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Total Health Spending, USD PPP Per Capita (2019): $10,948

(Note: “Health spending measures the final consumption of health care goods and services (i.e. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Health care is financed through a mix of financing arrangements including government spending and compulsory health insurance (“Government/compulsory”) as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations (“Voluntary”). This indicator is presented as a total and by type of financing (“Government/compulsory”, “Voluntary”, “Out-of-pocket”) and is measured as a share of GDP, as a share of total health spending and in USD per capita (using economy-wide PPPs).”

Source: OECD (2021), Health spending (indicator). doi: 10.1787/8643de7e-en. Last accessed 19 April 2022.

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Current Health Expenditure Per Capita (USD) (2019): $10,921

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

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Current Health Expenditure As Percentage Of Gross Domestic Product (2019): 16.77%

Source: Global Health Observatory. Current health expenditure (CHE) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed April 19, 2022.

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Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure (2019): 11.31%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed April 19, 2022.

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Out-Of-Pocket Expenditure Per Capita (USD) (2019): $1,235

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed August 24, 2022.

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Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2019): 22.4%
Population with household expenditures on health greater than 10% of total household expenditure or income (2012-2020) (%): 4.3%
Population with household expenditures on health greater than 25% of total household expenditure or income (2012-2020) (%): 0.8%

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“National health expenditures increased by 2.7 percent in 2021 to $4.3 trillion ($12,914 per person) after growing 10.3 percent in 2020, with a decline in federal government health care spending related to the COVID-19 pandemic as the main contributor to the slower growth rate (exhibit 1). Concurrently, after contracting in 2020, gross domestic product (GDP) increased by 10.7 percent¹ (the largest growth rate since 1984) as both real output² and prices³ accelerated (with inflation trends faster for the latter half of 2021). The divergent trends in the health sector and overall economy led to a decline in the health spending share of GDP to 18.3 percent in 2021 after a sharp increase in 2020 to 19.7 percent (up from 17.6 percent in 2019). Three key factors affected the spending trend in 2021, with the decline in federal government health care spending far outweighing greater use of health care goods and services and increased insurance coverage.

“Health care spending by the federal government declined 3.5 percent (by $0.05 trillion) to $1.46 trillion in 2021 after an increase of 36.8 percent in 2020 (from $1.10 trillion to $1.51 trillion) (exhibit 2). An influx of federal COVID-19 funding in 2020, such as from the Provider Relief Fund, the Paycheck Protection Program, and public health activity, contributed to the $0.41 trillion increase in federal government spending in 2020.⁴ Although this COVID-19 funding continued in 2021, it was at a much lower level than in 2020. In addition, federal Medicaid spending increased more slowly in 2021 (11.4 percent) than in 2020 (18.8 percent).

“The Provider Relief Fund and the Paycheck Protection Program — two federal COVID-19 supplemental funding programs that assisted businesses with payroll, potential increases in expenses, and lost revenue due to the pandemic — are included in the expenditure category ‘Other federal programs.’ Spending in this category decreased to $71.9 billion in 2021 from $193.1 billion in 2020 (a decline of 62.7 percent) but was still higher than its level of $14.0 billion in 2019 (exhibit 3). In the spending category ‘Public health activity,’ federal spending, which included funding for vaccine development and health facility preparedness, increased from $13.3 billion in 2019 to $135.8 billion in 2020 but then dropped to $78.8 billion in 2021 (a 41.9 percent decrease). The declines in spending in these two categories were the largest contributors to the slower growth in overall health care expenditures in 2021 (exhibit 4).

“As a share of total health spending, the federal government accounted for 34 percent in 2021 (compared with 36 percent in 2020 and 29 percent in 2019), whereas the other sponsors of health care (state and local governments, households, and businesses) all had similar or slightly larger shares in 2021 than in 2020 (exhibit 2).”

(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.

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“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.

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“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.

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“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.

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“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

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“In 2020, the United States had an estimated population of 326 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 8.6% of the U.S. population was uninsured. Individuals (including those who were uninsured), health insurers, and federal and state governments spent approximately $3.9 trillion on various types of health consumption expenditures (HCE) in 2020, which accounted for 18.8% of the nation’s gross domestic product.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated April 1, 2022.

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“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 $389 billion (9.9% of total HCE) in 2020.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated April 1, 2022.

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“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

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“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

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“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 2020, these markets covered an estimated 177 million individuals (54.4% of the U.S. population) and 34 million individuals (10.5% of the U.S. population), respectively.

“In 2020, private health insurance expenditures accounted for $1,151 billion (29.3% 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 in 2020 (Figure 2). This decline 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. Updated April 1, 2022.

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“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 (18.4% of the U.S. population) were enrolled in Medicare in 2020. The program accounted for $829 billion (21.1% of overall HCE); this share is about 10 percentage points higher than Medicare’s percentage of HCE in 1970 (Figure 2). In 2020, 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 April 1, 2022.

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“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 58 million individuals (17.8% of the U.S. population) received Medicaid or CHIP in 2020, and the programs accounted for $693 billion (17.6% 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 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). Long-term services and supports also include some postacute 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 April 1, 2022.

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“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 2020, an estimated 9 million individuals (2.8% of the U.S. population) had TRICARE and 3 million (0.9% of the U.S. population) individuals had VA Care. Together, these departments accounted for $136 billion (3.5%) of total HCE.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated April 1, 2022.

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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 sixteen other nations.

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Page last updated Dec. 23, 2022 by Doug McVay, Editor.