Diabetes, heart disease, and back pain dominate US health care spending

Just 20 conditions make up more than half of all spending on health care in the United States, according to a new comprehensive financial analysis that examines spending by diseases and injuries.

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, over the past 18 years. While these two conditions typically affect individuals 65 and older, low back and neck pain, the third-most expensive condition, primarily strikes adults of working age.

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

This study, published today in JAMA, 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. It covers 155 conditions.

"While it is well known that the US spends more than any other nation on health care, very little is known about what diseases drive that spending." said Dr. Joseph Dieleman, lead author of the paper and Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "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, Dr. Dieleman estimates that approximately $300 billion in costs, such as those of over-the-counter medications and privately funded home health care, remain unaccounted for, indicating total personal health care costs in the US 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 paper, "US Spending on Personal Health Care and Public Health, 1996-2013," tracks a total of $30.1 trillion in personal health care spending over 18 years. While the majority of those costs were associated with non-communicable diseases, the top infectious disease category was respiratory infections, such as bronchitis and pneumonia.

Other key findings from the paper include:

• Women ages 85 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 ages 85 and older spent $24,000 per person in 2013, with only 37% 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 is on nursing care facilities, and less than 5% of spending is on emergency department care. The conditions leading to the most spending in nursing care facilities are Alzheimer's and stroke, while the condition leading to the most spending in emergency departments is falls.
• Public health education and advocacy initiatives, such as anti-tobacco and cancer awareness campaigns, totaled an estimated $77.9 billion in 2013, less than 3% of total health spending.
• Only 6% of personal health care spending was on well-care, which is all care unrelated to the diagnosis and treatment of illnesses or injuries. Of this, nearly a third of the spending was on pregnancy and postpartum care, which was the 10th-largest category of spending.

"This paper offers private insurers, physicians, health policy experts, and government leaders a comprehensive review," said IHME's Director, Dr. Christopher Murray. "As the United States explores ways to deliver services more effectively and efficiently, our findings provide important metrics to influence the future, both in short- and long-term planning."

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