PhotoThere's a lot of talk about the high cost of health care, but do you know which conditions contribute most to health care spending?

If you said diabetes, you're right -- a new study finds diabetes costs $101 billion annually in diagnosis and treatment and is growing 36 times faster than the cost of heart disease, the leading cause of death and the second most-expensive condition. 

"While it is well known that the US spends more than any other nation on health care, very little is known about what diseases drive that spending." said Dr. Joseph Dieleman, lead author of a paper published in JAMA and Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively."

In fact, the study found that just 20 conditions make up more than half of all spending on health care in the United States.

While diabetes and heart disease primarily affected consumers 65 and over, lower back and neck pain, the third-most-expensive condition, primarily strikes adults of working age.

These three top spending categories, along with hypertension and injuries from falls, comprise 18% of all personal health spending and totaled $437 billion in 2013.

This study distinguishes between spending on public health programs from personal health spending, including both individual out-of-pocket costs and spending by private and government insurance programs. It covers 155 conditions.

$2.4 trillion

In addition to the $2.1 trillion spent on the 155 conditions examined in the study, Dr. Dieleman estimates that approximately $300 billion in costs, such as those of over-the-counter medications and privately funded home health care, remain unaccounted for, indicating total personal health care costs in the US reached $2.4 trillion in 2013.

Other expensive conditions among the top 20 include musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome, and rheumatoid arthritis; well-care associated with dental visits; and pregnancy and postpartum care.

Other key findings include:

  • Women ages 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 40% was expended on cardiovascular diseases, Alzheimer's disease, and falls.
  • Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a spouse at home to provide care.
  • Less than 10% of personal health care spending is on nursing care facilities, and less than 5% of spending is on emergency department care. The conditions leading to the most spending in nursing care facilities are Alzheimer's and stroke, while the condition leading to the most spending in emergency departments is falls.
  • Public health education and advocacy initiatives, such as anti-tobacco and cancer awareness campaigns, totaled an estimated $77.9 billion in 2013, less than 3% of total health spending.

Top 10 diseases

The top 10 most costly health expenses in 2013 were:

1. Diabetes - $101.4 billion

2. Ischemic heart disease - $88.1 billion

3. Low back and neck pain - $87.6 billion

4. Hypertension - $83.9 billion

5. Injuries from falls - $76.3 billion

6. Depressive disorders - $71.1 billion

7. Oral-related problems - $66.4 billion

8. Vision and hearing problems - $59 billion

9. Skin-related problems, such as cellulitis and acne - $55.7 billion

10. Pregnancy and postpartum care - $55.6 billion


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