US: Health System Expenditures - World Health Systems Facts

Current health expenditure (CHE) per capita in US$, 2022: $12,434.43

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure (OOP) per capita in US$, 2022: $1,380.12

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%), 2022: 11.1%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%), 2022: 44.83%

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) per capita in US$, 2022: $5,573.82

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%), 2022: 55.17%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%), 2022: 9.1%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) per capita in US$, 2022: $6,860.62

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Health expenditure per capita, USD PPP, 2022
– Government/compulsory: $10,644
– Voluntary/Out-of-pocket: $1,912
– Total: $12,555
Health expenditure as a share of GDP, 2022
– Government/compulsory: 14.1%
– Voluntary/out-of-pocket: 2%
Health expenditure by type of financing, 2021
– Government schemes: 30%
– Compulsory health insurance: 53%
– Voluntary health insurance: 1%
– Out-of-pocket: 11%
– Other: 5%
Out-of-pocket spending on health as share of final household consumption, 2021: 2.8%
Price levels in the healthcare sector, 2021 (OECD average = 100): 143
Expenditure on retail pharmaceuticals per capita, USD PPP, 2021
– Prescription medicines: $1,139
– Over-the-counter medicines: $293
– Total: $1,432
Expenditure on retail pharmaceuticals by type of financing, 2021:
– Government/compulsory schemes: 69%
– Voluntary health insurance schemes: 1%
– Out-of-pocket spending: 30%
Total long-term care spending as a share of GDP, 2021: 1.3%
Total long-term care spending by provider, 2021
– Nursing home: 59%
– Home care: 41%

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

(Note: “The OECD excludes from ‘health spending’ certain items included in the health spending data assembled and published by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (DHHS). Therefore, the OECD numbers are slightly lower than those published by the CMS, but the relative magnitude of spending among nations is indicative.” Source: Uwe E. Reinhardt, Priced Out: The Economic and Ethical Costs of American Health Care (Princeton University Press: Princeton, NJ, 2019), ISBN: 9780691192178.

Population with household expenditures on health >10% of total household expenditure or income, 2014-2021: 4.6%
Population with household expenditures on health >25% of total household expenditure or income, 2014-2021: 0.9%
Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE), 2021: 21.4%

Source: World health statistics 2024: monitoring health for the SDGs, Sustainable Development Goals: Statistical Annex. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. Last accessed June 8, 2024.

Annual household out-of-pocket payment in current USD per capita, 2020: $1,157

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed May 13, 2023.

“National health care spending reached $4.9 trillion in 2023 (or $14,570 per person), increasing 7.5 percent from 2022 (exhibit 1). This rate of growth was faster than in 2021 and 2022, when health care spending increased 4.2 percent and 4.6 percent, respectively. The lower growth during 2021 and 2022 was affected by the expiration of temporary federal funding associated with the COVID-19 pandemic (which was initiated in 2020 and was associated with a 10.4 percent increase in health spending in that year). In 2023, as the public health emergency ended and little COVID-19 federal funding remained, the acceleration in spending growth largely reflected increased use of health care goods and services, which influenced the strong growth in both private health insurance and Medicare spending. In addition, private health insurance enrollment increased and Medicaid enrollment levels remained high, leading to an insured share of the population that reached 92.5 percent (exhibit 2).

“Overall economic growth, as measured by gross domestic product (GDP), increased 6.6 percent in 2023 after a period of volatility that included a 0.9 percent decline in 2020 followed by increases of 10.9 percent in 2021 and 9.8 percent in 2022 (exhibit 1). Despite the volatility in health care spending and GDP growth over the past few years, on average, their growth rates were similar during 2020–23, at 6.6 percent per year and 6.5 percent per year, respectively (calculated from exhibit 1). Accordingly, health care spending as a share of GDP constituted 17.6 percent in 2023, similar to the 2019 share of 17.5 percent before the COVID-19 pandemic.

“The acceleration in health care spending growth (from 4.6 percent in 2022 to 7.5 percent in 2023) reflected growth in nonprice factors such as the use and intensity of services.¹ When adjusted for health care price inflation (as measured by the National Health Expenditure deflator), real health care spending increased 4.4 percent in 2023—a higher rate than the increase of 1.4 percent for such spending in 2022 and higher than the growth rate of real GDP, which was 2.9 percent in 2023 (exhibit 1).²

“Health care prices, as measured by the National Health Expenditure deflator, grew 3.0 percent in 2023 (exhibit 1), similar to the increase of 3.1 percent in 2022 and the average annual growth of 2.5 percent during 2020–22 but distinctly faster than the average rate of 1.4 percent for 2016–19.³ Economywide inflation, as measured by the GDP price index, grew 3.6 percent in 2023, which was a much slower rate than its increases of 4.5 percent in 2021 and 7.1 percent in 2022 (the fastest rate of growth since 1981).⁴

