Report: Diabetes, Heart Disease, and Back Pain Dominate U.S. Health Care Spending

Twenty medical problems account for half of all expenses

Just 20 medical conditions account for more than half of all spending on health care in the United States, according to a new financial analysis from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The most expensive condition, diabetes, totaled $101 billion in diagnoses and treatments, growing 36 times faster than the cost of ischemic heart disease, the number one cause of death, during the 18-year study period (1996-2013), according to the study. While these two conditions typically affect individuals 65 years of age and older, low-back and neck pain, the third-most expensive conditions, primarily affect adults of working age.

These three top spending categories, along with hypertension and injuries from falls, accounted for 18% of all personal health spending and totaled $437 billion in 2013.

The new study, published in the Journal of the American Medical Association, distinguishes spending on public health programs from personal health spending, including both individual out-of-pocket costs and spending by private and government insurance programs. The report covers 155 conditions.

“While it is well known that the U.S. spends more than any other nation on health care, very little is known about what diseases drive that spending.” said lead author Dr. Joseph Dieleman. “IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively.”

In addition to the $2.1 trillion spent on the 155 conditions examined in the study, Dieleman estimates that approximately $300 billion in costs, such as those of over-the-counter medications and privately funded home health care, remains unaccounted for, indicating that total personal health care costs in the United States reached $2.4 trillion in 2013.

Other expensive conditions among the top 20 include musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome, and rheumatoid arthritis; well-care associated with dental visits; and pregnancy and postpartum care.

The study tracked a total of $30.1 trillion in personal health care spending during 1996–2013. While most of those costs were associated with noncommunicable diseases, the top infectious-disease category was respiratory infections, such as bronchitis and pneumonia.

Other key findings from the study include:

  • Women 85 years of age and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 40% was expended on cardiovascular diseases, Alzheimer’s disease, and falls.
  • Men 85 years of age and older spent $24,000 per person in 2013, with only 37% spent on nursing facilities, largely because women live longer and men more often have a spouse at home to provide care.
  • Less than 10% of personal health care spending was on nursing-care facilities, and less than 5% of spending was on emergency-department care. The conditions leading to the most spending in nursing facilities were Alzheimer’s disease and stroke, while the condition leading to the most spending in emergency departments was falls.
  • Public health education and advocacy initiatives, such as anti-tobacco and cancer awareness campaigns, cost an estimated $77.9 billion in 2013––less than 3% of total health care spending.
  • Only 6% of personal health care spending was on “well care” (all care unrelated to the diagnosis and treatment of illnesses or injuries). Of this, nearly one-third of the spending was on pregnancy and postpartum care, which was the tenth largest category of spending.

The top 10 most-costly health expenses in 2013 were:

  1. Diabetes – $101.4 billion
  2. Ischemic heart disease – $88.1 billion
  3. Low-back and neck pain – $87.6 billion
  4. Hypertension – $83.9 billion
  5. Injuries from falls – $76.3 billion
  6. Depressive disorders – $71.1 billion
  7. Oral-related problems – $66.4 billion
  8. Vision and hearing problems – $59 billion
  9. Skin-related problems, such as cellulitis and acne – $55.7 billion
  10. Pregnancy and postpartum care – $55.6 billion

Sources: IHME; December 27, 2016; and JAMA; December 27, 2016.