National Health Care Spending In 2018: Growth Driven by ...
National Health Care Spending In 2018: Growth Driven by Accelerations in Medicare
and Private Insurance Spending
Office of the Actuary National Health Statistics Group
Micah Hartman, micah.hartman@cms. Anne Martin, anne.martin@cms.
Joseph Benson, joseph.benson@cms. Aaron Catlin, Deputy Director, aaron.catlin@cms.
and The National Health Expenditure Accounts Team
1
Overview
National Health Expenditures reached $3.6 trillion, or $11,172 per
person in 2018.
National health spending increased 4.6 percent in 2018 following 4.2
percent growth in 2017.
The acceleration was largely due to faster growth in private health
insurance and Medicare due in part to the health insurance tax.
Faster growth in prices more than offset a slight slowdown in use and
intensity of services.
The share of Gross Domestic Product (GDP) devoted to health was
17.7 percent in 2018--less than the 17.9 percent share in 2017.
2
Percent
Growth in National Health Expenditures and
Gross Domestic Product, 1987-2018
20.0 18.0 16.0 14.0 12.0 10.0
National health spending increased 4.6%; Share of GDP reached 17.7%
July 1990March 1991
Recession
March 2001November 2001
Recession
December 2007June 2009 Recession
NHE share of GDP: 17.7%
8.0
GDP: 5.4%
6.0
4.0
NHE: 4.6%
2.0
0.0
-2.0
2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987
Calendar Years
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group;
U.S. Department of Commerce, Bureau of Economic Analysis and National Bureau of Economic Research, Inc.
3
Drivers of Growth
2016: 4.6% growth
Slower growth in enrollment (PHI, Medicaid) and spending (all three major payers) Slower growth in use and intensity of good and services Rapid slowdown in growth in retail prescription drug spending from a decline in spending for
hepatitis C drugs, fewer new drugs introduced, and slower growth in prices
2017: 4.2% growth
Slower growth in use and intensity of goods and services, particularly for hospital care, physician
and clinical services, and retail prescription drugs
Nearly all major sources of insurance and sponsors of health care experienced slower growth The moratorium on the health insurance tax also contributed to the slowdown
2018: 4.6% growth
Faster growth in net cost of administration, Medicare, private health insurance, and retail
prescription drugs
Faster growth in economywide prices and the collection of the health insurance tax
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. 4
Enrollment in Private Health Insurance, Medicaid, Medicare, and the Uninsured (Levels in Millions)
Private Health Insurance Employer Sponsored Direct Purchase Marketplace Medigap Other Direct Purchase
2014
194.7 169.8 26.2
5.5 10.6 10.1
2015
200.3 172.2 29.6
9.0 11.6 9.0
2016
201.8 173.1 30.1 10.0 12.1
8.0
2017
202.1 175.6 28.0
9.8 11.9 6.4
2018
200.5 175.2 26.7
9.9 11.8 5.0
Medicaid Medicare
65.6
69.3
71.1
72.1
72.8
52.8
54.3
55.8
57.2
58.7
Uninsured
35.5
29.5
28.7
Insured Share of Population 88.8%
90.8%
91.1%
Note: Enrollment estimates are not mutually exclusive and are therefore not additive.
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
29.7 90.8%
30.7 90.6%
5
Annual Percent Change
Factors Accounting for Growth in
Per Capita National Health Expenditures,
Selected Calendar Years 2004-2018
Per capita health spending grew 4.0% in 2018
6.5% 6.0% 5.5% 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0%
5.7% 2004-2007
3.0% 2008-2013
Age and sex factors
4.5%
5.0%
3.8 %
3.5%
2014
2015
Residual use and intensity
2016
2017
Medical prices
4.0% 2018
NOTES: Medical price growth, which includes economywide and excess medical-specific price growth (or changes in medical-specific prices in excess of economywide inflation), is calculated using the chain-weighted national health expenditures (NHE) deflator for NHE. "Residual use and intensity" is calculated by removing the effects of population, age and sex factors, and price growth from the nominal expenditure level.
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
6
The Nation's Health Dollar, Calendar Year 2018: Where It Went
Public health, 3%
Government administration and net cost of health insurance,
8%
Investment, 5%
Hospital care, 33%
Other services, 13%
Nursing care facilities and continuing care retirement communities,
5% Other health, residential,
and personal care, 5%
Retail Prescription drugs, 9%
Physician and clinical services, 20%
NOTE: "Other services" includes Dental services, Other professional services, Home health care, Durable medical equipment, and Other nondurable medical products.
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
7
Annual Growth in National Health Expenditures, 2017 and 2018
2017 2018
National Health Expenditures
4.2 4.6
Personal Health Care
Government administration and net cost of health insurance
Public health activities
Investment
0.0
4.1 4.1
3.6
Health insurance tax impacts
12.0
3.0 2.4
7.4 3.6
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Annual Percent Change
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
8
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