Health care spending on diabetes in the United States, 1996-2013

Abstract

The mortality and morbidity attributable to diabetes in the United States has increased by 31% from 1990 to 2015 to become the second leading cause of disease burden. During this same time period, health care spending on diabetes has also increased. These spending increases have not been examined in detail, making it difficult to design policies to contain diabetes health care spending. This research seeks to describe health care spending on diabetes in the United States from 1996 through 2013, disaggregated by age and sex of the patient and by type of care, and to determine what factors are driving increases in diabetes spending. Health spending estimates were extracted from the Disease Expenditure 2013 project database, produced by the Institute for Health Metrics and Evaluation. These estimates were made by synthesizing 183 data sources containing granular information on spending and utilization of health services across different types of care. Estimates were produced annually from 1996 to 2013, were adjusted for the presence of comorbid conditions, and were scaled to the official US Government spending records. Data on disease burden was extracted from the Global Burden of Disease 2015 study. We used demographic decomposition to measure the impact of population growth, population aging, diabetes prevalence, service utilization, and service price and intensity on diabetes health care spending. Health spending on diabetes in the US increased from $37 (95% Uncertainty Interval: 32-42) billion in 1996 to $101 (97-107) billion in 2013. The greatest amount of health care spending on diabetes in 2013 occurred in prescribed retail pharmaceuticals ($58 [55-63] billion), followed by ambulatory care ($24 [22-26] billion), inpatient care ($9.6 [8.6-11] billion), and nursing facility care ($9.2 [8.1-10] billion). Spending patterns also varied by age. In particular, spending was greatest for ages 65 and older ($43 [41-46] billion), followed by ages 45 to 64 ($45 [42-48] billion) and ages 20 to 44 ($11 [10-13] billion). Service and price intensity was the biggest determinant of spending increases in pharmaceutical spending and inpatient care, and increases in disease prevalence were the biggest determinant of spending increases in ambulatory care and nursing facility care. Knowing the types of care where spending increases are occurring can help policymakers attempting to control future spending on diabetes. In particular, growth in pharmaceutical spending reveals one important area of future focus.