Healthcare spending in the United States continues to vary substantially from one patient population to the next, according to a new study published in JAMA. The trend appears to be just as prevalent when it comes to spending related to cardiovascular disease as it is in other areas.
"Measuring healthcare spending by race and ethnicity is important for understanding patterns in utilization and treatment," wrote lead author Joseph L. Dieleman, PhD, with the Institute for Health Metrics and Evaluation in Seattle, and colleagues.
The team's analysis included information from 7.3 million health system visits, admissions and prescriptions. from Data was extracted from the Medical Expenditure Panel Survey (2002-2016), the Medicare Current Beneficiary Survey (2002-2012) the National Health Interview Survey (2002; 2016) and healthcare spending estimates from the Disease Expenditure project (1996-2016). They focused on six areas of care: cardiovascular diseases, cerebrovascular diseases, diabetes, low-back and neck pain, asthma, chronic obstructive pulmonary disease (COPD) and hypertension.
Many prior studies in this area occurred before the Affordable Care Act was signed into law, Dieleman et al. explained. Also, they wanted to focus more on the types of care patients are receiving.
The study's authors found statistically significant differences in estimated healthcare spending across six race and ethnicity groups, with differences reported for total spending, age-standardized spending, spending by type of care and health-condition specific spending per notified case.
Overall, the authors results revealed that 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.
The study is available here.
These are 3 important takeaways from the group's findings:
1. Healthcare spending is especially high for white patients.
In 2016, almost $2.4 trillion was spent on healthcare across the six types of care included in the team's analysis. White patients, which made up 61% of the population, accounted for 72% of healthcare spending. Hispanic and Black patients, which made up 18% and 12% of the population, respectively, accounted for 11% of total healthcare spending. Meanwhile, Asian, Native Hawaiian, or Pacific Islanders made up 6% of the total population, but accounted for just 3% of all healthcare spending.
2. Black patients spent a higher percentage of healthcare dollars on inpatient, emergency and nursing care.
Study data showed that the most relative variation in spending was for nursing facilities, emergency departments and dental care. Emergency department spending on American Indian or Alaska Native individuals was projected to be more per person than the all-population mean. American Indian or Alaska Native patients had less spending per person on dental care while Asian, Native Hawaiian, or Pacific Islander individuals had the least amount of estimated spending per person on each type of care relative to the other race and ethnicity groups, except for dental care.
Black patients spent less on ambulatory and dental care. However, they spent more on inpatient, emergency department, and nursing facility care. Hispanic patients had significantly less estimated spending per person for ambulatory, dental care, nursing facility care, and prescribed pharmaceuticals. White patient healthcare spending had projections higher than the all-population mean for ambulatory care and prescribed pharmaceuticals.
3. Healthcare spending for asthma, cardiovascular disease, cerebrovascular disease and COPD was high among Black patients.
Black and white patients had the most statistically significant differences when it came to healthcare spending. For asthma, cardiovascular disease, cerebrovascular disease, and COPD. Black individuals had significantly more spending per notified case. All statistically significant differences for Black individuals showed they had less utilization per notified case for ambulatory care, and more utilization per notified case for prescribed pharmaceuticals and especially inpatient care and emergency department care. White individuals had statistically less spending per notified case for asthma, cerebrovascular disease, COPD, and hypertension, and statistically significantly more spending per notified case on low back and neck pain.
The authors concluded by suggesting that further research is warranted to determine current healthcare spending by race and ethnicity, including spending related to the COVID-19 pandemic.