US: Health System Financing - World Health Systems Facts

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 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.

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.

“The federal government is the largest sponsor of health care expenditures ($1.7 trillion and a 31 percent share in 2024); its share includes the federal portion of Medicaid payments, federal Medicare payments, and federal government contributions to private health insurance as an employer, as well as other federal health insurance and programs (exhibit 4). Federal government–sponsored health care spending increased 5.5 percent in 2024, accelerating from growth of 3.8 percent in 2023. The increase in 2024 was driven by continued rapid growth in Marketplace tax credits and subsidies (34.9 percent in 2024, following 25.5 percent growth in 2023), as well as strong growth in federal Medicare expenditures financed by the federal government (9.6 percent in 2024, following 14.9 percent growth in 2023),¹⁰ which was associated with provisions in the Inflation Reduction Act (IRA) of 2022 that reduced beneficiary cost sharing and shifted more financial responsibility to the federal government (data not shown).¹¹ Although still growing, federal Medicaid spending increased just 0.7 percent in 2024, after growth of 3.6 percent in 2023 (exhibit 5), as enrollment in the program dropped by 7.9 million people (calculated from exhibit 3) and the enhanced federal medical assistance percentage (FMAP) was phased out.¹²“

Source: Hartman M, Martin AB, Lassman D, Catlin A; National Health Expenditure Accounts Team. National Health Care Spending Increased 7.2 Percent In 2024 As Utilization Remained Elevated. Health Aff (Millwood). Published online January 14, 2026. doi:10.1377/hlthaff.2025.01683

“Health care spending by households ($1.5 trillion) represented 28 percent of all health care spending in 2024 and increased 6.9 percent, a similar rate of growth as in 2023 (6.7 percent) (exhibit 4). The stable trend was a result of offsetting factors. Household spending for Medicare premiums and payroll taxes paid by individuals, as well as premiums paid for individually purchased health insurance, all grew faster in 2024; both increased by 7.0 percent (data not shown). In contrast, growth in out-of-pocket spending (such as deductibles, copayments, and coinsurance) slowed from 6.8 percent in 2023 to 5.9 percent in 2024 (exhibit 5), and growth in employee contributions to employer-sponsored private health insurance slowed from 8.8 percent in 2023 to 6.8 percent in 2024.¹³ Of note was slower out-of-pocket spending growth in 2024 for nondurable medical products such as nonprescription drugs and other medical products (from 6.3 percent growth in 2023 to 3.7 percent growth in 2024).¹³“

“Private businesses’ health spending ($967.4 billion) represented 18 percent of all health expenditures in 2024 and increased by 5.6 percent, slowing from growth of 10.3 percent in 2023 (exhibit 4). More than three-quarters of spending in this category is for private businesses’ contributions to employer-sponsored private health insurance. Private employers contributed 72 percent to private employer–sponsored private health insurance spending, and households contributed the remaining 28 percent, a split that has been relatively stable in recent years. In 2024, private businesses’ spending on employer-sponsored private health insurance grew 6.3 percent, a deceleration from 12.2 percent growth in 2023.¹³“

“Spending by state and local governments ($859.7 billion) accounted for 16 percent of total health care expenditures in 2024 and increased 12.1 percent—a slightly faster rate of growth than in 2023, when this spending increased 11.1 percent (exhibit 4). The state and local portion of Medicaid payments, which accounted for 39 percent of all state and local government spending,¹³ exhibited strong growth in both 2023 and 2024, increasing 18.2 percent and 19.2 percent, respectively (exhibit 5), as states paid for a greater share of spending as a result of the phasing out of the enhanced FMAP.¹²“

Table 18 - Political Economic Research Institute 2018 report on Medicare For All

“Overall then, as Table 18 shows, our bottom-line figure for all existing public funding sources available to finance Medicare for All is $1.88 trillion (rounded down from $1.884 trillion). This figure includes, again, 1) all available public insurance funds; 2) funds now provided for other public third-party payers; and 3) federal tax subsidies as well as health insurance spending on federal government employees.

“Given our estimate that the costs of providing universal coverage under Medicare for All would be $2.93 trillion in 2017, we can then conclude that, for the U.S. economy as of 2017, we would need to raise an additional $1.05 trillion in new taxes to fully fund Medicare for All. We show our simple derivation of this figure in Table 19.

“Of course, these new tax revenues would not constitute a net additional cost or spending burden on the U.S. economy. These funds would rather be serving to substitute for the loss of revenue into the U.S. health care system that presently come from existing private revenue sources— i.e. primarily private health insurance and out-of-pocket expenditures. These private revenue sources would no longer operate.”

Source: Pollin R, Heintz J, Arno P, Wicks-Lim J, Ash M. Economic analysis of Medicare for All. Research report. Political Economics Research Institute. 30 November 2018.

US: Health System Financing - Government, Private, Out-Of-Pocket, Current Health Expenditures - 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 February 8, 2026 by Doug McVay, Editor.