Abstract
This article distributes the Health Care Financing Administration's (HCFA) estimates of 1995 personal health care expenditures (PHCE) according to sex, age, and diagnosis for each type of health care service. Aggregate and per capita expenditures are reported for 18 broad categories of disease classified according to the International Classification of Diseases (ICD-9-CM). Special emphasis is given to expenditures for persons age 65 or over, the segment of the population with the highest expenditures. These results show how the relative importance of medical conditions and type of health services differs between the sexes and changes with increasing age.
Introduction
National health expenditures (NHE) were $991 billion in 1995, and accounted for 13.6 percent of gross domestic product (Levit et al., 1997). Almost 88 percent of NHE, $869 billion, was for personal health care. Knowing how PHCE are distributed among medical conditions, how much spending for each disease goes to the various health services, and the profile of spending for each disease and health service according to sex and age is a first step in achieving awareness of the costs of specific diseases, who bears the medical care expenditure burden, and potential savings attainable through effective, targeted interventions.
Although there are many studies of expenditures for specific diseases, these frequently employ diverse data and methods so that alternative estimates for the same disease are not consistent, and the relative amounts spent for different diseases are distorted. Only by employing consistent methodology and data across all diseases can it be ensured that expenditures for various diseases can be compared and the sum of expenditures for all diseases totals to HCFA's PHCE. The initial pioneering analysis that distributed total PHCE by medical diagnosis and type of health care service was by Dorothy Rice (1966) for 1963. This paved the way for later analyses of medical expenditures that disaggregated PHCE into broad categories of disease according to the ICD-9-CM list of three-digit categories (Public Health Service and Health Care Financing Administration, 1980) in 1972 (Cooper and Rice, 1976) and fiscal 1975 (Berk, Paringer, and Mushkin, 1978). The last comprehensive analysis of how total PHCE are distributed by sex, age, medical diagnosis, and type of health care service examined PHCE in 1980 (Hodgson and Kopstein, 1984; Rice, Hodgson, and Kopstein, 1985).
In this article, we continue this trend, updating expenditures to 1995 by disaggregating HCFA's PHCE, using a variety of data sources to produce expenditures by sex, age, and medical diagnosis for each type of health care service. Although the format of disaggregating PHCE by diagnosis has remained basically unchanged since initiated by Rice, estimates for each year have benefitted from data newly available since the prior calculations. Expenditures for 1995 have profited, for example, from new surveys on hospital ambulatory care (National Hospital Ambulatory Care Survey) and home health care (National Home and Hospice Care Survey) and on medical care expenditures (National Medical Expenditure Survey), which provide data not heretofore available. Also, our estimates for 1995 are the first to examine the age distribution of expenditures among persons age 65 or over, who represent less than 15 percent of the population (Byerly and Deardorff, 1995) but account for more than 40 percent of PHCE.
Data
HCFA publishes annual estimates of PHCE by health service type (Levit et al., 1997), including expenditures for hospital care, physician services, dental services, other professional services, home health care, drugs and other medical non-durables, vision products and other medical durables, nursing home care, and other personal health care (PHC). In addition to the published annual estimates for the various types of PHC, HCFA can disaggregate the totals for several types into their components; for example, hospital care by type of hospital, physician services by place of service, etc. (Levit et al., 1994). We used data on utilization and charges for each health service type to distribute PHCE for each health service according to sex, age, and diagnosis.
A variety of data were used in the analysis. In addition to PHCE, HCFA data include Medicare Provider Analysis and Review and physician/supplier Part B files of Medicare claims for services (Mitchell et al., 1994).
Data from the National Center for Health Statistics include the National Hospital Discharge Survey of inpatient stays in short-stay, non-Federal hospitals; National Health Interview Survey of the health of the U.S. civilian non-institutionalized population; National Ambulatory Medical Care Survey (NAMCS) of physician-patient encounters in the offices of office-based, patient care physicians; National Hospital Ambulatory Medical Care Survey (NHAMCS) of visits by patients to emergency and outpatient departments of non-Federal, short-stay, or general hospitals; National Home and Hospice Care Survey of home health agencies and hospices; and National Nursing Home Survey (NNHS) of nursing home residents and discharges (National Center for Health Statistics, 1997).
Data from the Agency for Healthcare Research and Quality consist of the National Medical Expenditure Survey (NMES) of households of the civilian, non-institutionalized population and medical providers reported as providing services to persons in the household component (Edwards and Berlin, 1989).
The Department of Veterans Affairs (VA) administrative data systems provide information on patient treatment at VA and non-VA facilities (National Center for Health Statistics, 1997; National Center for Veteran Analysis and Statistics, 1994). Finally, data from IMS America include information from the National Disease and Therapeutic Index on diagnosis and treatment of disease by office-based physicians in the continental United States and National Prescription Audit Plus, which tracks prescriptions written by physicians and dispensed by pharmacists in retail pharmacies, including costs to consumers (IMS America, 1994).
Each data source, including specific statistics used in our analysis, is described in Table 1. Although most data are from 1992-1995, the NNHS and NMES are from 1985 and 1987, respectively. Nevertheless, these were the best sources for nursing home expenditures and average charges for many health services that were available at the time this analysis was undertaken. Results are not affected by changes since 1985 and 1987 in absolute levels of utilization or charges because all estimates of expenditures are scaled to HCFA's PHCE, as explained in the following section. However, changes in relative utilization or average charge per service among diagnoses could affect estimated expenditures for certain diagnoses.
Table 1. Data Sources and Statistics.
| Source | Description | Statistics1 |
|---|---|---|
| Health Care Financing Administration | ||
| Personal Health Care Expenditures, 1995 | Total national expenditures for personal health care for each health service type. | Expenditures for hospital care: inpatient, outpatient (OP), emergency (ER) departments, facility home health care, Department of Veterans Affairs. Physician services: offices, hospital inpatients, OP and ER departments, nursing homes, laboratory, and X-ray. Other professional services: chiropractors, podiatrists, Medicare ambulance services. Home health care. Prescription drugs. Medical durables. Nursing home care.2 |
| Medicare Provider Analysis and Review File, 1992 | Claims data for Part A services used by Medicare beneficiaries. A 20-percent sample contains 2 million discharges. | Number of inpatient hospital days (persons 65 or over). |
| Physician/Supplier Part B File, 1992 | Claims data for Part B services used by Medicare beneficiaries. A 5-percent sample contains about 26 million claims. | Number of physician visits to hospital inpatients (persons 65 or over). Average charge per physician visit for hospital inpatients, nursing home residents, laboratory and X-ray services during a visit, Medicare ambulance services (persons 65 or over). |
| National Center for Health Statistics | ||
| National Hospital Discharge Survey, 1993 | Nationwide probability sample of inpatient records for 235,000 discharges in short-stay, non-Federal hospitals. | Number of inpatient hospital days. |
| National Health Interview Survey, 1993 | Nationwide probability sample of about 127,000 persons in the civilian non-institutionalized U.S. population. | Number of visits to physician offices, hospital OP departments, and dentists (by sex and age only). |
| National Ambulatory Medical Care Survey, 1992 | Nationwide probability sample of almost 35,000 physician patient encounters with office-based, patient care physicians.3 | Number of visits to physician offices and number of visits with 1 or more diagnostic/screening services. |
| National Hospital Ambulatory Medical Care Survey, 1992 | Nationwide probability sample of patient records of more than 71,000 visits to ER and OP departments in short-stay, non-Federal hospitals.4 | Number of visits to ER departments. |
| National Home and Hospice Care Survey, 1992 | Nationwide probability sample of data from almost 14,000 patient records in home and hospice care agencies. | Number of home health care patients. Average charge per month. |
| National Nursing Home Survey, 1985 | Nationwide probability sample of data from more than 11,000 patient records in nursing homes.6 | Number of nursing home residents. Average charge per month. |
| Agency for Healthcare Research and Quality | ||
| National Medical Expenditure Survey, 1987 | Nationwide probability sample survey of about 35,000 persons in the civilian non-institutionalized U.S. population during in-home interviews, and a survey of medical providers reported giving services to persons in the household survey. | Number of visits to hospital OPs, chiropractors, podiatrists, and optometrists. Average facility charge per hospital inpatient day, OP, and ER visit. Average physician charge per office, OP, and ER visit. Average charge per chiropractor, podiatrist, and optometrist visit. Expenditures for other medical expenses excluding expenses for eyeglasses, contact lenses, and hearing aids. |
| Census Bureau | ||
| Census Analysis System, 1990 | Data from the Census of Population. | Number of persons in nursing homes and mental (psychiatric) hospitals (by sex and age only). |
| Veterans Administration | ||
| Data, 1994 | Unpublished data from Department of Veterans Affairs, Biometrics Division. | Number of inpatient hospital days. |
| IMS America | ||
| National Disease and Therapeutic Index | A stratified random sample of 2,940 office-based physicians who report on treatment of each patient during a2 day period. | Number of physician visits to hospital inpatients and nursing home residents. |
| National Prescription Audit Plus | Tracks prescriptions dispensed by more than 20,000 randomly selected retail pharmacies from a database including more than one-half of all retail pharmacies in the continental United States. | Consumer expenditures for prescription drugs. |
All statistics are by sex, age, and diagnosis unless otherwise noted. Only statistics used in this analysis are listed.
Total expenditures only for each health service type.
Visits to hospital-based physicians, specialists in anesthesiology, pathology, radiology, and physicians principally engaged in teaching, research, or administration are excluded. Telephone contacts and non- office visits are also excluded.
Telephone contacts are excluded.