“Strong growth in private health insurance enrollment, which began in 2022, continued into 2023 and contributed to an increase in the insured share of the population, which reached 92.5 percent in 2023, up from 92.0 percent in 2022 (exhibit 2). Much of the growth in private health insurance enrollment was due to rapid growth in Affordable Care Act Marketplace enrollment, which increased by 5.8 million people during 2020–23 (data not shown), primarily as a result of enhanced subsidies that were made available by the American Rescue Plan Act of 2021 and renewed under the Inflation Reduction Act of 2022.⁵ Although Medicaid enrollment experienced much slower growth in 2023, mainly because of states resuming the redetermination of Medicaid eligibility after the end of pandemic-era coverage protections (also referred to as “unwinding”), enrollment still remained high, at 91.7 million beneficiaries—or, on average, 15.5 million more than were enrolled in 2020 (exhibit 2).⁶

Source: Anne B. Martin, Micah Hartman, Benjamin Washington, Aaron Catlin, and The National Health Expenditure Accounts Team, National Health Expenditures In 2023: Faster Growth As Insurance Coverage And Utilization Increased, Health Affairs (2024), doi.org/10.1377/hlthaff.2024.01375.

“Among payers, the acceleration in overall health spending growth in 2023 was driven mostly by private health insurance spending,⁷ which increased 11.5 percent in 2023 compared with growth of 6.8 percent in 2022 (exhibit 3). Medicare spending also grew at a faster rate, increasing 8.1 percent in 2023, compared with growth of 6.4 percent in 2022. For both payers, this faster spending growth was attributable to hospital care services and retail prescription drugs (data not shown).⁸ For Medicaid, in contrast, growth in spending continued to be strong, but it slowed from 9.7 percent in 2022 to 7.9 percent in 2023 (exhibit 3). This deceleration was influenced by much slower growth in enrollment as the Medicaid continuous enrollment provision ended on March 31, 2023.⁹

“Among health care goods and services, the acceleration in total national health spending growth in 2023 was primarily driven by faster growth in the three largest categories: hospital care, physician and clinical services, and retail prescription drugs. Hospital spending increased 10.4 percent in 2023, following much slower growth of 3.2 percent in 2022, and spending for physician and clinical services increased 7.4 percent in 2023, following growth of 4.6 percent in 2022 (exhibit 4). In both instances, the acceleration reflected an increase in nonprice factors, such as the use and intensity of services, after notably slower growth in 2022 (data not shown). Retail prescription drug spending also contributed to the acceleration, increasing 11.4 percent in 2023 from a rate of 7.8 percent in 2022 (exhibit 4), largely because of changes in the mix of drugs dispensed toward higher-cost, newer brand-name drugs¹⁰ and faster growth in retail prescription drug prices.¹¹“

“The United States spends far more money on healthcare than any other country, both on an absolute and a per capita basis. In 2017 total spending grew to $3.5 trillion (Martin et al., 2018). Table 3.1 shows US trends in spending from 1970 to 2018. After adjusting for inflation, real per capita expenditures increased by more than six-fold over this period and represented 17.7% of GDP in 2018.

“The government sector has also experienced large increases in health expenditures over the past 40 years. Compared to 1990, in 2018 the public (federal, state and local) share of total national health expenditures increased nearly 13 percentage points, from 32.3 to 44.8. Currently, about half of each healthcare dollar in the United States is paid for by the government – a figure that would probably surprise those who think of the system as largely a private one. Similarly, the proportion of all government spending accounted for by healthcare has risen from 14.5% in 1970 to 28.0% in 2018.”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2020; 22(4): pp. i–441.

“The share of GDP represented by government spending on healthcare has almost tripled since 1970. According to the 2018 US Federal Budget, total spending on Medicare and Medicaid exceeded total spending on both the Department of Defense and Social Security, which provides retirement income to seniors (defined here as those aged 65 and older) and disabled populations (CBO, 2018a).

“Historically, national health expenditure growth has outpaced that of the GDP (Fig. 3.1). Nevertheless, these growth rates have declined over the last 40 years. It is generally believed that the main factor for reduced growth rates in the 1990s was the proliferation of restrictive managed care practices. It is less clear why there has been a decline in the rate of growth since the mid-2000s. Part of the reason is probably related to financial constraints: it is difficult to afford sustained growth in healthcare spending when the national economy is largely stagnant. Prior to the ACA’s coverage expansions, this has been illustrated by the growth in the number of uninsured, higher premiums and cost-sharing requirements borne by consumers, all of which quell service usage. It is also worth noting that, despite a lower rate of growth in national health expenditures, absolute spending has doubled within the previous two decades, from $1.5 trillion in 2000 to $3.2 trillion in 2018, so even lower rates of growth can still represent substantial increases in spending. Growth in spending increased in 2014 and 2015 as millions more Americans gained insurance but has since slowed due to decreases in utilization, including hospital and physician care and prescription drugs (Martin et al., 2018).

