Tracking US health care spending by health condition and county
Published February 14, 2025, in JAMA (opens in a new window)
This report reveals striking county-level variation in utilization of health care services and in health care spending, notably in private insurance, out-of-pocket spending, and emergency care.
Abstract
Importance
Understanding health conditions with the most spending and variation across locations and over time is important for identifying trends, highlighting inequalities, and developing strategies for lowering health spending.
Objective
To estimate US health care spending for each of 3110 US counties, across 4 payers (Medicare, Medicaid, private insurance, and out-of-pocket payments), and according to 148 health conditions, 38 age/sex groups, and 7 types of care from 2010 to 2019.
Design, setting, and participants
Observational analysis using more than 40 billion insurance claims and nearly 1 billion facility records.
Exposures
Ambulatory care, dental care, emergency department care, home health care, hospital inpatient care, nursing facility care, and purchase of prescribed retail pharmaceuticals.
Main outcomes and measures
Health care spending and utilization (eg, number of visits, admissions, or prescriptions) estimates from 2010 through 2019.
Results
Between 2010 and 2019, 76.6%of personal health care spending was captured by this study. More spending was on type 2 diabetes ($143.9 billion [95%CI, $140 billion - $147.2 billion]) than on any other health condition, followed by other musculoskeletal disorders, which includes joint pain and osteoporosis ($108.6 billion [95%CI, $106.4 billion-$110.3 billion]), oral disorders ($93 billion [95%CI, $92.7 billion-$93.3 billion]), and ischemic heart disease ($80.7 billion [95%CI, $79 billion-$82.4 billion]). Of total spending, 42.2%(95%CI, 42.2%-42.2%) was on ambulatory care, while 23.8% (95%CI, 23.8%-23.8%) was on hospital inpatient care and 13.7%(95%CI, 13.7%-13.7%) was on prescribed retail pharmaceuticals. At the county level, age-standardized spending per capita ranged from $3410 (95%CI, $3281-$3529) in Clark County, Idaho, to $13 332 (95%CI, $13 177-$13 489) in Nassau County, New York. Across counties, the greatest variation was in age-standardized out-of-pocket spending, followed by private insurance spending. Cross-county variation was driven more by variation in utilization rates than variation in price and intensity of care, although both types of variation were substantial for all payers but Medicare.
Conclusions and relevance
Broad variation in health care spending was observed across US counties. Understanding this variation by health condition, sex, age, type of care, and payer is valuable for identifying outliers, highlighting inequalities, and assessing health care gaps.
Citation
Dieleman JL, Beauchamp M, Crosby S, et al. Tracking US health care spending by health condition and county. JAMA. 14 February 2025. doi: 10.1001/jama.2024.26790
Authors
- Joseph Dieleman,
- Christopher J.L. Murray,
- Meera Beauchamp,
- Sawyer Crosby,
- Drew DeJarnatt,
- Haley Lescinsky,
- Theresa McHugh,
- Ian Pollock,
- Maitreyi Sahu,
- Vivianne Swart,
- Kayla Taylor,
- Azalea Thomson,
- Golsum Tsakalos,
- Max Weil,
- Lauren Wilner,
- Herbert Duber,
- Annie Haakenstad,
- Ali Mokdad,
- Mohsen Naghavi,
- Gregory Roth,
- John Scott