National Nursing Home Survey data for 1995 were not available at the time of this analysis.
Homes providing only personal or domiciliary care are excluded.
SOURCE: Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
Methods
Sex-, age-, and diagnosis-specific expenditures for each health service are calculated by distributing HCFA's total PHCE for the service by the sex, age, and diagnosis distribution of the annual number of services, weighted by the respective average charge per service described in Table 1. Utilization and charges for a health service are defined according to the first-listed or primary diagnosis reported on medical records. This is the condition chiefly responsible for occasioning the use of the health service. Algebraic description of the disaggregation of PHCE for each type of health service is:
where:
| (UH)S,A,D | = | annual utilization of services for health service type = H, sex = S, age = A, diagnosis = D |
| (CH)S,A,D | = | average charge per service for health service type = H, sex = S, age = A, diagnosis = D |
| PHCEH | = | HCFA's total expenditure for health service type = H |
Estimated expenditures by diagnosis are scaled to HCFA's NHE for each health service type. Scaling ensures that if expenditures are estimated for all diagnoses with the same data and methods used in this article, the sums over diagnoses would correspond exactly to HCFA's totals for PHCE, less unallocated expenditures described later. Each health service type and the specific data used to distribute total expenditures for the service by sex, age, and diagnosis are listed in Table 2.
Table 2. Methodology for Allocating Expenditures.
|
(PHCEH)S,A,D Estimated Expenditures for Health Service Type H by Sex, Age, and Diagnosis |
(UH)S,A,D Utilization of Services for Health Service Type H by Sex, Age, and Diagnosis |
(CH)S,A,D Charges for Health Service Type H by Sex, Age, and Diagnosis |
|---|---|---|
| Hospital Expenditures | ||
| Inpatients | NHDS inpatient days. | NMES average charge per day. |
| Outpatients (OP and ER) | NMES OP visits adjusted by NHIS OP visits to reflect changes in age, sex distribution of visits since NMES; NHAMCS ER visits. | NMES average facility charge per OP and ER visit. |
| Hospital-Based Home Health Care | NHHCS patients receiving home health care. | NHHCS average charge. |
| Department of Veterans Affairs (VA) Inpatients | VA inpatient days. | No VA charge per day; assume same charge for all diagnoses. |
| Non-Federal Non-Community Psychiatric Hospitals1 | Census Bureau patients in mental (psychiatric) hospitals. | Not applicable. |
| Physician Expenditures2 | ||
| Office Visits | NAMCS office visits adjusted by NHIS office visits to account for NAMCS under reporting.3 | NMES average charge per visit. |
| Hospital Inpatients | NDTI physician visits to hospital inpatients. | HCFA physician/supplier Part B file average charge per visit for 65 or over; Part B average charges adjusted by ratios of Medicare to private payer fees for those under 65 years.4 |
| Hospital Outpatients (OP and ER) | NMES OP visits adjusted by NHIS OP visits to reflect changes in age and sex distribution of visits since NMES; NHAMCS ER visits. | NMES average physician charge per OP and ER visit. |
| Nursing Home Residents | NDTI physician visits to nursing home residents. | HCFA physician/supplier Part B file average charge per visit for 65 or over; Part B average charges adjusted by ratios of Medicare to private payer fees for those under 65 years.4 |
| Laboratory and X-ray Services | NAMCS office visits with 1 or more diagnostic/screening services. | HCFA physician/supplier Part B file average charge per visit for 65 or over; Part B average charges adjusted by ratios of Medicare to private payer fees for those under 65 years.4 |
| Other Professional Services Expenditures | ||
| Chiropractors, Podiatrists, Optometrists | NMES visits to each provider. | NMES average charge per visit. |
| Dentists5 | NHIS visits. | Not applicable. |
| Medicare Ambulance Services | Not applicable. | HCFA physician/supplier Part B file charges. |
| Dialysis Centers6 | Not applicable. | Allowed charges from HCFA physician/supplier Part B file. |
| Home Health Expenditures7 | ||
| Freestanding Home Health Facilities | NHHCS patients receiving home health care. | NHHCS average charge. |
| Medical Durables Expenditures8 | Not applicable. | NMES expenditures. |
| Prescription Drug Expenditures | Not applicable. | Consumer expenditures derived from NDTI and NPA. |
| Nursing Home Expenditures | NNHS residents adjusted by increase by sex and age 1985-1990. | NNHS average charge. |
All expenditures are attributed to mental disorders. To the extent some expenditures are for other conditions incurred during stays in these hospitals, mental health expenditures may be overstated. Nevertheless, the primary reason for being in a psychiatric hospital is for treatment of mental illness. The amount of overstatement, if any, is unknown.
For physicians who bill separately.
Certain types of physicians are out of scope for the NAMCS survey (Schappert, 1997; Gardocki, McLemore, and DeLozier, 1984).
Adjustment ratios derived from analysis of Medicare and private payer physician fees (Miller, Zuckerman, and Gates, 1993).
All expenditures are attributed to diseases of the digestive system.
All expenditures are attributed to diseases of the genitourinary system.
Expenditures for home health care provided by hospitals are included in hospital expenditures.
All expenditures for vision products and hearing aids are attributed to diseases of the nervous system and sense organs.
NOTES: NHDS is National Hospital Discharge Survey. OP is outpatient, ER is emergency. NMES is National Medical Expenditure Survey. NHIS is National Health Interview Survey. NHAMCS is National Hospital Ambulatory Medical Care Survey. NHHCS is National Home and Hospice Care Survey. NAMCS is National Ambulatory Medical Care Survey. NDTI is National Disease and Therapeutic Index. HCFA is Health Care Financing Administration. NPA is National Prescription Audit Plus. NNHS is National Nursing Home Survey.
SOURCE: Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
An advance over prior disaggregations of PHCE by diagnosis is our employment of the most detailed breakdown of health care services that data allow. This provides more accurate distributions of expenditures by taking into account the variation in utilization and charges by diagnosis among components of a health care service. For example, the relative importance of hospital inpatient and outpatient care varies by diagnosis. Accounting for this variation rather than treating all forms of hospital expenditures alike avoids distortion of the distribution of hospital expenditures by diagnosis. Following HCFA's convention for publishing PHCE, we only report expenditures for the major categories of health care services: hospital care, physician and other professional services, home health care, prescription drugs, medical durables, and nursing home care. Expenditures for each of the broader categories of health services presented in the tables, for example, hospital, physician, and other professional services, are the sum of their separately estimated components in Table 2.
Unallocated Expenditures
Lack of information on how utilization is related to sex, age, and diagnosis prohibited allocating expenditures for some services (Table 3). With available data, it was possible to allocate 87 percent of total PHCE according to type of health service, sex, age, and medical diagnosis. The proportion of allocated expenditures varies according to type of health service. For example, 100 percent of expenditures for nursing homes, home health care, and medical durables, 99 percent of expenditures for hospital care, and 94 percent of expenditures for physician services are allocated, compared with only 65 percent for drugs and medical non-durables, 60 percent for other professional services, and no expenditures for other personal health care.
Table 3. HCFA Estimated and Allocated Amounts for Personal Health Care Expenditures, by Health Service Type: 1995.
| Item | Total Personal Health Care | Hospital Care | Physician Services | Other Professional Services | Home Health Care | Drugs and Medical Non-Durables | Medical Durables | Nursing Home Care | Other Personal Health Care |
|---|---|---|---|---|---|---|---|---|---|
| Amount in Billions | |||||||||
| HCFA Estimate | $869.0 | $346.7 | $196.4 | $99.0 | $28.4 | $84.9 | $13.1 | $75.2 | $25.3 |
| Allocated Amount | 757.8 | 342.7 | 183.8 | 59.2 | 28.4 | 55.4 | 13.1 | 75.2 | 0.0 |
| Unallocated Amount | 111.2 | 4.0 | 12.6 | 39.8 | 0.0 | 29.5 | 0.0 | 0.0 | 25.3 |
| Percent Distribution | |||||||||
| HCFA Estimate | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Allocated Amount | 87.2 | 98.8 | 93.6 | 59.8 | 100.0 | 65.3 | 100.0 | 100.0 | 0.0 |
| Unallocated Amount | 12.8 | 1.2 | 6.4 | 40.2 | 0.0 | 34.7 | 0.0 | 0.0 | 100.0 |
NOTES: HCFA is Health Care Financing Administration.
SOURCES: (Levit et al., 1997) and estimates derived from Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
Suitable data were not available to distribute:
1 percent of hospital expenditures for care in non-Federal non-community hospitals that are not psychiatric hospitals and certain Federal hospitals, including spending by the National Institutes of Health, Department of Justice, Coast Guard, and spending for Hanson's disease.
6 percent of expenditures for physician services that were merchandise sales by physicians, including prescription and non-prescription drugs, optical goods, and orthopedic appliances;
40 percent of expenditures for other professional services of licensed professionals, such as physical therapists, visiting nurses, and psychologists, and professional services in blood banks and specialty outpatient clinics other than hospital outpatient departments;
35 percent of expenditures for drugs and medical non-durables that were non-prescription and over-the-counter drugs and medical sundries (all expenditures for prescription drugs were allocated); and
All expenditures for other personal health care, which includes industrial inplant health care provided by employers at the work site, and a variety of public programs such as school health. Nevertheless, 97 percent of combined spending for the basic and widely used services of hospitals, physicians, dentists, home health agencies, prescription drugs, and nursing homes could be allocated and is included in the following results.
