Health Care Spending on Respiratory Diseases in the United States, 1996-2016

Abstract

Rationale: Respiratory conditions account for a large proportion of health care spending in the United States. A full characterization of spending across multiple conditions and over time has not been performed. Objectives: To estimate health care spending in the United States for 11 respiratory conditions from 1996 to 2016, providing detailed trends and an evaluation of factors associated with spending growth. Methods: We extracted data from the Institute of Health Metrics and Evaluation's Disease Expenditure Project Database, producing annual estimates in spending for 38 age and sex groups, 7 types of care, and 3 payer types. We performed a decomposition analysis to estimate the change in spending associated with changes in each of five factors (population growth, population aging, disease prevalence, service usage, and service price and intensity). Measurements and Main Results: Total spending across all respiratory conditions in 2016 was $170.8 billion (95% confidence interval [CI], $164.2-179.2 billion), increasing by $71.7 billion (95% CI, $63.2-80.8 billion) from 1996. The respiratory conditions with the highest spending in 2016 were asthma and chronic obstructive pulmonary disease, contributing $35.5 billion (95% CI, $32.4-38.2 billion) and $34.3 billion (95% CI, $31.5-37.3 billion), respectively. Increasing service price and intensity were associated with 81.4% (95% CI, 70.3-93.0%) growth from 1996 to 2016. Conclusions: U.S. spending on respiratory conditions is high, particularly for chronic conditions like asthma and chronic obstructive pulmonary disease. Our findings suggest that service price and intensity, particularly for pharmaceuticals, should be a key focus of attention for policymakers seeking to reduce health care spending growth.

Keywords: health economics; health expenditures; health policy.

Figure 1.

Total respiratory health care spending in the United States by age group, condition, and type of health care, 2016. Reported in 2016 U.S. dollars. Each of the three columns sums to the estimated $170.8 billion of 2016 respiratory spending disaggregated in this study. The width of each line reflects the relative share of the estimated $170.8 billion attributed to that age group, type of service, or respiratory condition.

Figure 2.

Total health care spending in the United States across time for all respiratory conditions and the five respiratory conditions with the greatest absolute increases in annual spending from 1996 to 2016. Reported in 2016 U.S. dollars. Each panel shows spending changes over time for a respiratory condition, disaggregated by type of care. Each colored line within a panel represents the mean estimate for a given type of care. Shaded areas indicate uncertainty intervals.

Figure 3.

Five-factor decomposition of changes in total spending from 1996 to 2016 for all respiratory conditions and the five respiratory conditions with the most spending in 2016. Reported in 2016 U.S. dollars. Each color corresponds to one of five factors and reflects the amount of spending change associated with that factor. Colored bars to the left of the vertical line (no change) indicate factors associated with decreased spending; to the right of the line, factors associated with increased spending within that type of care. Within each type of care, the sum of the five colored bars equals the total spending change, 1996 through 2016, indicated with a black marker. Error bars indicate uncertainty intervals of the total spending change.