“Total US healthcare spending as a share of GDP has consistently exceeded that of other OECD economies since 1970, and the gap is growing (Figs 3.2 and 3.3). In 2019 most European economies’ healthcare spending accounted for 8–11% of GDP and only a handful of OECD countries (France, Germany and Switzerland), exceeded 11%, compared to 17% in the United States. While it is difficult to anticipate how much spending will grow in future years, especially in light of the recent system reforms, the US government currently estimates that by 2026 spending will rise to $5.7 trillion and comprise 19.7% of GDP (Cuckler et al., 2018).”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2020; 22(4): pp. i–441.

“FINDINGS In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population !15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant mortality was the highest (5.8 deaths per 1000 live births in the US; 3.6 per 1000 for all 11 countries). The US did not differ substantially from the other countries in physician workforce (2.6 physicians per 1000; 43% primary care physicians), or nursing workforce (11.1 nurses per 1000). The US had comparable numbers of hospital beds (2.8 per 1000) but higher utilization of magnetic resonance imaging (118 per 1000) and computed tomography (245 per 1000) vs other countries. The US had similar rates of utilization (US discharges per 100,000 were 192 for acute myocardial infarction, 365 for pneumonia, 230 for chronic obstructive pulmonary disease; procedures per 100,000 were 204 for hip replacement, 226 for knee replacement, and 79 for coronary artery bypass graft surgery). Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries. For pharmaceutical costs, spending per capita was $1443 in the US vs a range of $466 to $939 in other countries. Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218,173 in the US compared with a range of $86,607 to $154,126 in the other countries.

“CONCLUSIONS AND RELEVANCE The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions.”

Source: Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA. 2018;319(10):1024-1039.

“Computations yielded the following estimated ranges of total annual cost of waste: failure of care delivery, $102.4 billion to $165.7 billion; failure of care coordination, $27.2 billion to $78.2 billion; overtreatment or low-value care, $75.7 billion to $101.2 billion; pricing failure, $230.7 billion to $240.5 billion; fraud and abuse, $58.5 billion to $83.9 billion; and administrative complexity, $265.6 billion. The estimated annual savings from measures to eliminate waste were as follows: failure of care delivery, $44.4 billion to $97.3 billion; failure of care coordination, $29.6 billion to $38.2 billion; overtreatment or low-value care, $12.8 billion to $28.6 billion; pricing failure, $81.4 billion to $91.2 billion; and fraud and abuse, $22.8 billion to $30.8 billion. No studies were identified that focused on interventions targeting administrative complexity. The estimated total annual costs of waste were $760 billion to $935 billion and savings from interventions that address waste were $191 billion to $286 billion.”

Source: Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. doi:10.1001/jama.2019.13978

“In 2021, the United States had an estimated population of 327 million individuals. Most of those individuals had private health insurance or were covered under a federal program (such as Medicare or Medicaid). About 8.6% of the U.S. population was uninsured. Individuals (including those who were uninsured), health insurers, and federal and state governments spent approximately $4.0 trillion on various types of health consumption expenditures (HCE) in 2021, which accounted for 17.4% of the nation’s gross domestic product.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. CRS Report No. IF10830. Updated Feb. 6, 2023, last accessed Nov. 10, 2023.

“Out-of-pocket spending (other than premiums) includes all amounts paid by the privately insured and other insured individuals for coinsurance, deductibles, and services not covered by insurance. It also includes amounts paid by the uninsured for health care goods and services. Among all individuals, out-of-pocket spending was $433 billion (10.7% of total HCE) in 2021, with roughly 30% attributable to durable medical equipment and other nondurable medical products.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. CRS Report No. IF10830. Updated Feb. 6, 2023, last accessed Nov. 10, 2023.

“In a retrospective analysis of consumer credit reports, the mean amount of medical debt was high, and it was greater among individuals who lived in the South and in zip codes in the lowest income deciles. Medicaid expansion under the ACA was associated with reduced medical debt overall, and with reduced gaps in the amount of medical debt between low-income and high-income communities.

“During the last decade, medical debt has become the largest source of debt in collections. The reductions in nonmedical debt in collections between 2009 and 2020 occurred simultaneously with the economic recovery from the Great Recession, consistent with the well-documented association between unemployment and loan delinquency.¹⁴ In contrast, total medical debt in collections decreased by a more modest amount. As a result, as of June 2020 individuals had $39 more in mean medical debt in collections than they had in mean debt in collections from all other sources combined ($429 vs $390), including credit cards, utilities, and phone bills.”