Results
We have estimated aggregate and per capita PHCE by sex, age, diagnosis, and health service type. With so much detail, there are various relationships to examine and ways to summarize information. We present some highlights in several tables and figures but leave it to the interested reader to explore additional dimensions in Tables 8 and 9, which give detailed cross tabulations for aggregate and per capita expenditures. With existing data, we were able to distribute 87 percent of PHCE by sex, age, diagnosis, and health service type. All discussion refers to allocated expenditures.
Table 8. Allocated Personal Health Care Expenditures Aggregate Amounts, by Type of Health Service, Sex, Age, Diagnosis, and ICD-9-CM Code: 1995.
| Sex, Age, Diagnosis, and ICD-9-CM Code | Total | Hospital Care | Physician and Other Professional Services1 | Home Health Care | Prescription Drugs | Medical Durables | Nursing Home Care |
|---|---|---|---|---|---|---|---|
|
| |||||||
| Amount in Millions2 | |||||||
| Both Sexes, All Ages | |||||||
| All Conditions | $757,830 | $342,744 | $243,032 | $28,400 | $55,354 | $13,100 | $75,200 |
| Infectious and Parasitic Diseases 001-139 | 17,040 | 8,966 | 5,253 | 605 | 1,890 | 45 | 281 |
| Neoplasms 140-239 | 41,184 | 26,732 | 9,479 | 2,049 | 954 | 215 | 1,756 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 32,655 | 13,928 | 6,970 | 2,574 | 4,442 | 577 | 4,164 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 4,704 | 2,512 | 992 | 473 | 163 | 25 | 538 |
| Mental Disorders 290-319 | 71,348 | 41,064 | 7,651 | 631 | 6,071 | 20 | 15,910 |
| Diseases of the Nervous System and Sense Organs 320-389 | 63,338 | 12,600 | 27,537 | 2,123 | 3,424 | 9,089 | 8,566 |
| Diseases of the Circulatory System 390-459 | 127,799 | 64,303 | 18,766 | 7,146 | 11,749 | 570 | 25,266 |
| Diseases of the Respiratory System 460-519 | 59,305 | 29,523 | 17,075 | 1,656 | 7,656 | 569 | 2,826 |
| Diseases of the Digestive System 520-579 | 86,690 | 27,287 | 51,728 | 946 | 4,881 | 110 | 1,739 |
| Diseases of the Genitourinary System 580-629 | 36,108 | 16,913 | 14,175 | 685 | 2,800 | 67 | 1,469 |
| Complications of Pregnancy, Childbirth, and the Puerperium 630-676 | 3,413 | 2,017 | 1,311 | 11 | 56 | 18 | 0 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 18,291 | 6,098 | 7,598 | 1,665 | 2,338 | 25 | 566 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 48,526 | 19,511 | 16,792 | 2,674 | 4,083 | 489 | 4,977 |
| Congenital Anomalies 740-759 | 4,864 | 2,595 | 1,292 | 611 | 22 | 19 | 326 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 3,214 | 2,411 | 491 | 274 | 3 | 25 | 10 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 22,670 | 7,307 | 8,959 | 1,233 | 1,944 | 250 | 2,976 |
| Injury and Poisoning 800-999 | 68,961 | 38,458 | 23,278 | 2,328 | 1,037 | 935 | 2,925 |
| Supplementary Classifications V01-V82 | 47,721 | 20,519 | 23,685 | 716 | 1,843 | 53 | 905 |
| Male, All Ages | |||||||
| All Conditions | $335,250 | $170,965 | $105,515 | $9,782 | $22,857 | $5,506 | $20,624 |
| Infectious and Parasitic Diseases 001-139 | 8,326 | 4,762 | 2,294 | 277 | 918 | 8 | 67 |
| Neoplasms 140-239 | 19,112 | 12,625 | 4,396 | 939 | 387 | 95 | 671 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 14,057 | 6,815 | 3,371 | 828 | 1,701 | 253 | 1,089 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 1,847 | 1,137 | 401 | 69 | 98 | 12 | 131 |
| Mental Disorders 290-319 | 35,413 | 25,017 | 3,452 | 154 | 2,340 | 3 | 4,447 |
| Diseases of the Nervous System and Sense Organs 320-389 | 27,612 | 6,682 | 11,458 | 1,031 | 1,368 | 3,925 | 3,147 |
| Diseases of the Circulatory System 390-459 | 61,296 | 37,952 | 9,835 | 1,894 | 5,616 | 245 | 5,755 |
| Diseases of the Respiratory System 460-519 | 27,621 | 14,719 | 7,337 | 803 | 3,327 | 264 | 1,170 |
| Diseases of the Digestive System 520-579 | 38,891 | 12,611 | 23,287 | 356 | 2,115 | 42 | 479 |
| Diseases of the Genitourinary System 580-629 | 12,712 | 6,372 | 4,831 | 234 | 645 | 37 | 594 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 8,624 | 3,309 | 3,298 | 759 | 1,041 | 13 | 203 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 17,916 | 8,070 | 6,805 | 665 | 1,377 | 83 | 916 |
| Congenital Anomalies 740-759 | 2,265 | 1,319 | 530 | 283 | 13 | 6 | 113 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 1,595 | 1,273 | 260 | 48 | 2 | 13 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 9,528 | 3,854 | 3,597 | 434 | 692 | 136 | 815 |
| Injury and Poisoning 800-999 | 34,976 | 19,971 | 12,820 | 739 | 479 | 363 | 604 |
| Supplementary Classifications V01-V82 | 13,459 | 4,477 | 7,543 | 268 | 739 | 10 | 422 |
| Male, Under 65 Years | |||||||
| All Conditions | $209,410 | $102,556 | $79,879 | $3,515 | $15,855 | $3,741 | $3,864 |
| Infectious and Parasitic Diseases 001-139 | 6,227 | 3,129 | 2,062 | 219 | 806 | 1 | 9 |
| Neoplasms 140-239 | 7,707 | 5,570 | 1,814 | 112 | 137 | 27 | 47 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 8,572 | 4,384 | 2,588 | 172 | 1,110 | 131 | 186 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 983 | 639 | 265 | 15 | 53 | 12 | 0 |
| Mental Disorders 290-319 | 27,233 | 20,555 | 3,051 | 92 | 2,104 | 3 | 1,429 |
| Diseases of the Nervous System and Sense Organs 320-389 | 16,542 | 3,800 | 7,263 | 703 | 1,015 | 2,942 | 818 |
| Diseases of the Circulatory System 390-459 | 23,573 | 15,167 | 4,864 | 259 | 2,731 | 70 | 482 |
| Diseases of the Respiratory System 460-519 | 16,131 | 7,044 | 5,966 | 392 | 2,631 | 64 | 34 |
| Diseases of the Digestive System 520-579 | 29,554 | 7,863 | 19,974 | 117 | 1,486 | 30 | 85 |
| Diseases of the Genitourinary System 580-629 | 6,869 | 3,460 | 2,826 | 44 | 381 | 14 | 144 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 5,903 | 2,098 | 2,574 | 309 | 907 | 11 | 4 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 12,376 | 5,647 | 5,402 | 259 | 1,003 | 40 | 25 |
| Congenital Anomalies 740-759 | 2,173 | 1,298 | 479 | 283 | 10 | 5 | 98 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 1,595 | 1,273 | 260 | 48 | 2 | 13 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 6,247 | 3,026 | 2,362 | 104 | 498 | 73 | 184 |
| Injury and Poisoning 800-999 | 28,957 | 15,756 | 12,052 | 233 | 436 | 302 | 178 |
| Supplementary Classifications V01-V82 | 8,768 | 1,847 | 6,076 | 154 | 546 | 5 | 141 |
| Male, 65 Years or Over | |||||||
| All Conditions | $125,839 | $68,409 | $25,636 | $6,267 | $7,002 | $1,764 | $16,761 |
| Infectious and Parasitic Diseases 001-139 | 2,099 | 1,633 | 232 | 58 | 113 | 7 | 58 |
| Neoplasms 140-239 | 11,405 | 7,055 | 2,582 | 827 | 250 | 68 | 624 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 5,485 | 2,431 | 783 | 656 | 590 | 122 | 903 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 864 | 498 | 135 | 54 | 45 | 0 | 131 |
| Mental Disorders 290-319 | 8,180 | 4,462 | 401 | 62 | 236 | 0 | 3,018 |
| Diseases of the Nervous System and Sense Organs 320-389 | 11,070 | 2,882 | 4,195 | 328 | 353 | 983 | 2,330 |
| Diseases of the Circulatory System 390-459 | 37,724 | 22,785 | 4,971 | 1,635 | 2,885 | 175 | 5,273 |
| Diseases of the Respiratory System 460-519 | 11,490 | 7,675 | 1,371 | 411 | 696 | 200 | 1,137 |
| Diseases of the Digestive System 520-579 | 9,337 | 4,748 | 3,313 | 240 | 629 | 13 | 394 |
| Diseases of the Genitourinary System 580-629 | 5,843 | 2,912 | 2,006 | 190 | 264 | 23 | 450 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 2,721 | 1,212 | 724 | 450 | 134 | 2 | 199 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 5,540 | 2,422 | 1,402 | 407 | 374 | 43 | 891 |
