要性美国医疗保健支出持续增加，目前占美国经济的18%，尽管人们对每种健康状况的支出如何因支付者而异以及这些金额如何随时间而变化知之甚少。目的根据3种类型的支付者（公共保险[包括医疗保险，医疗补助和其他政府计划]，私人保险或自付费用）以及健康状况，年龄组，性别和护理类型估计1996年至2016年美国的医疗保健支出。收集了1996年至2016年的政府预算、保险索赔、设施记录、家庭调查和美国官方记录，以估计154种健康状况的支出。支出增长率（按人口规模和年龄组标准化）计算每种类型的付款人和健康状况。暴露门诊护理、住院护理、护理设施停留、急诊科护理、牙科护理和在零售环境中购买处方药。主要成果和措施国家支出估计按健康状况，年龄组，性别，护理类型和付款人类型分层，并为1996年至2016年的每年建模。医疗保健总支出从1996年估计的1.4万亿美元（占国内生产总值[GDP]的13.3%;人均5259美元）增加到2016年估计的3.1万亿美元（占GDP的17.9%;人均9655美元）;这项研究包括了85.2%的支出。2016年，估计48.0%（95%CI，48.0%-48.0%）的医疗保健支出由私人保险支付，42.6%（95%CI，42.5%-42.6%）由公共保险支付，9.4%（95%CI，9.4%-9.4%）由自付支付。2016年，在154种病症中，腰痛和颈部疼痛的医疗保健支出最高，估计为1345亿美元（95%CI，1224 - 1469亿美元），其中57.2%（95% CI，52.2%-61.2%）由私人保险支付，33.7%（95% CI，30.0%-38.4%）由公共保险支付，9.2%（95% CI，8.3%-10.4%）由自付支付。其他肌肉骨骼疾病占医疗保健支出的第二高金额（估计为1298亿美元[95%CI，1163 - 1497亿美元]），大多数有私人保险（56.4% [95%CI，52.6%-59.3%]）。糖尿病占医疗保健支出的第三高（估计为1112亿美元[95%CI，1057 - 1159亿美元]），大多数人有公共保险（49.8% [95%CI，44.4%-56.0%]）。据估计，2016年其他需要大量医疗保健支出的疾病是缺血性心脏病（893亿美元[95% CI，811 - 955亿美元]），福尔斯（874亿美元[95% CI，750 - 1001亿美元]），泌尿系统疾病（860亿美元[95% CI，763 - 959亿美元]），皮肤和皮下疾病（850亿美元[95% CI，805 - 902亿美元]），骨关节炎（800亿美元[95% CI，722 - 861亿美元]），痴呆（792亿美元[95% CI，676 - 908亿美元]）和高血压（790亿美元[95% CI，726 - 868亿美元]）。支出最高的条件因付款人类型、年龄、性别、护理类型和年份而异。在对通货膨胀、人口规模和年龄组的变化进行调整后，公共保险支出估计以2.9%（95%CI，2.9%-2.9%）的年化增长率增长;私人保险，2.6%（95%CI，2.6%-2.6%）;自付费用，1.1%（95%CI，1.0%-1.1%）。结论和相关性美国医疗保健支出的估计显示，从1996年到2016年，人口调整后的公共保险支出增幅最大。尽管用于下背部和颈部疼痛、其他肌肉骨骼疾病和糖尿病的支出占最高金额，支付者和年度支出增长率的变化率差异很大。问题不同支付者在不同健康状况上的支出如何变化（公共保险，私人保险，或自付），以及这种支出如何随着时间的推移而变化？从1996年到2016年，医疗保健总支出从估计的1.4万亿美元增加到估计的3.1万亿美元。2016年，私人保险占医疗支出的48.0%（95%CI，48.0%-48.0%），公共保险占医疗支出的42.6%（95%CI，42.5%-42.6%），自付医疗支出占医疗支出的9.4%（95%CI，9.4%-9.4%）。调整人口规模和老龄化后，私人保险的年化支出增长率为2.6%（95% CI，2.6%-2.6%），公共保险为2.9%（95% CI，2.9%-2.9%），自付支付为1.1%（95% CI，1.0%-1.1%）。了解每个支付者在每种健康状况上花费了多少钱，以及这些金额如何随着时间的推移而变化，可以为医疗保健政策提供信息。这项研究估计了1996年至2016年美国最常见的健康状况的医疗保健支出，包括腰痛和肌肉骨骼疾病，糖尿病和缺血性心脏病。
Importance US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time. Objective To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016. Design and Setting Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition. Exposures Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting. Main Outcomes and Measures National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016. Results Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP; $9655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion (95% CI, $122.4-$146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion [95% CI, $116.3-$149.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion]), falls ($87.4 billion [95% CI, $75.0-$100.1 billion]), urinary diseases ($86.0 billion [95% CI, $76.3-$95.9 billion]), skin and subcutaneous diseases ($85.0 billion [95% CI, $80.5-$90.2 billion]), osteoarthritis ($80.0 billion [95% CI, $72.2-$86.1 billion]), dementias ($79.2 billion [95% CI, $67.6-$90.8 billion]), and hypertension ($79.0 billion [95% CI, $72.6-$86.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%). Conclusions and Relevance Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance.Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.Question How does spending on different health conditions vary by payer (public insurance, private insurance, or out-of-pocket payments) and how has this spending changed over time? Findings From 1996 to 2016, total health care spending increased from an estimated $1.4 trillion to an estimated $3.1 trillion. In 2016, private insurance accounted for 48.0% (95% CI, 48.0%-48.0%) of health care spending, public insurance for 42.6% (95% CI, 42.5%-42.6%) of health care spending, and out-of-pocket payments for 9.4% (95% CI, 9.4%-9.4%) of health care spending. After adjusting for population size and aging, the annualized spending growth rate was 2.6% (95% CI, 2.6%-2.6%) for private insurance, 2.9% (95% CI, 2.9%-2.9%) for public insurance, and 1.1% (95% CI, 1.0%-1.1%) for out-of-pocket payments. Meaning Understanding how much each payer spent on each health condition and how these amounts have changed over time can inform health care policy.This study estimates health care spending for the most common health conditions in the United States, including low back pain and musculoskeletal disorders, diabetes, and ischemic heart disease, between 1996 and 2016.