America is notorious for overspending on health care. The World Bank estimates that the US spends 17.1% of its total GDP on health care, a greater percentage than literally every other country in the world. And it’s only going to grow: By 2020, US health care costs are expected to be so high that the country’s health care system would, on its own, comprise the fourth-largest economy in the world.
Whether the US is spending all that money wisely is another question. Compared to other wealthy countries, the US has relatively low life expectancy, a high infant mortality rate, a high percentage of adults with multiple chronic health issues, and extremely high levels of obesity. In an effort to figure out exactly how the US is squandering its health care dollars, researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington took data from the National Health Expenditure Accounts (NHEA) and broke them down into personal health spending and government public health activities, and then further separated the numbers into 155 specific conditions.
The final count, published today in JAMA, is striking. The top five conditions accounted for a total of $437 billion dollars in 2013—18% of all personal health spending, which includes hospital care, physician and clinical services, nursing facility care, and prescribed retail pharmaceutical spending.
Note: Various types of cancers were considered as their own separate conditions. The cancers Americans spent the most on in 2013 were colon and rectum cancer ($18.5 billion); trachea, bronchus, and lung cancer ($13.1 billion); and breast cancer ($12.1 billion).
But perhaps more interesting is how much of the burden of health care costs is born by individuals and their insurers (including Medicare and Medicaid): Total public health spending on things like education and advocacy initiatives such as government anti-tobacco awareness campaigns in 2013 was $77.9 billion, or just 2.8% of total health spending. Personal health care costs totaled about $2.1 trillion.
That’s despite the fact that initiatives like screening, immunization, and surveillance programs have been shown to be highly effective ways of improving overall public health. It also seems that the government’s expenditures on public health initiatives do not fully align with either those conditions commanding the most money from patients and their insurers, or with the illnesses that have the highest impact on life expectancy.
When it came to public health spending, the US government allocated more dollars to AIDS/HIV than any other condition, by far. And yet, in 2014 there were just 6,721 deaths in the country directly attributed to HIV. In addition, according to the new data published in JAMA, AIDS/HIV is ranked 75th on the list of personal health care expenditures, coming in at $4.8 billion.
The University of Washington research team also published an online data visualization tool that allows you to see in more detail how personal health care spending breaks down by disease type, age group, gender, and type of care (e.g. spending on drugs vs. on nursing care)—and to see how spending has changed over the years, from 1996 to 2013.
Correction: This article has been updated to clarify that personal health care spending includes Medicare and Medicaid, and to clarify what is included in “public health spending.”