| Congenital Anomalies 740-759 | 91 | 21 | 51 | 0 | 3 | 1 | 16 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 3,281 | 828 | 1,235 | 330 | 194 | 63 | 631 |
| Injury and Poisoning 800-999 | 6,018 | 4,215 | 768 | 506 | 43 | 60 | 425 |
| Supplementary Classifications V01-V82 | 4,691 | 2,630 | 1,467 | 115 | 193 | 5 | 282 |
| Male, 65-74 Years | |||||||
| All Conditions | $55,462 | $31,548 | $12,450 | $2,226 | $4,488 | $1,001 | $3,749 |
| Infectious and Parasitic Diseases 001-139 | 835 | 617 | 113 | 9 | 81 | 7 | 9 |
| Neoplasms 140-239 | 5,650 | 3,692 | 1,411 | 300 | 136 | 30 | 80 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 2,541 | 1,260 | 418 | 217 | 446 | 89 | 110 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 302 | 218 | 40 | 7 | 24 | 0 | 14 |
| Mental Disorders 290-319 | 2,766 | 1,500 | 208 | 35 | 176 | 0 | 848 |
| Diseases of the Nervous System and Sense Organs 320-389 | 4,913 | 1,305 | 2,071 | 109 | 180 | 575 | 674 |
| Diseases of the Circulatory System 390-459 | 17,077 | 11,098 | 2,629 | 509 | 1,799 | 102 | 940 |
| Diseases of the Respiratory System 460-519 | 4,924 | 3,144 | 741 | 122 | 440 | 111 | 367 |
| Diseases of the Digestive System 520-579 | 3,520 | 2,193 | 659 | 115 | 460 | 8 | 86 |
| Diseases of the Genitourinary System 580-629 | 2,630 | 1,211 | 1,064 | 82 | 168 | 13 | 91 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 1,352 | 575 | 394 | 205 | 84 | 2 | 91 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 2,657 | 1,345 | 801 | 96 | 246 | 17 | 151 |
| Congenital Anomalies 740-759 | 68 | 18 | 43 | 0 | 0 | 1 | 6 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 1,389 | 363 | 549 | 121 | 119 | 7 | 230 |
| Injury and Poisoning 800-999 | 2,488 | 1,767 | 439 | 212 | 25 | 35 | 11 |
| Supplementary Classifications V01-V82 | 2,350 | 1,243 | 871 | 86 | 105 | 4 | 42 |
| Male, 75-84 Years | |||||||
| All Conditions | $44,512 | $23,281 | $8,629 | $2,852 | $2,014 | $629 | $7,108 |
| Infectious and Parasitic Diseases 001-139 | 777 | 599 | 81 | 29 | 19 | 0 | 48 |
| Neoplasms 140-239 | 4,177 | 2,335 | 977 | 343 | 94 | 34 | 393 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 1,909 | 716 | 249 | 320 | 107 | 24 | 493 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 317 | 145 | 81 | 20 | 21 | 0 | 50 |
| Mental Disorders 290-319 | 2,316 | 983 | 112 | 19 | 47 | 0 | 1,155 |
| Diseases of the Nervous System and Sense Organs 320-389 | 4,306 | 956 | 1,724 | 183 | 132 | 338 | 974 |
| Diseases of the Circulatory System 390-459 | 14,096 | 8,396 | 1,849 | 776 | 840 | 64 | 2,172 |
| Diseases of the Respiratory System 460-519 | 4,173 | 2,771 | 434 | 213 | 226 | 66 | 464 |
| Diseases of the Digestive System 520-579 | 2,449 | 1,648 | 383 | 101 | 137 | 4 | 177 |
| Diseases of the Genitourinary System 580-629 | 2,215 | 1,095 | 766 | 59 | 91 | 6 | 197 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 797 | 368 | 245 | 125 | 35 | 0 | 24 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 2,065 | 784 | 507 | 253 | 116 | 25 | 381 |
| Congenital Anomalies 740-759 | 10 | 0 | 7 | 0 | 3 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 1,213 | 233 | 526 | 146 | 62 | 47 | 200 |
| Injury and Poisoning 800-999 | 2,282 | 1,497 | 239 | 240 | 14 | 21 | 271 |
| Supplementary Classifications V01-V82 | 1,411 | 756 | 449 | 27 | 69 | 0 | 110 |
| Male, 85 Years or Over | |||||||
| All Conditions | $17,897 | $8,067 | $2,103 | $1,190 | $500 | $134 | $5,903 |
| Infectious and Parasitic Diseases 001-139 | 406 | 341 | 34 | 19 | 13 | 0 | 0 |
| Neoplasms 140-239 | 1,021 | 491 | 172 | 184 | 20 | 3 | 150 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 858 | 301 | 94 | 118 | 37 | 8 | 300 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 215 | 108 | 13 | 27 | 0 | 0 | 67 |
| Mental Disorders 290-319 | 1,357 | 277 | 43 | 8 | 14 | 0 | 1,015 |
| Diseases of the Nervous System and Sense Organs 320-389 | 1,438 | 241 | 367 | 37 | 42 | 69 | 682 |
| Diseases of the Circulatory System 390-459 | 5,658 | 2,457 | 434 | 350 | 246 | 9 | 2,161 |
| Diseases of the Respiratory System 460-519 | 1,862 | 1,254 | 172 | 76 | 30 | 24 | 306 |
| Diseases of the Digestive System 520-579 | 951 | 657 | 106 | 24 | 32 | 1 | 131 |
| Diseases of the Genitourinary System 580-629 | 805 | 434 | 153 | 48 | 4 | 3 | 162 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 449 | 159 | 72 | 120 | 14 | 0 | 84 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 688 | 167 | 91 | 58 | 12 | 1 | 359 |
| Congenital Anomalies 740-759 | 11 | 0 | 1 | 0 | 0 | 0 | 10 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 495 | 76 | 133 | 63 | 13 | 10 | 201 |
| Injury and Poisoning 800-999 | 1,062 | 772 | 83 | 54 | 5 | 5 | 143 |
| Supplementary Classifications V01-V82 | 620 | 332 | 136 | 3 | 19 | 1 | 130 |
| Female, All Ages | |||||||
| All Conditions | $422,580 | $171,779 | $137,517 | $18,618 | $32,497 | $7,594 | $54,576 |
| Infectious and Parasitic Diseases 001-139 | 8,714 | 4,204 | 2,959 | 328 | 971 | 37 | 214 |
| Neoplasms 140-239 | 22,071 | 14,107 | 5,083 | 1,110 | 567 | 120 | 1,085 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 18,599 | 7,113 | 3,599 | 1,747 | 2,741 | 324 | 3,075 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 2,857 | 1,375 | 591 | 404 | 66 | 13 | 407 |
| Mental Disorders 290-319 | 35,934 | 16,047 | 4,199 | 477 | 3,731 | 17 | 11,463 |
| Diseases of the Nervous System and Sense Organs 320-389 | 35,726 | 5,918 | 16,079 | 1,091 | 2,055 | 5,164 | 5,419 |
| Diseases of the Circulatory System 390-459 | 66,503 | 26,351 | 8,932 | 5,252 | 6,133 | 325 | 19,511 |
| Diseases of the Respiratory System 460-519 | 31,684 | 14,804 | 9,738 | 853 | 4,328 | 305 | 1,656 |
| Diseases of the Digestive System 520-579 | 47,799 | 14,676 | 28,440 | 589 | 2,766 | 67 | 1,260 |
| Diseases of the Genitourinary System 580-629 | 23,396 | 10,541 | 9,344 | 452 | 2,155 | 30 | 874 |
| Complications of Pregnancy, Childbirth, and the Puerperium 630-676 | 3,413 | 2,017 | 1,311 | 11 | 56 | 18 | 0 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 9,667 | 2,789 | 4,301 | 906 | 1,297 | 12 | 363 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 30,610 | 11,441 | 9,987 | 2,009 | 2,706 | 406 | 4,061 |
| Congenital Anomalies 740-759 | 2,600 | 1,275 | 761 | 328 | 9 | 13 | 213 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 1,618 | 1,139 | 230 | 226 | 1 | 12 | 10 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 13,142 | 3,453 | 5,363 | 799 | 1,252 | 114 | 2,161 |
| Injury and Poisoning 800-999 | 33,986 | 18,487 | 10,458 | 1,589 | 558 | 573 | 2,321 |
| Supplementary Classifications V01-V82 | 34,261 | 16,042 | 16,142 | 448 | 1,104 | 44 | 482 |
| Female, Under 65 Years | |||||||
| All Conditions | $236,545 | $97,522 | $104,206 | $4,421 | $21,880 | $5,119 | $3,398 |
| Infectious and Parasitic Diseases 001-139 | 6,147 | 2,541 | 2,525 | 242 | 793 | 34 | 12 |
| Neoplasms 140-239 | 11,505 | 7,594 | 3,135 | 404 | 229 | 80 | 63 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 8,008 | 3,426 | 2,163 | 481 | 1,539 | 196 | 204 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 1,258 | 824 | 363 | 26 | 45 | 1 | 0 |
| Mental Disorders 290-319 | 19,695 | 11,847 | 3,225 | 115 | 3,284 | 13 | 1,209 |
| Diseases of the Nervous System and Sense Organs 320-389 | 19,785 | 3,221 | 9,973 | 549 | 1,496 | 3,808 | 738 |
| Diseases of the Circulatory System 390-459 | 13,896 | 6,597 | 3,867 | 494 | 2,308 | 88 | 542 |
| Diseases of the Respiratory System 460-519 | 18,930 | 7,057 | 8,043 | 187 | 3,437 | 123 | 83 |
| Diseases of the Digestive System 520-579 | 33,292 | 7,432 | 23,889 | 106 | 1,812 | 20 | 34 |