Source: Kluender R, Mahoney N, Wong F, Yin W. Medical Debt in the US, 2009-2020. JAMA. 2021;326(3):250–256. doi:10.1001/jama.2021.8694

“At the national level, 17.8% of persons with a credit report had medical debt in collections and 13.0% accrued medical debt during the prior year. Conditional on having medical debt, the mean stock was $2424 and the mean flow was $2396.”

Source: Kluender R, Mahoney N, Wong F, Yin W. Medical Debt in the US, 2009-2020. JAMA. 2021;326(3):250–256. doi:10.1001/jama.2021.8694

“Private health insurance is the predominant source of health insurance coverage in the United States. The private health insurance market includes both the group market (largely made up of employer-sponsored insurance) and the nongroup market (commonly referred to as the individual market, which includes plans directly purchased from an insurer both on and off health insurance exchanges). In 2021, these markets covered an estimated 179 million individuals (54.7% of the U.S. population) and 45 million individuals (13.7% of the U.S. population), respectively.

“In 2021, private health insurance expenditures accounted for $1,211 billion (29.9% of overall HCE). Private health insurance expenditures include amounts paid by insuring organizations to providers and all insuring organizations’ nonmedical net costs, which include but are not limited to taxes, net gains or losses to reserves, and profits. A majority of this spending was for hospital care and physician and professional services (Figure 1). Private health insurance spending experienced a decline from 2019 to 2020 (Figure 2), which was predominantly caused by enrollment decreases and lower health care utilization stemming from the Coronavirus Disease 2019 (COVID-19) pandemic.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. CRS Report No. IF10830. Updated Feb. 6, 2023, last accessed Nov. 10, 2023.

“Medicare is a federal health insurance program that pays for covered health care services for most people aged 65 and older and for certain permanently disabled individuals under the age of 65.

“An estimated 60 million individuals (18.2% of the U.S. population) were enrolled in Medicare in 2021. The program accounted for $901 billion (22.3% of overall HCE); this share is about 11 percentage points higher than Medicare’s percentage of HCE in 1970 (Figure 2). In 2021, most of the spending was for hospital care and physician and professional services (Figure 1).”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. CRS Report No. IF10830. Updated Feb. 6, 2023, last accessed Nov. 10, 2023.

“Medicaid is a joint federal-state program that finances the delivery of primary and acute medical services, as well as long-term services and supports, to a diverse low-income population, including children, pregnant women, adults, individuals with disabilities, and people aged 65 and older. The State Children’s Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance.

“An estimated 69 million individuals (21.1% of the U.S. population) received Medicaid or CHIP in 2021, and the programs accounted for $756 billion (18.7% of overall HCE). This spending is about 11 percentage points higher than Medicaid/CHIP’s percentage of total HCE in 1970 (Figure 2). Furthermore, relative to other coverage, Medicaid spends the highest percentage of its expenditures on long-term services and supports, which include (1) other health, residential, and personal care; (2) nursing care facilities and continuing care retirement communities; and (3) home health care (Figure 1).”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. CRS Report No. IF10830. Updated Feb. 6, 2023, last accessed Nov. 10, 2023.

“Health care services for military servicemembers, veterans, and their dependents are provided by the Department of Defense, through programs such as TRICARE, and the Department of Veterans Affairs. In 2021, an estimated 9 million individuals (2.7% of the U.S. population) had TRICARE and 7 million (2.2% of the U.S. population) individuals had VA Care. Together, these departments accounted for $150 billion (3.7%) of total HCE.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. CRS Report No. IF10830. Updated Feb. 6, 2023, last accessed Nov. 10, 2023.

“Approximately 28 million individuals (8.6% of the U.S. population) were uninsured in 2021. The uninsured rate was relatively stable from 2008 to 2013 before dropping 6 percentage points by 2016 to 8.6% (Figure 3). This drop in the uninsured rate corresponds with increases in nongroup coverage and Medicaid/CHIP coverage, which are associated with the implementation of various provisions of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), such as the exchanges, premium tax credit, and Medicaid expansion. Since 2016, the uninsured rate slowly increased to 9.2% in 2019 before falling to 8.6% in 2021, a decline that again corresponds with increases in nongroup coverage and Medicaid/CHIP coverage.

“The cost of care for the uninsured population is accounted for in multiple spending categories (Figure 1 and Figure 2). Payments made by uninsured individuals for health care services are included in the out-of-pocket total. (Payments that help cover the costs of services provided to uninsured individuals are included in other source totals.) Any amounts received by providers that help to partially and/or indirectly cover the cost of care for the uninsured are accounted for in corresponding source totals (e.g., Medicare and Medicaid disproportionate share hospital payments are included in program totals).”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. CRS Report No. IF10830. Updated Feb. 6, 2023, last accessed Nov. 10, 2023.

US: Health System Expenditures - out-of-pocket, price levels, insurance, pharmaceuticals, long-term care - National Policies - World Health Systems Facts

World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated March 17, 2025 by Doug McVay, Editor.