NHE Fact Sheet
Historical NHE, 2021:
- NHE grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP).
- Medicare spending grew 8.4% to $900.8 billion in 2021, or 21 percent of total NHE.
- Medicaid spending grew 9.2% to $734.0 billion in 2021, or 17 percent of total NHE.
- Private health insurance spending grew 5.8% to $1,211.4 billion in 2021, or 28 percent of total NHE.
- Out of pocket spending grew 10.4% to $433.2 billion in 2021, or 10 percent of total NHE.
- Other Third Party Payers and Programs and Public Health Activity spending declined 20.7% in 2021 to $596.6 billion, or 14 percent of total NHE.
- Hospital expenditures grew 4.4% to $1,323.9 billion in 2021, slower than the 6.2% growth in 2020.
- Physician and clinical services expenditures grew 5.6% to $864.6 billion in 2021, slower growth than the 6.6% in 2020.
- Prescription drug spending increased 7.8% to $378.0 billion in 2021, faster than the 3.7% growth in 2020.
- The largest shares of total health spending were sponsored by the federal government (34 percent) and the households (27 percent). The private business share of health spending accounted for 17 percent of total health care spending, state and local governments accounted for 15 percent, and other private revenues accounted for 7 percent.
For further detail see NHE Tables in downloads below.
Projected NHE, 2022-2031:
- Over 2022-2031 average growth in NHE (5.4 percent) is projected to outpace that of average GDP growth (4.6 percent) resulting in an increase in the health spending share of GDP from 18.3 percent in 2021 to 19.6 percent in 2031.
- The insured share of the population is projected to have been 92.3 percent in 2022 (an historic high) related to high Medicaid enrollment and gains in Marketplace enrollment and remain at that rate through 2023.
- Medicaid enrollment is projected to decline from its 2022 peak of 90.4M to 81.1M by 2025 as states disenroll beneficiaries no longer eligible for coverage. By 2031 the insured share of the population is projected to be 90.5%.
- The Inflation Reduction Act is projected to result in lower OOP spending on prescription drugs for 2024 and beyond as Medicare beneficiaries incur savings associated with several provisions from the legislation including the $2,000 annual OOP spending cap and lower gross prices resulting from negotiations with manufacturers.
For further detail see NHE projections 2022-2031 in downloads below.
NHE by Age Group and Sex, Selected Years 2002, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018, and 2020:
- Per person personal health care spending for the 65 and older population was $22,356 in 2020, over 5 times higher than spending per child ($4,217) and almost 2.5 times the spending per working-age person ($9,154).
- In 2020, children accounted for approximately 23 percent of the population and about 10 percent of all PHC spending.
- The working-age group comprised the majority of spending and population in 2014, 53 percent and over 60 percent respectively.
- Older Adults (aged 65 and older) were the smallest population group, about 17 percent of the population, and accounted for approximately 37 percent of all spending in 2020.
- Per person spending for females ($10,887) was 14 percent more than males ($9,554) in 2020.
- In 2020, per person spending for male children (0-18) was 10 percent more than females. However, for working age adults per person spending for females was 20 percent more than for males. For older adults, spending for males was 2 percent more than for females.
For further detail see health expenditures by age in downloads below.
NHE by State of Residence, 1991-2020:
- In 2020, per capita personal health care spending ranged from $7,522 in Utah to $14,007 in New York. Per capita spending in New York state was 37 percent higher than the national average ($10,191) while spending in Utah was about 26 percent lower.
- Health care spending by region continued to exhibit considerable variation. In 2020, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($12,728 and $12,577, respectively), or 25 and 23 percent higher than the national average. In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita ($8,497 and $8,587, respectively) with average spending 17 and 16 percent lower than the national average, respectively.
- Between 2014 and 2020, average growth in per capita personal health care spending was highest in New York at 6.1 percent per year and lowest in Wisconsin at 3.0 percent per year (compared with average growth of 4.3 percent nationally).
- The spread between the highest and the lowest per capita personal health spending across the states has remained relatively stable over 2014-20. Accordingly, the highest per capita spending levels were 90 to 100 percent higher per year than the lowest per capita spending levels during the period.
- Medicare expenditures per beneficiary were highest in Florida ($13,652) and lowest in Vermont ($8,726) in 2020.
- Medicaid expenditures per enrollee were highest in North Dakota ($12,314) and lowest in Georgia ($4,754) in 2020.
For further detail, see health expenditures by state of residence in downloads below.
NHE by State of Provider, 1980-2020:
- Between 2014 and 2020, U.S. personal health care spending grew, on average, 4.8 percent per year, with spending in Arizona growing the fastest (6.6 percent) and spending in Vermont growing the slowest (2.7 percent).
- In 2020, California’s personal health care spending was highest in the nation ($410.9 billion), representing 12.2 percent of total U.S. personal health care spending. Comparing historical state rankings through 2020, California consistently had the highest level of total personal health care spending, together with the highest total population in the nation. Other large states, New York, Texas, Florida, and Pennsylvania, also were among the states with the highest total personal health care spending.
- Wyoming’s personal health care spending was lowest in the nation (as has been the case historically), representing just 0.1 percent of total U.S. personal health care spending in 2020. Vermont, North Dakota, Alaska, and Montana were also among the states with the lowest personal health care spending in both 2020 and historically. All these states have smaller populations.
- Gross Domestic Product (GDP) by state measures the value of goods and services produced in each state. Health spending as a share of a state’s GDP shows the importance of the health care sector in a state’s economy. As a share of GDP, West Virginia ranked the highest (28.7 percent) and Washington state the lowest (11.7 percent) in 2020.
For further detail, see health expenditures by state of provider in downloads below.
Health expenditures by state of residence: summary tables (ZIP)
Health expenditures by state of provider: summary tables (ZIP)
NHE Tables (ZIP)
Age and Sex Tables (ZIP)
NHE Projections - Tables (ZIP)