| Diseases of the Genitourinary System 580-629 | 17,411 | 7,926 | 7,408 | 275 | 1,777 | 12 | 13 |
| Complications of Pregnancy, Childbirth, and the Puerperium 630-676 | 3,413 | 2,017 | 1,311 | 11 | 56 | 18 | 0 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 6,113 | 1,434 | 3,293 | 244 | 1,109 | 8 | 24 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 15,295 | 5,854 | 7,230 | 227 | 1,755 | 194 | 35 |
| Congenital Anomalies 740-759 | 2,460 | 1,268 | 694 | 309 | 9 | 13 | 167 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 1,618 | 1,139 | 230 | 226 | 1 | 12 | 10 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 7,607 | 2,665 | 3,703 | 92 | 960 | 51 | 136 |
| Injury and Poisoning 800-999 | 20,090 | 10,189 | 8,635 | 250 | 468 | 419 | 129 |
| Supplementary Classifications V01-V82 | 30,023 | 14,490 | 14,517 | 183 | 802 | 30 | 0 |
| Female, 65 Years or Over | |||||||
| All Conditions | $186,025 | $74,246 | $33,311 | $14,197 | $10,618 | $2,476 | $51,178 |
| Infectious and Parasitic Diseases 001-139 | 2,567 | 1,663 | 434 | 87 | 178 | 3 | 202 |
| Neoplasms 140-239 | 10,559 | 6,506 | 1,948 | 705 | 338 | 41 | 1,022 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 10,587 | 3,685 | 1,436 | 1,265 | 1,202 | 129 | 2,871 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 1,598 | 550 | 229 | 378 | 21 | 13 | 407 |
| Mental Disorders 290-319 | 16,240 | 4,199 | 974 | 362 | 447 | 4 | 10,254 |
| Diseases of the Nervous System and Sense Organs 320-389 | 15,941 | 2,696 | 6,106 | 542 | 560 | 1,356 | 4,681 |
| Diseases of the Circulatory System 390-459 | 52,607 | 19,755 | 5,064 | 4,758 | 3,825 | 237 | 18,969 |
| Diseases of the Respiratory System 460-519 | 12,754 | 7,747 | 1,694 | 666 | 892 | 183 | 1,573 |
| Diseases of the Digestive System 520-579 | 14,507 | 7,244 | 4,552 | 483 | 955 | 47 | 1,226 |
| Diseases of the Genitourinary System 580-629 | 5,985 | 2,615 | 1,936 | 176 | 378 | 18 | 862 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 3,555 | 1,354 | 1,007 | 662 | 188 | 3 | 339 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 15,314 | 5,587 | 2,757 | 1,782 | 951 | 212 | 4,025 |
| Congenital Anomalies 740-759 | 140 | 7 | 67 | 19 | 0 | 0 | 46 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 5,536 | 788 | 1,659 | 707 | 292 | 64 | 2,025 |
| Injury and Poisoning 800-999 | 13,896 | 8,298 | 1,823 | 1,339 | 90 | 153 | 2,193 |
| Supplementary Classifications V01-V82 | 4,238 | 1,551 | 1,625 | 265 | 302 | 14 | 482 |
| Female, 65-74 Years | |||||||
| All Conditions | $60,739 | $28,781 | $14,327 | $3,868 | $6,076 | $1,217 | $6,471 |
| Infectious and Parasitic Diseases 001-139 | 833 | 529 | 204 | 15 | 75 | 1 | 9 |
| Neoplasms 140-239 | 5,080 | 3,337 | 990 | 331 | 217 | 17 | 189 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 4,189 | 1,523 | 674 | 478 | 874 | 84 | 557 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 452 | 237 | 99 | 84 | 10 | 5 | 17 |
| Mental Disorders 290-319 | 4,220 | 1,893 | 412 | 143 | 281 | 4 | 1,487 |
| Diseases of the Nervous System and Sense Organs 320-389 | 6,197 | 1,051 | 3,048 | 186 | 257 | 708 | 946 |
| Diseases of the Circulatory System 390-459 | 14,145 | 7,161 | 2,122 | 989 | 1,980 | 86 | 1,807 |
| Diseases of the Respiratory System 460-519 | 4,922 | 2,826 | 851 | 204 | 530 | 94 | 417 |
| Diseases of the Digestive System 520-579 | 4,414 | 2,768 | 821 | 162 | 544 | 11 | 107 |
| Diseases of the Genitourinary System 580-629 | 2,339 | 848 | 1,066 | 30 | 255 | 1 | 139 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 1,319 | 444 | 511 | 205 | 117 | 1 | 40 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 5,465 | 2,626 | 1,393 | 403 | 572 | 103 | 368 |
| Congenital Anomalies 740-759 | 81 | 4 | 25 | 14 | 0 | 0 | 37 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 1,507 | 346 | 626 | 156 | 147 | 28 | 205 |
| Injury and Poisoning 800-999 | 3,916 | 2,595 | 711 | 394 | 36 | 66 | 114 |
| Supplementary Classifications V01-V82 | 1,659 | 592 | 772 | 73 | 181 | 10 | 31 |
| Female, 75-84 Years | |||||||
| All Conditions | $71,002 | $29,710 | $11,487 | $6,186 | $3,515 | $927 | $19,175 |
| Infectious and Parasitic Diseases 001-139 | 1,190 | 705 | 157 | 71 | 90 | 1 | 167 |
| Neoplasms 140-239 | 4,105 | 2,492 | 788 | 316 | 102 | 14 | 393 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 3,995 | 1,321 | 490 | 549 | 255 | 32 | 1,348 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 567 | 218 | 58 | 138 | 9 | 3 | 141 |
| Mental Disorders 290-319 | 6,470 | 1,608 | 344 | 115 | 119 | 0 | 4,285 |
| Diseases of the Nervous System and Sense Organs 320-389 | 6,829 | 1,347 | 2,349 | 260 | 224 | 499 | 2,151 |
| Diseases of the Circulatory System 390-459 | 20,278 | 8,205 | 1,897 | 2,184 | 1,415 | 104 | 6,473 |
| Diseases of the Respiratory System 460-519 | 4,986 | 2,984 | 560 | 340 | 270 | 79 | 753 |
| Diseases of the Digestive System 520-579 | 4,430 | 2,893 | 592 | 230 | 309 | 36 | 370 |
| Diseases of the Genitourinary System 580-629 | 2,171 | 1,089 | 677 | 58 | 95 | 13 | 239 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 1,245 | 497 | 362 | 250 | 49 | 1 | 87 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 5,576 | 2,091 | 1,095 | 742 | 322 | 82 | 1,244 |
| Congenital Anomalies 740-759 | 41 | 3 | 36 | 2 | 0 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 2,207 | 288 | 720 | 303 | 118 | 17 | 761 |
| Injury and Poisoning 800-999 | 5,218 | 3,322 | 723 | 532 | 46 | 43 | 552 |
| Supplementary Classifications V01-V82 | 1,693 | 648 | 639 | 97 | 93 | 4 | 212 |
| Female, 85 Years or Over | |||||||
| All Conditions | $50,590 | $15,647 | $3,909 | $4,143 | $1,027 | $332 | $25,532 |
| Infectious and Parasitic Diseases 001-139 | 532 | 428 | 63 | 0 | 13 | 2 | 26 |
| Neoplasms 140-239 | 1,349 | 676 | 146 | 58 | 19 | 10 | 440 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 2,345 | 841 | 213 | 239 | 73 | 12 | 966 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 566 | 96 | 59 | 155 | 2 | 4 | 250 |
| Mental Disorders 290-319 | 5,384 | 654 | 95 | 104 | 47 | 0 | 4,482 |
| Diseases of the Nervous System and Sense Organs 320-389 | 2,837 | 287 | 641 | 97 | 79 | 149 | 1,584 |
| Diseases of the Circulatory System 390-459 | 18,020 | 4,375 | 894 | 1,585 | 430 | 46 | 10,689 |
| Diseases of the Respiratory System 460-519 | 2,787 | 1,931 | 231 | 121 | 91 | 10 | 403 |
| Diseases of the Digestive System 520-579 | 2,775 | 1,577 | 255 | 91 | 102 | 0 | 749 |
| Diseases of the Genitourinary System 580-629 | 1,442 | 674 | 164 | 88 | 28 | 4 | 483 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 956 | 411 | 101 | 208 | 22 | 2 | 212 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 4,232 | 865 | 231 | 637 | 58 | 27 | 2,413 |
| Congenital Anomalies 740-759 | 19 | 1 | 5 | 3 | 0 | 0 | 9 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 1,766 | 150 | 262 | 248 | 28 | 19 | 1,060 |
| Injury and Poisoning 800-999 | 4,724 | 2,376 | 357 | 413 | 7 | 45 | 1,526 |
| Supplementary Classifications V01-V82 | 857 | 305 | 191 | 95 | 27 | 0 | 240 |
All expenditures for dental services are allocated to diseases of the digestive system.
Excludes expenditures for Department of Veterans Affairs hospitals, physician services in nursing homes, and dental services that cannot be distributed by age at ages 65 or over.
NOTES: The figure 0 denotes amounts less than $500,000. Expenditures for hospice services may be included with expenditures for hospital, nursing home, or home health care, according to who provided the services. Numbers may not add to totals shown because of rounding. ICD-9-CM is International Classification of Diseases, 9th Revision, Clinical Modification.
