US spending on personal health care and public health has increased substantially from 1996 to 2013, with diabetes, ischemic heart disease (IHD), and low back and neck pain accounting for the highest amounts of spending by disease category, according to a study published in JAMA.

Joseph L Dieleman, PhD, from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, and colleagues, identified government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 to 2013.  A total of 183 sources of data were used to estimate spending for 155 conditions.  For each record, spending was extracted, as well as the age and sex of the patient and the type of care received. Spending was adjusted to reflect the health condition treated, rather than the patient’s primary diagnosis.

Among the condition categories, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Diabetes had the highest healthcare spending in 2013, with an estimated $101.4 billion in spending, which includes 57.6% spent on pharmaceuticals and 23.5% spent on ambulatory care. IHC was the second-largest category with an estimated spending of $88.1 billion. Low back and neck pain accounted for the third-highest amount, with estimated healthcare spending of $87.6 billion.

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Personal health care spending increased for 143 of 155 conditions from 1996 to 2013. Spending on low back and neck pain and on diabetes increased the most, by an estimated $57.2 billion and $64.4 billion, respectively. Spending on emergency care and pharmaceuticals increased at the fastest rates, which were higher than annual rates for spending on inpatient care and nursing facility care.

Many of the top 20 conditions of healthcare spending in 2013 were chronic diseases with relatively high disease prevalence and health burden: diabetes, IHD, chronic obstructive pulmonary disease (COPD), and cerebrovascular disease. Also included in this list are disorders related to low back and neck pain, osteoarthritis, musculoskeletal disorders, neurologic disorders associated with pain syndromes and muscular dystrophy, injuries from falls, and depressive disorders.

“Understanding how healthcare spending varies can help health system researchers and policy makers identify which conditions, age and sex groups, and types of care are driving spending increases,” said the authors. “In particular, this information can be used to identify where new technologies and processes may yield a potential return on investment.”


  1. Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996-2013. JAMA. 27 December 2016. doi: 10.1001/jama.2016.16885.