US: Health System Expenditures - Health Systems Facts

Current Health Expenditure Per Capita (USD) (2016): $9,870
Current Health Expenditure as Percentage of Gross Domestic Product (%) (2016): 17.1%
Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2016): 39.5%
Population with household expenditures on health greater than 10% of total household expenditure or income (2009-2015) (%): 4.8%
Population with household expenditures on health greater than 25% of total household expenditure or income (2009-2015) (%): 0.8%

Source: World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf
https://www.who.int/gho/publications/world_health_statistics/2019/en/

Annual household out-of-pocket payment, constant (2016) PPP, per capita (USD) (2016): $1,094

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Nov. 15, 2019.
http://apps.who.int/nha/database/

“US health care spending increased 4.6 percent to reach $3.8 trillion in 2019, similar to the rate of growth of 4.7 percent in 2018. The share of the economy devoted to health care spending was 17.7 percent in 2019 compared with 17.6 percent in 2018. In 2019 faster growth in spending for hospital care, physician and clinical services, and retail purchases of prescription drugs—which together accounted for 61 percent of total national health spending—was offset mainly by expenditures for the net cost of health insurance, which were lower because of the suspension of the health insurance tax in 2019.”

Source: Anne B. Martin, Micah Hartman, David Lassman, Aaron Catlin, and The National Health Expenditure Accounts Team. National Health Care Spending In 2019: Steady Growth For The Fourth Consecutive Year
Health Affairs (2021). https://doi.org/10.1377/hlthaff.2020.02022
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.02022

(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.
https://press.princeton.edu/books/hardcover/9780691192178/priced-out

“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.
https://www.ncbi.nlm.nih.gov/pubmed/29536101

“In 2017, the United States had an estimated population of 321 million individuals. Most of those individuals had private health insurance or received health care services under a federal program (such as Medicare or Medicaid). About 8.7% of the U.S. population was uninsured.

“Individuals (including those who were uninsured), health insurers, and federal and state governments spent approximately $3.3 trillion on various types of health consumption expenditures (HCE) in 2017, which accounted for 17.1% of the nation’s gross domestic product.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated March 21, 2019.
https://crsreports.congress.gov/product/pdf/IF/IF10830

“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 any amounts paid by the uninsured for health care goods and services. Among all individuals, out-of-pocket spending totaled $365 billion (11.0% of total HCE) in 2017.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated March 21, 2019.
https://crsreports.congress.gov/product/pdf/IF/IF10830

“In 2017, private health insurance accounted for $1,184 billion (35.6% of overall HCE). Private health insurance expenditures (Figure 1) 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.

“Most of this spending was for hospital care and physician and professional services (Figure 1). Private health insurance spending, as a percentage of all health consumption expenditures, has increased by about 12 percentage points since 1960 (Figure 2). This growth is partially due to increases in enrollment and, when considered alongside the implementation and expansions of Medicare and Medicaid, corresponds with the drop in out-of-pocket spending since 1960.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated March 21, 2019.
https://crsreports.congress.gov/product/pdf/IF/IF10830

“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 55 million individuals (17.3% of the U.S. population) were enrolled in Medicare in 2017. The program accounted for $706 billion (21.2% of overall HCE); this share is about 10 percentage points higher than Medicare’s percentage of HCE in 1970 (Figure 2). In 2017, 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. Updated March 21, 2019.
https://crsreports.congress.gov/product/pdf/IF/IF10830

“An estimated 66 million individuals (20.6% of the U.S. population) received Medicaid or CHIP in 2017, and the programs accounted for $600 billion (18.0% of overall HCE). This spending is about 10 percentage points higher than Medicaid/CHIP’s percentage of total HCE in 1970 (Figure 2). Furthermore, Medicaid spends the highest percentage of expenditures on long-term services and supports, which includes (1) other health, residential, and personal care; (2) nursing care facilities and continuing care retirement communities; and (3) home health care (Figure 1). Long-term services and supports also includes some post-acute care (i.e., skilled care provided over a short term, typically after a hospitalization).”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated March 21, 2019.
https://crsreports.congress.gov/product/pdf/IF/IF10830

“Health care services for military service-members, veterans, and their dependents are provided by the Department of Defense, through programs such as TRICARE, and the Department of Veterans Affairs. In 2017, an estimated 9 million individuals (2.7% of the U.S. population) had TRICARE and 7 million (2.3% of the U.S. population) individuals had VA Care. Together, these departments accounted for $114 billion (3.4%) of total HCE.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated March 21, 2019.
https://crsreports.congress.gov/product/pdf/IF/IF10830

“Administrative costs are considerably higher in the United States than in other countries. Private insurers usually operate on a for-profit basis and seek returns for investors. They market through advertising, determine whether a person or group should be eligible to purchase private coverage and process claims. Obtaining payment from insurers – both public and private – often involves considerable administrative effort. Hospitals and physician groups require substantial resources (labour and capital) for administration in dealing with multiple private insurers as well as government programmes, particularly Medicare and Medicaid.”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2013; 15(3): 1– 431.
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/united-states-of-america-hit-2013

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

Page last updated Dec. 16, 2020 by Doug McVay, Editor.