SOURCE: (Public Health Service and Health Care Financing Administration, 1980.) Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
Table 9. Allocated Personal Health Care Expenditures per Capita Amounts, by Type of Health Service, Sex, Age, Diagnosis, and ICD-9-CM Code: 1995.
| Sex, Age, Diagnosis, and ICD-9-CM Code | Total | Hospital Care | Physician and Other Professional Services1 | Home Health Care | Prescription Drugs | Medical Durables | Nursing Home Care |
|---|---|---|---|---|---|---|---|
| Both Sexes, All Ages | |||||||
| All Conditions | $2,884 | $1,304 | $925 | $108 | $211 | $50 | $286 |
| Infectious and Parasitic Diseases 001-139 | 65 | 34 | 20 | 2 | 7 | 0 | 1 |
| Neoplasms 140-239 | 157 | 102 | 36 | 8 | 4 | 1 | 7 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 124 | 53 | 27 | 10 | 17 | 2 | 16 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 18 | 10 | 4 | 2 | 1 | 0 | 2 |
| Mental Disorders 290-319 | 272 | 156 | 29 | 2 | 23 | 0 | 61 |
| Diseases of the Nervous System and Sense Organs 320-389 | 241 | 48 | 105 | 8 | 13 | 35 | 33 |
| Diseases of the Circulatory System 390-459 | 486 | 245 | 71 | 27 | 45 | 2 | 96 |
| Diseases of the Respiratory System 460-519 | 226 | 112 | 65 | 6 | 29 | 2 | 11 |
| Diseases of the Digestive System 520-579 | 330 | 104 | 197 | 4 | 19 | 0 | 7 |
| Diseases of the Genitourinary System 580-629 | 137 | 64 | 54 | 3 | 11 | 0 | 6 |
| Complications of Pregnancy, Childbirth, and the Puerperium 630-676 | 13 | 8 | 5 | 0 | 0 | 0 | 0 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 70 | 23 | 29 | 6 | 9 | 0 | 2 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 185 | 74 | 64 | 10 | 16 | 2 | 19 |
| Congenital Anomalies 740-759 | 19 | 10 | 5 | 2 | 0 | 0 | 1 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 12 | 9 | 2 | 1 | 0 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 86 | 28 | 34 | 5 | 7 | 1 | 11 |
| Injury and Poisoning 800-999 | 262 | 146 | 89 | 9 | 4 | 4 | 11 |
| Supplementary Classifications V01-V82 | 182 | 78 | 90 | 3 | 7 | 0 | 3 |
| Male, All Ages | |||||||
| All Conditions | $2,613 | $1,332 | $822 | $76 | $178 | $43 | $161 |
| Infectious and Parasitic Diseases 001-139 | 65 | 37 | 18 | 2 | 7 | 0 | 1 |
| Neoplasms 140-239 | 149 | 98 | 34 | 7 | 3 | 1 | 5 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 110 | 53 | 26 | 6 | 13 | 2 | 8 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 14 | 9 | 3 | 1 | 1 | 0 | |
| Mental Disorders 290-319 | 276 | 195 | 27 | 1 | 18 | 0 | 35 |
| Diseases of the Nervous System and Sense Organs 320-389 | 215 | 52 | 89 | 8 | 11 | 31 | 25 |
| Diseases of the Circulatory System 390-459 | 478 | 296 | 77 | 15 | 44 | 2 | 45 |
| Diseases of the Respiratory System 460-519 | 215 | 115 | 57 | 6 | 26 | 2 | 9 |
| Diseases of the Digestive System 520-579 | 303 | 98 | 181 | 3 | 16 | 0 | 4 |
| Diseases of the Genitourinary System 580-629 | 99 | 50 | 38 | 2 | 5 | 0 | 5 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 67 | 26 | 26 | 6 | 8 | 0 | 2 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 140 | 63 | 53 | 5 | 11 | 1 | 7 |
| Congenital Anomalies 740-759 | 18 | 10 | 4 | 2 | 0 | 0 | 1 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 12 | 10 | 2 | 0 | 0 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 74 | 30 | 28 | 3 | 5 | 1 | 6 |
| Injury and Poisoning 800-999 | 273 | 156 | 100 | 6 | 4 | 3 | 5 |
| Supplementary Classifications V01-V82 | 105 | 35 | 59 | 2 | 6 | 0 | 3 |
| Male, Under 65 Years | |||||||
| All Conditions | $1,827 | $895 | $697 | $31 | $138 | $33 | $34 |
| Infectious and Parasitic Diseases 001-139 | 54 | 27 | 18 | 2 | 7 | 0 | 0 |
| Neoplasms 140-239 | 67 | 49 | 16 | 1 | 1 | 0 | 0 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 75 | 38 | 23 | 1 | 10 | 1 | 2 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 9 | 6 | 2 | 0 | 0 | 0 | 0 |
| Mental Disorders 290-319 | 238 | 179 | 27 | 1 | 18 | 0 | 12 |
| Diseases of the Nervous System and Sense Organs 320-389 | 144 | 33 | 63 | 6 | 9 | 26 | 7 |
| Diseases of the Circulatory System 390-459 | 206 | 132 | 42 | 2 | 24 | 1 | 4 |
| Diseases of the Respiratory System 460-519 | 141 | 61 | 52 | 3 | 23 | 1 | 0 |
| Diseases of the Digestive System 520-579 | 258 | 69 | 174 | 1 | 13 | 0 | 1 |
| Diseases of the Genitourinary System 580-629 | 60 | 30 | 25 | 0 | 3 | 0 | 1 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 51 | 18 | 22 | 3 | 8 | 0 | 0 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 108 | 49 | 47 | 2 | 9 | 0 | 0 |
| Congenital Anomalies 740-759 | 19 | 11 | 4 | 2 | 0 | 0 | 1 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 14 | 11 | 2 | 0 | 0 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 55 | 26 | 21 | 1 | 4 | 1 | 2 |
| Injury and Poisoning 800-999 | 253 | 137 | 105 | 2 | 4 | 3 | 2 |
| Supplementary Classifications V01-V82 | 76 | 16 | 53 | 1 | 5 | 0 | 1 |
| Male, 65 Years or Over | |||||||
| All Conditions | $9,193 | $4,997 | $1,873 | $458 | $511 | $129 | $1,224 |
| Infectious and Parasitic Diseases 001-139 | 153 | 119 | 17 | 4 | 8 | 1 | 4 |
| Neoplasms 140-239 | 833 | 515 | 189 | 60 | 18 | 5 | 46 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 401 | 178 | 57 | 48 | 43 | 9 | 66 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 63 | 36 | 10 | 4 | 3 | 0 | 10 |
| Mental Disorders 290-319 | 598 | 326 | 29 | 5 | 17 | 0 | 220 |
| Diseases of the Nervous System and Sense Organs 320-389 | 809 | 211 | 306 | 24 | 26 | 72 | 170 |
| Diseases of the Circulatory System 390-459 | 2,756 | 1,664 | 363 | 119 | 211 | 13 | 385 |
| Diseases of the Respiratory System 460-519 | 839 | 561 | 100 | 30 | 51 | 15 | 83 |
| Diseases of the Digestive System 520-579 | 682 | 347 | 242 | 17 | 46 | 1 | 29 |
| Diseases of the Genitourinary System 580-629 | 427 | 213 | 147 | 14 | 19 | 2 | 33 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 199 | 89 | 53 | 33 | 10 | 0 | 15 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 405 | 177 | 102 | 30 | 27 | 3 | 65 |
| Congenital Anomalies 740-759 | 7 | 2 | 4 | 0 | 0 | 0 | 1 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 240 | 60 | 90 | 24 | 14 | 5 | 46 |
| Injury and Poisoning 800-999 | 440 | 308 | 56 | 37 | 3 | 4 | 31 |
| Supplementary Classifications V01-V82 | 343 | 192 | 107 | 8 | 14 | 0 | 21 |
| Male, 65-74 Years2 | |||||||
| All Conditions | $6,649 | $3,782 | $1,492 | $267 | $538 | $120 | $449 |
| Infectious and Parasitic Diseases 001-139 | 100 | 74 | 14 | 1 | 10 | 1 | 1 |
| Neoplasms 140-239 | 677 | 443 | 169 | 36 | 16 | 4 | 10 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 305 | 151 | 50 | 26 | 53 | 11 | 13 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 36 | 26 | 5 | 1 | 3 | 0 | 2 |
| Mental Disorders 290-319 | 332 | 180 | 25 | 4 | 21 | 0 | 102 |
| Diseases of the Nervous System and Sense Organs 320-389 | 589 | 156 | 248 | 13 | 22 | 69 | 81 |
| Diseases of the Circulatory System 390-459 | 2,047 | 1,330 | 315 | 61 | 216 | 12 | 113 |
| Diseases of the Respiratory System 460-519 | 590 | 377 | 89 | 15 | 53 | 13 | 44 |
| Diseases of the Digestive System 520-579 | 422 | 263 | 79 | 14 | 55 | 1 | 10 |
| Diseases of the Genitourinary System 580-629 | 315 | 145 | 128 | 10 | 20 | 2 | 11 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 162 | 69 | 47 | 25 | 10 | 0 | 11 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 319 | 161 | 96 | 11 | 30 | 2 | 18 |
| Congenital Anomalies 740-759 | 8 | 2 | 5 | 0 | 0 | 0 | 1 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 166 | 43 | 66 | 15 | 14 | 1 | 28 |
| Injury and Poisoning 800-999 | 298 | 212 | 53 | 25 | 3 | 4 | 1 |
| Supplementary Classifications V01-V82 | 282 | 149 | 104 | 10 | 13 | 0 | 5 |
