Escalating U.S. Healthcare Expenditures Attributed to Diabetes and Cardiovascular Diseases
A recent in-depth study has highlighted that US healthcare expenditures are largely influenced by cardiovascular diseases and type 2 diabetes, with notable differences across regions and payer categories. The extensive analysis, which examined over 40 billion insurance claims and nearly 1 billion facility claims, evaluated spending on 148 health conditions from 2010 to 2019. The study also assessed expenditures across four major payers: Medicare, Medicaid, private insurance, and out-of-pocket costs, providing valuable insights into the financial burden of these chronic illnesses.
In 2019, aggregated spending on cardiovascular diseases topped the list at $265.4 billion. Neoplasms followed closely at $258.8 billion, and musculoskeletal disorders accounted for $245.2 billion. Focusing on individual health conditions, type 2 diabetes emerged as the most costly, with expenditures reaching $143.9 billion in 2019. Throughout the study period, spending on type 2 diabetes exhibited an annual growth rate of 1.9%.
A detailed breakdown of type 2 diabetes spending revealed that 57.5% was allocated to adults aged 65 and older. Ambulatory care services constituted 34.5% of the expenses, while prescribed pharmaceuticals accounted for 31.2%. Medicare was the primary payer for type 2 diabetes, contributing 39.6% of the total spending across all payer types.
Other significant expenditures in 2019 included musculoskeletal disorders, encompassing conditions like joint pain and osteoporosis, at $108.6 billion; oral disorders, such as dental caries and orthodontic treatments, at $93 billion; ischemic heart disease at $80.7 billion; and urinary diseases at $72.2 billion.
The study also identified conditions with the fastest age- and sex-standardized annualized per capita growth rates during the study period. These included autism spectrum disorders, opioid use disorders, alcohol use disorders, other substance use disorders, and kidney cancer, each with at least $5 billion in spending.
Spending patterns varied notably across age groups. Individuals aged 65 and older accounted for a substantial portion of healthcare expenditures, with the 65-69 age bracket incurring more costs than other groups. Per capita spending peaked among those aged 85 and above. Post-65, Medicare covered 62.8% of expenses, private insurance 18.5%, out-of-pocket payments 11.5%, and Medicaid 7.2%.
Geographical disparities were evident, with nearly a threefold difference in spending between low- and high-expenditure counties, even after adjusting for age and population size. This variation was particularly pronounced in out-of-pocket costs, private insurance spending, and Medicaid expenditures. The study emphasized that understanding local-level variations by health condition, sex, age, type of care, and payer is crucial for identifying outliers, tracking growth patterns, highlighting inequities, and assessing healthcare performance.
These findings underscore the pressing need for targeted interventions and policies aimed at managing and reducing the financial burden of chronic diseases, particularly cardiovascular conditions and type 2 diabetes, on the U.S. healthcare system.
