Current, real-world healthcare cost information is needed to project future expenditures and inform policy. We estimated the healthcare costs for adults in 2019 in the United States by age, sex, race/ethnicity, geographic region, and comorbidity.
We aggregated and summarized the healthcare costs in 2021 US dollars using claims data derived from Optum’s deidentified Clinformatics® Data Mart Database, which includes inpatient, outpatient, and prescription claims for commercial and Medicare Advantage beneficiaries nationwide.
A total of 9 227 901 adults were included in the analysis. The largest group represented was 71 to 75 years old (13%), female (53%), White (68%), received care in the South (41%), and had commercial health insurance (56%). There was a positive relationship between healthcare cost and age. Females had a 1.3-fold multiplicative increase in costs than males (95% CI 1.33–1.34). There were 92.5% of individuals who had health claims in the Northeast, 89.6% in the Midwest, 88.9% in the South, 77.1% in the West, and 12.7% with unknown geographic region. Patients with severe renal failure, heart failure, or metastatic cancer incurred the highest mean yearly costs ($139 844, $113 031, and $85 299, respectively). Metastatic cancer and severe renal failure were associated with a 5.3-fold multiplicative increase in costs than not having these conditions, after adjusting for potential confounders (95% CI 5.26–5.41 and 4.98–5.16, respectively).
We identified patient characteristics and medical conditions that are associated with high healthcare cost burden and could benefit from tailored interventions. We provided detailed cost estimates to aid healthcare modeling, cost projection, and cost-minimizing interventions.
Understanding healthcare costs in the United States is crucial for planning future healthcare expenditures and shaping policies. This study analyzed healthcare costs for adults in 2019, focusing on how these costs vary by age, sex, race/ethnicity, geographic region, and health conditions (comorbidities). The research utilized a large database of health claims to provide a detailed picture of healthcare spending.
The analysis included over 9 million adults, finding that those aged 71 to 75 years represented the largest group. Overall, healthcare costs increased with age, with women experiencing 30% higher costs than men. Geographic location also influenced costs, with the Northeast and South showing higher expenses compared to the West. Certain health conditions significantly raised costs, especially severe renal failure, heart failure, and metastatic cancer, which had average yearly costs of $139,844, $113,031, and $85,299, respectively. Individuals with these conditions faced costs that were more than 5 times higher than those without them.
The findings highlight the significant financial burden associated with healthcare in the United States and the urgent need for targeted strategies to manage these costs, especially for high-risk groups. Tailored interventions, such as early referrals to financial counselors and proactive healthcare management, could help alleviate the financial strain on patients and the healthcare system.
This research is vital for patients, healthcare decision makers, and researchers. For patients, it emphasizes the importance of understanding their potential healthcare costs based on age and health conditions. For healthcare decision makers, the study provides essential data to inform policy and program development aimed at reducing costs while maintaining care quality. Researchers can use these insights to explore more effective ways to manage healthcare expenditures and improve patient outcomes.
In summary, this study sheds light on the complex landscape of healthcare costs in the United States, emphasizing the need for informed interventions to promote financial sustainability in healthcare while ensuring access to high-quality care for all.