History of Health Spending in the United States, 1960-2013
- This paper discusses trends in health care spending in the United States from 1960 to 2013. The authors break the times series into eras to analyze the different forces that drove health care spending and growth during the 53 year history of the National Health Expenditure Accounts. These forces include policy changes, legislation, recessions, prices, and public and private initiatives. Additionally, the article details changes in the mix of goods and services consumed as well as the payers, programs, and sponsors of health care spending.
2010 Comprehensive Revision
- In 2010 the National Health Statistics Group will undertake a comprehensive revision or benchmark. The purpose of this exercise is to incorporate any needed changes into the National Health Expenditure Accounts (NHEA). These changes include revisions to data, methodology, processing, and definitions as well as conceptual changes which will be incorporated into the estimates. This periodic review of the accounts helps ensure that the accounts remain current in concept, definition, and data.
- In this paper the authors compare the incremental or marginal increases in US health spending to that of the historical and projected Gross Domestic Product, Federal Outlays, and State and Local government expenditures. When viewed relative to the constraints in financial resources, these incremental changes in health spending provide a better understanding of the implications of decisions made by our Nation's health policymakers and financers of health care.
NHE Conference: Future Directions for the National Health Expenditure Accounts:
In April 2005, the National Health Statistics Group in the Office of the Actuary sponsored a conference to discuss future directions for the National Health Expenditure Accounts. A conference overview and a paper (“Reconciling Medical Expenditure Estimates from MEPS and NHEA, 2002”) presented at that conference were published in the Fall 2006 Issue of the Health Care Financing Review. Additional papers presented at the conference are available in downloadable files below.
These papers include:
- “The OECD System of Health Accounts and the US National Health Account: Improving Connections Through Shared Experiences” by Eva Orosz – A discussion of harmonization issues between the OECD and US measures of health spending.
- “How Policy Makers Use the National Health Accounts” by Nancy-Ann DeParle –The first paper discusses the impact of the MMA on the health accounting and what policy makers would like to see in the presentation of the Part D benefit.
- “Display and Categorization of Source of Funds Estimates in the National Health Accounts: Incorporating the MMA” by the National Health Statistics Group –This paper discusses how NHSG proposes to classify Part D spending from a health accounting perspective.
Capital in the National Health Accounts
- The National Health Expenditure Accounts were revised with the release of the 2004 estimates to include new measures of investment in medical sector structures and capital equipment. This study, "Capital in the National Health Accounts," prepared by Gerald F. Donahoe, formed the basis of the methodology for the new estimate. The study includes sections on the uses of data on capital, definitions of capital in various economic accounting systems, a survey of data available to estimates medical sector capital investment, as well as recommendations and prototype investment estimates.
The Impact of Technological Change on Health Care Cost Spending: An Evaluation of the Literature
- The impact of medical technology on growth in health care spending has long been a subject of vital interest, particularly in the context of long-term projections of health spending, which must address the issue of the applicability of historical trends to future periods. The objective of this paper is to estimate an approximate range for the contribution of technological change to growth in health spending based on a review of recent literature, and to evaluate factors which might modify this impact in the future.
Display and Categorization of Source of Funds Estimates in the National Health Expenditure Accounts: Incorporating the MMA (PDF)
DeParle: How Policy Makers Use the National Health Accounts (PDF)
Marginal analysis tables (PDF)
Orosz: OECD System of Health Accounts and the US National Health Account (PDF)
Donahoe: Capital in the National Health Accounts (PDF)
2010 Comprehensive Revision (PDF)
Smith et al: The Impact of Technological Change on Health Care Cost Spending: An Evaluation of the Literature (PDF)
Catlin and Cowan: History of Health Spending in the United States, 1960-2013 (PDF)
Hartman, Smith, Heffler, and Freeland: Monitoring Health Spending Increases: Incremental Budget Analyses Reveal Challenging Tradeoffs (PDF)