U.S. healthcare spending soars on diabetes, heart diseases

Conditions with the most U.S. healthcare spending included cardiovascular diseases as well as type 2 diabetes, although spending significantly varied by location and payer types, according to a new study.

The observational analysis of over 40 billion insurance claims and nearly 1 billion facility claims estimated U.S. healthcare spending across four payers (Medicare, Medicaid, private insurance and out-of-pocket costs) for 148 health conditions from 2010 to 2019.

The study showed that, in 2019, aggregated health conditions with the most healthcare spending were cardiovascular diseases at $265.4 billion.

Out of the 24 aggregated health conditions, spending was also high on neoplasms at $258.8 billion and musculoskeletal disorders at $245.2 billion.

For a single health condition, type 2 diabetes was the most expensive of the 148 conditions analyzed in the study. Spending on type 2 diabetes reached $143.9 billion in 2019. During the study's period, though, spending on type 2 diabetes increased at a rate of 1.9%.

The study also found that 57.5% of the spending on type 2 diabetes was specific to adults 65 years or older, 34.5% was on ambulatory care and 31.2% was on prescribed pharmaceutical care. Medicare also spent the most on type 2 diabetes, contributing 39.6% of total spending across the four payer types.

Other costly single conditions in 2019 included musculoskeletal disorders, which include joint pain and osteoporosis, at $108.6 billion; oral disorders, which include dental caries and orthodontia, at $93 billion; ischemic heart disease at $80.7 billion; and urinary diseases at $72.2 billion.

Conditions with the fastest age- and sex-standardized annualized per capita growth rate during the study's period included autism spectrum disorders, opioid use disorders, alcohol use disorders, substance use disorders other than opioid and alcohol use disorders and kidney cancer. These conditions had at least $5 billion in spending.

Across all conditions, spending was concentrated on individuals 65 years or older, with more spending on those 65-69 years old versus all other age groups. However, spending per capita was greatest for the oldest age group (85 years or older).

With more spending concentrated among individuals at the Medicare-eligibility age, the study found that Medicare spent the most on older populations. Specifically, after the age of 65 years, 62.8% was estimated to be paid by Medicare, 18.5% paid by private insurance, 11.5% paid out of pocket and 7.2% paid by Medicaid.

Among younger populations, 62.8% was estimated to be paid by Medicare, 18.5% paid by private insurance, 11.5% paid out of pocket and 7.2% paid by Medicaid.

However, researchers pointed out that spending levels significantly varied by U.S. county, with nearly a three-fold difference from low-spending counties to high-spending counties, even after adjustments for age and size of population. The variation in spending was especially pertinent for out-of-pocket costs, private insurance spending and Medicaid spending.

"Understanding this variation at a local level, by health condition, sex, age, type of care, and payer offers critical insights for identifying outliers, tracking growth patterns, highlighting inequities, and assessing health care performance," the study stated.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.