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How did health care spending vary by race and ethnicity groups in the US from 2002 through 2016?
This exploratory study that included data from 7.3 million health system visits, admissions, or prescriptions found age-standardized per-person spending was significantly greater for White individuals than the all-population mean for ambulatory care; for Black individuals for emergency department and inpatient care; and for American Indian and Alaska Native individuals for emergency department care. Hispanic and Asian, Native Hawaiian, and Pacific Islander individuals had significantly less per-person spending than did the all-population mean for most types of care, and these differences persisted when controlling for underlying health.
In the US from 2002 through 2016, there were differences in age-standardized health care spending by race and ethnicity across different types of care.
Measuring health care spending by race and ethnicity is important for understanding patterns in utilization and treatment.
To estimate, identify, and account for differences in health care spending by race and ethnicity from 2002 through 2016 in the US.
Design, Setting, and Participants
This exploratory study included data from 7.3 million health system visits, admissions, or prescriptions captured in the Medical Expenditure Panel Survey (2002-2016) and the Medicare Current Beneficiary Survey (2002-2012), which were combined with the insured population and notified case estimates from the National Health Interview Survey (2002; 2016) and health care spending estimates from the Disease Expenditure project (1996-2016).
Six mutually exclusive self-reported race and ethnicity groups.
Main Outcomes and Measures
Total and age-standardized health care spending per person by race and ethnicity for each year from 2002 through 2016 by type of care. Health care spending per notified case by race and ethnicity for key diseases in 2016. Differences in health care spending across race and ethnicity groups were decomposed into differences in utilization rate vs differences in price and intensity of care.
In 2016, an estimated $2.4 trillion (95% uncertainty interval [UI], $2.4 trillion-$2.4 trillion) was spent on health care across the 6 types of care included in this study. The estimated age-standardized total health care spending per person in 2016 was $7649 (95% UI, $6129-$8814) for American Indian and Alaska Native (non-Hispanic) individuals; $4692 (95% UI, $4068-$5202) for Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals; $7361 (95% UI, $6917-$7797) for Black (non-Hispanic) individuals; $6025 (95% UI, $5703-$6373) for Hispanic individuals; $9276 (95% UI, $8066-$10 601) for individuals categorized as multiple races (non-Hispanic); and $8141 (95% UI, $8038-$8258) for White (non-Hispanic) individuals, who accounted for an estimated 72% (95% UI, 71%-73%) of health care spending. After adjusting for population size and age, White individuals received an estimated 15% (95% UI, 13%-17%; P < .001) more spending on ambulatory care than the all-population mean. Black (non-Hispanic) individuals received an estimated 26% (95% UI, 19%-32%; P < .001) less spending than the all-population mean on ambulatory care but received 19% (95% UI, 3%-32%; P = .02) more on inpatient and 12% (95% UI, 4%-24%; P = .04) more on emergency department care. Hispanic individuals received an estimated 33% (95% UI, 26%-37%; P < .001) less spending per person on ambulatory care than the all-population mean. Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals received less spending than the all-population mean on all types of care except dental (all P < .001), while American Indian and Alaska Native (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 90% more; 95% UI, 11%-165%; P = .04), and multiple-race (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 40% more; 95% UI, 19%-63%; P = .006). All 18 of the statistically significant race and ethnicity spending differences by type of care corresponded with differences in utilization. These differences persisted when controlling for underlying disease burden.
Conclusions and Relevance
In the US from 2002 through 2016, health care spending varied by race and ethnicity across different types of care even after adjusting for age and health conditions. Further research is needed to determine current health care spending by race and ethnicity, including spending related to the COVID-19 pandemic.
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Corresponding Author: Joseph L. Dieleman, PhD, Institute for Health Metrics and Evaluation, Population Health Bldg/Hans Rosling Center, 3980 15th Ave NE, Seattle, WA 98195 (firstname.lastname@example.org).
Accepted for Publication: June 4, 2021.
Author Contributions: Dr Dieleman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Dieleman, Chen, Crosby, Liu, McCracken, Sahu, Mokdad, Scott, Murray.
Acquisition, analysis, or interpretation of data: Dieleman, Crosby, Liu, McCracken, Pollock, Sahu, Tsakalos, Dwyer-Lindgren, Haakenstad, Mokdad, Roth.
Drafting of the manuscript: Dieleman, McCracken, Mokdad, Scott.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Dieleman, Chen, Crosby, Liu, Haakenstad, Mokdad.
Obtained funding: Dieleman, Dwyer-Lindgren, Mokdad.
Administrative, technical, or material support: Dieleman, Liu, McCracken, Tsakalos, Mokdad, Scott.
Supervision: Dieleman, Tsakalos, Mokdad, Murray.
Conflict of Interest Disclosures: Dr McCracken’s position was supported in part through the Wellcome Trust and by the Department of Health and Social Care using UK aid funding managed by the Fleming Fund. Dr Dwyer-Lindgren reported receiving grants from the Bill and Melinda Gates Foundation and the Kaiser Foundation Research Institute outside the submitted work. No other disclosures were reported.
Funding/Support: This research was supported by grants 75N94019C00016 from the National Institute of Minority Health and Health Disparities, P30AG047845 from the National Institute on Aging, and from the Peterson Center on Healthcare (Drs Dieleman and McCracken; Mss Chen, Sahu, and Tsakalos; and Messrs Crosby and Pollock).
Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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