| Male, 75-84 Years2 | |||||||
| All Conditions | $10,280 | $5,377 | $1,993 | $659 | $465 | $145 | $1,642 |
| Infectious and Parasitic Diseases 001-139 | 180 | 138 | 19 | 7 | 4 | 0 | 11 |
| Neoplasms 140-239 | 965 | 539 | 226 | 79 | 22 | 8 | 91 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 441 | 165 | 57 | 74 | 25 | 6 | 114 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 73 | 33 | 19 | 5 | 5 | 0 | 12 |
| Mental Disorders 290-319 | 535 | 227 | 26 | 4 | 11 | 0 | 267 |
| Diseases of the Nervous System and Sense Organs 320-389 | 994 | 221 | 398 | 42 | 30 | 78 | 225 |
| Diseases of the Circulatory System 390-459 | 3,255 | 1,939 | 427 | 179 | 194 | 15 | 502 |
| Diseases of the Respiratory System 460-519 | 964 | 640 | 100 | 49 | 52 | 15 | 107 |
| Diseases of the Digestive System 520-579 | 566 | 381 | 88 | 23 | 32 | 1 | 41 |
| Diseases of the Genitourinary System 580-629 | 512 | 253 | 177 | 14 | 21 | 1 | 45 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 184 | 85 | 57 | 29 | 8 | 0 | 5 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 477 | 181 | 117 | 58 | 27 | 6 | 88 |
| Congenital Anomalies 740-759 | 2 | 0 | 2 | 0 | 1 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 280 | 54 | 121 | 34 | 14 | 11 | 46 |
| Injury and Poisoning 800-999 | 527 | 346 | 55 | 55 | 3 | 5 | 63 |
| Supplementary Classifications V01-V82 | 326 | 175 | 104 | 6 | 16 | 0 | 25 |
| Male, 85 Years or Over2 | |||||||
| All Conditions | $17,598 | $7,932 | $2,068 | $1,170 | $491 | $132 | $5,804 |
| Infectious and Parasitic Diseases 001-139 | 400 | 335 | 33 | 19 | 12 | 0 | 0 |
| Neoplasms 140-239 | 1,004 | 483 | 169 | 181 | 20 | 3 | 148 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 844 | 296 | 92 | 116 | 37 | 8 | 295 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 212 | 106 | 13 | 27 | 0 | 0 | 66 |
| Mental Disorders 290-319 | 1,334 | 272 | 42 | 8 | 13 | 0 | 998 |
| Diseases of the Nervous System and Sense Organs 320-389 | 1,414 | 237 | 361 | 36 | 41 | 68 | 671 |
| Diseases of the Circulatory System 390-459 | 5,563 | 2,416 | 427 | 344 | 242 | 9 | 2,125 |
| Diseases of the Respiratory System 460-519 | 1,831 | 1,233 | 170 | 75 | 29 | 23 | 301 |
| Diseases of the Digestive System 520-579 | 935 | 646 | 104 | 24 | 32 | 1 | 129 |
| Diseases of the Genitourinary System 580-629 | 791 | 426 | 151 | 47 | 4 | 3 | 160 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 442 | 156 | 71 | 118 | 14 | 0 | 83 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 677 | 164 | 90 | 57 | 12 | 1 | 353 |
| Congenital Anomalies 740-759 | 10 | 0 | 1 | 0 | 0 | 0 | 10 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 487 | 75 | 131 | 62 | 13 | 9 | 198 |
| Injury and Poisoning 800-999 | 1,044 | 759 | 81 | 53 | 5 | 5 | 141 |
| Supplementary Classifications V01-V82 | 610 | 327 | 134 | 3 | 19 | 1 | 128 |
| Female, All Ages | |||||||
| All Conditions | $3,143 | $1,278 | $1,023 | $138 | $242 | $56 | $406 |
| Infectious and Parasitic Diseases 001-139 | 65 | 31 | 22 | 2 | 7 | 0 | 2 |
| Neoplasms 140-239 | 164 | 105 | 38 | 8 | 4 | 1 | 8 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 138 | 53 | 27 | 13 | 20 | 2 | 23 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 21 | 10 | 4 | 3 | 0 | 0 | 3 |
| Mental Disorders 290-319 | 267 | 119 | 31 | 4 | 28 | 0 | 85 |
| Diseases of the Nervous System and Sense Organs 320-389 | 266 | 44 | 120 | 8 | 15 | 38 | 40 |
| Diseases of the Circulatory System 390-459 | 495 | 196 | 66 | 39 | 46 | 2 | 145 |
| Diseases of the Respiratory System 460-519 | 236 | 110 | 72 | 6 | 32 | 2 | 12 |
| Diseases of the Digestive System 520-579 | 356 | 109 | 212 | 4 | 21 | 1 | 9 |
| Diseases of the Genitourinary System 580-629 | 174 | 78 | 70 | 3 | 16 | 0 | 7 |
| Complications of Pregnancy, Childbirth, and the Puerperium 630-676 | 25 | 15 | 10 | 0 | 0 | 0 | 0 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 72 | 21 | 32 | 7 | 10 | 0 | 3 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 228 | 85 | 74 | 15 | 20 | 3 | 30 |
| Congenital Anomalies 740-759 | 19 | 9 | 6 | 2 | 0 | 0 | 2 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 12 | 8 | 2 | 2 | 0 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 98 | 26 | 40 | 6 | 9 | 1 | 16 |
| Injury and Poisoning 800-999 | 253 | 138 | 78 | 12 | 4 | 4 | 17 |
| Supplementary Classifications V01-V82 | 255 | 119 | 120 | 3 | 8 | 0 | 4 |
| Female, Under 65 Years | |||||||
| All Conditions | $2,064 | $851 | $909 | $39 | $191 | $45 | $30 |
| Infectious and Parasitic Diseases 001-139 | 54 | 22 | 22 | 2 | 7 | 0 | 0 |
| Neoplasms 140-239 | 100 | 66 | 27 | 4 | 2 | 1 | 1 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 70 | 30 | 19 | 4 | 13 | 2 | 2 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 11 | 7 | 3 | 0 | 0 | 0 | 0 |
| Mental Disorders 290-319 | 172 | 103 | 28 | 1 | 29 | 0 | 11 |
| Diseases of the Nervous System and Sense Organs 320-389 | 173 | 28 | 87 | 5 | 13 | 33 | 6 |
| Diseases of the Circulatory System 390-459 | 121 | 58 | 34 | 4 | 20 | 1 | 5 |
| Diseases of the Respiratory System 460-519 | 165 | 62 | 70 | 2 | 30 | 1 | 1 |
| Diseases of the Digestive System 520-579 | 291 | 65 | 208 | 1 | 16 | 0 | 0 |
| Diseases of the Genitourinary System 580-629 | 152 | 69 | 65 | 2 | 16 | 0 | 0 |
| Complications of Pregnancy, Childbirth, and the Puerperium 630-676 | 30 | 18 | 11 | 0 | 0 | 0 | 0 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 53 | 13 | 29 | 2 | 10 | 0 | 0 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 133 | 51 | 63 | 2 | 15 | 2 | 0 |
| Congenital Anomalies 740-759 | 21 | 11 | 6 | 3 | 0 | 0 | 1 |
| Certain Conditions Originating in the Perinatal Period 760-779 | 14 | 10 | 2 | 2 | 0 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 66 | 23 | 32 | 1 | 8 | 0 | 1 |
| Injury and Poisoning 800-999 | 175 | 89 | 75 | 2 | 4 | 4 | 1 |
| Supplementary Classifications V01-V82 | 262 | 126 | 127 | 2 | 7 | 0 | 0 |
| Female, 65 Years or Over | |||||||
| All Conditions | $9,375 | $3,742 | $1,679 | $715 | $535 | $125 | $2,579 |
| Infectious and Parasitic Diseases 001-139 | 129 | 84 | 22 | 4 | 9 | 0 | 10 |
| Neoplasms 140-239 | 532 | 328 | 98 | 36 | 17 | 2 | 51 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 534 | 186 | 72 | 64 | 61 | 6 | 145 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 81 | 28 | 12 | 19 | 1 | 1 | 21 |
| Mental Disorders 290-319 | 818 | 212 | 49 | 18 | 23 | 0 | 517 |
| Diseases of the Nervous System and Sense Organs 320-389 | 803 | 136 | 308 | 27 | 28 | 68 | 236 |
| Diseases of the Circulatory System 390-459 | 2,651 | 996 | 255 | 240 | 193 | 12 | 956 |
| Diseases of the Respiratory System 460-519 | 643 | 390 | 85 | 34 | 45 | 9 | 79 |
| Diseases of the Digestive System 520-579 | 731 | 365 | 229 | 24 | 48 | 2 | 62 |
| Diseases of the Genitourinary System 580-629 | 302 | 132 | 98 | 9 | 19 | 1 | 43 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 179 | 68 | 51 | 33 | 9 | 0 | 17 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 772 | 282 | 139 | 90 | 48 | 11 | 203 |
| Congenital Anomalies 740-759 | 7 | 0 | 3 | 1 | 0 | 0 | 2 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 279 | 40 | 84 | 36 | 15 | 3 | 102 |
| Injury and Poisoning 800-999 | 700 | 418 | 92 | 67 | 5 | 8 | 111 |
| Supplementary Classifications V01-V82 | 214 | 78 | 82 | 13 | 15 | 1 | 24 |
| Female, 65-74 Years2 | |||||||
| All Conditions | $5,831 | $2,763 | $1,375 | $371 | $583 | $117 | $621 |
| Infectious and Parasitic Diseases 001-139 | 80 | 51 | 20 | 1 | 7 | 0 | 1 |
| Neoplasms 140-239 | 488 | 320 | 95 | 32 | 21 | 2 | 18 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 402 | 146 | 65 | 46 | 84 | 8 | 53 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 43 | 23 | 9 | 8 | 1 | 1 | 2 |
| Mental Disorders 290-319 | 405 | 182 | 40 | 14 | 27 | 0 | 143 |
| Diseases of the Nervous System and Sense Organs 320-389 | 595 | 101 | 293 | 18 | 25 | 68 | 91 |
| Diseases of the Circulatory System 390-459 | 1,358 | 687 | 204 | 95 | 190 | 8 | 173 |
| Diseases of the Respiratory System 460-519 | 472 | 271 | 82 | 20 | 51 | 9 | 40 |
| Diseases of the Digestive System 520-579 | 424 | 266 | 79 | 16 | 52 | 1 | 10 |
| Diseases of the Genitourinary System 580-629 | 225 | 81 | 102 | 3 | 24 | 0 | 13 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 127 | 43 | 49 | 20 | 11 | 0 | 4 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 525 | 252 | 134 | 39 | 55 | 10 | 35 |
| Congenital Anomalies 740-759 | 8 | 0 | 2 | 1 | 0 | 0 | 4 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 145 | 33 | 60 | 15 | 14 | 3 | 20 |
| Injury and Poisoning 800-999 | 376 | 249 | 68 | 38 | 3 | 6 | 11 |
| Supplementary Classifications V01-V82 | 159 | 57 | 74 | 7 | 17 | 1 | 3 |
| Female, 75-84 Years2 | |||||||
| All Conditions | $10,418 | $4,360 | $1,686 | $908 | $516 | $136 | $2,814 |
| Infectious and Parasitic Diseases 001-139 | 175 | 103 | 23 | 10 | 13 | 0 | 24 |
| Neoplasms 140-239 | 602 | 366 | 116 | 46 | 15 | 2 | 58 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 586 | 194 | 72 | 81 | 37 | 5 | 198 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 83 | 32 | 9 | 20 | 1 | 1 | 21 |
| Mental Disorders 290-319 | 949 | 236 | 50 | 17 | 17 | 0 | 629 |
| Diseases of the Nervous System and Sense Organs 320-389 | 1,002 | 198 | 345 | 38 | 33 | 73 | 316 |
| Diseases of the Circulatory System 390-459 | 2,975 | 1,204 | 278 | 320 | 208 | 15 | 950 |
| Diseases of the Respiratory System 460-519 | 732 | 438 | 82 | 50 | 40 | 12 | 110 |
| Diseases of the Digestive System 520-579 | 650 | 425 | 87 | 34 | 45 | 5 | 54 |
| Diseases of the Genitourinary System 580-629 | 319 | 160 | 99 | 8 | 14 | 2 | 35 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 183 | 73 | 53 | 37 | 7 | 0 | 13 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 818 | 307 | 161 | 109 | 47 | 12 | 183 |
| Congenital Anomalies 740-759 | 6 | 0 | 5 | 0 | 0 | 0 | 0 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 324 | 42 | 106 | 44 | 17 | 3 | 112 |
| Injury and Poisoning 800-999 | 766 | 488 | 106 | 78 | 7 | 6 | 81 |
| Supplementary Classifications V01-V82 | 248 | 95 | 94 | 14 | 14 | 1 | 31 |
| Female, 85 Years or Over2 | |||||||
| All Conditions | $19,376 | $5,993 | $1,497 | $1,587 | $393 | $127 | $9,778 |
| Infectious and Parasitic Diseases 001-139 | 204 | 164 | 24 | 0 | 5 | 1 | 10 |
| Neoplasms 140-239 | 517 | 259 | 56 | 22 | 7 | 4 | 168 |
| Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders 240-279 | 898 | 322 | 82 | 91 | 28 | 5 | 370 |
| Diseases of the Blood and Blood-Forming Organs 280-289 | 217 | 37 | 23 | 59 | 1 | 2 | 96 |
| Mental Disorders 290-319 | 2,062 | 251 | 37 | 40 | 18 | 0 | 1,717 |
| Diseases of the Nervous System and Sense Organs 320-389 | 1,087 | 110 | 246 | 37 | 30 | 57 | 607 |
| Diseases of the Circulatory System 390-459 | 6,902 | 1,676 | 343 | 607 | 165 | 18 | 4,094 |
| Diseases of the Respiratory System 460-519 | 1,067 | 739 | 88 | 46 | 35 | 4 | 154 |
| Diseases of the Digestive System 520-579 | 1,063 | 604 | 98 | 35 | 39 | 0 | 287 |
| Diseases of the Genitourinary System 580-629 | 552 | 258 | 63 | 34 | 11 | 2 | 185 |
| Diseases of the Skin and Subcutaneous Tissue 680-709 | 366 | 157 | 38 | 80 | 8 | 1 | 81 |
| Diseases of the Musculoskeletal System and Connective Tissue 710-739 | 1,621 | 331 | 89 | 244 | 22 | 10 | 924 |
| Congenital Anomalies 740-759 | 7 | 0 | 2 | 1 | 0 | 0 | 3 |
| Symptoms, Signs, and Ill-Defined Conditions 780-799 | 677 | 57 | 100 | 95 | 11 | 7 | 406 |
| Injury and Poisoning 800-999 | 1,809 | 910 | 137 | 158 | 3 | 17 | 584 |
| Supplementary Classifications V01-V82 | 328 | 117 | 73 | 36 | 10 | 0 | 92 |
All expenditures for dental services are allocated to diseases of the digestive system.
Excludes expenditures for Department of Veterans Affairs hospitals, physician services in nursing homes, and dental services that cannot be distributed by age at ages 65 or over.
NOTES: The figure 0 denotes amounts less than $.50. Expenditures for hospice services may be included with expenditures for hospital, nursing home, or home health care according to who provided the services. Numbers may not add to totals because of rounding. ICD-9-CM is International Classification of Diseases, 9th Revision, Clinical Modification.
SOURCE: (Public Health Service and Health Care Financing Administration, 1980.) Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
Age and Health Service Type
Total allocated expenditures in 1995 were $757.8 billion in aggregate and $2,884 per capita (Table 4). Persons under age 65 years accounted for 59 percent of aggregate PHCE, those age 65 or over the remaining 41 percent. The distribution between the two age groups varied by the type of health service. Persons under age 65 were relatively heavy users of professional services (76 percent of the total for these services), prescription drugs and medical durables (68 percent), and hospital care (58 percent). The elderly, however, were the predominant users of home health care and nursing home care, accounting for 72 and 90 percent of the totals, respectively, for these services. Aggregate expenditures continued to decrease with age among the elderly except for home health care, which was more evenly distributed among age groups, and nursing home care, which increased sharply with age. The patterns observed for home health care and nursing home care are attributable to heavy use of these services by older females.
Table 4. Allocated Personal Health Care Expenditures Aggregate and per Capita Amounts and Percent Distribution, by Health Service and Age: 1995.
| Age | Total | Hospital Care | Professional Services | Home Health Care | Drugs and Medical Durables | Nursing Home Care |
|---|---|---|---|---|---|---|
| Amount in Billions | ||||||
| All Ages | $757.8 | $342.7 | $243.0 | $28.4 | $68.5 | $75.2 |
| Under 65 Years | 446.0 | 200.1 | 184.1 | 7.9 | 46.6 | 7.3 |
| 65-74 Years | 116.2 | 60.3 | 26.8 | 6.1 | 12.8 | 10.2 |
| 75-84 Years | 115.5 | 53.0 | 20.1 | 9.0 | 7.1 | 26.3 |
| 85 Years or Over | 68.5 | 23.7 | 6.0 | 5.3 | 2.0 | 31.4 |
| Percent Distribution | ||||||
| All Ages | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Under 65 Years | 58.9 | 58.4 | 75.8 | 27.8 | 68.0 | 9.7 |
| 65-74 Years | 15.3 | 17.6 | 11.0 | 21.5 | 18.7 | 13.6 |
| 75-84 Years | 15.2 | 15.5 | 8.3 | 31.7 | 10.4 | 35.0 |
| 85 Years or Over | 9.0 | 6.9 | 2.5 | 18.7 | 2.9 | 41.8 |
| Per Capita Amount | ||||||
| All Ages | $2,884 | $1,304 | $925 | $108 | $261 | $286 |
| Under 65 Years | 1,946 | 873 | 803 | 35 | 203 | 32 |
| 65-74 Years | 6,194 | 3,216 | 1,427 | 325 | 681 | 545 |
| 75-84 Years | 10,365 | 4,755 | 1,805 | 811 | 636 | 2,358 |
| 85 Years or Over | 18,877 | 6,536 | 1,657 | 1,470 | 550 | 8,665 |
| Percent Distribution | ||||||
| All Ages | 100.0 | 45.2 | 32.1 | 3.7 | 9.0 | 9.9 |
| Under 65 Years | 100.0 | 44.9 | 41.3 | 1.8 | 10.4 | 1.6 |
| 65-74 Years | 100.0 | 51.9 | 23.1 | 5.2 | 11.0 | 8.8 |
| 75-84 Years | 100.0 | 45.9 | 17.4 | 7.8 | 6.1 | 22.8 |
| 85 Years or Over | 100.0 | 34.6 | 8.8 | 7.7 | 2.9 | 45.8 |
NOTES: Expenditures in Department of Veterans Affairs hospitals are not included in expenditures for ages 65-74, 75-84, and 85 or over. Numbers and percents may not add to totals shown because of rounding.
SOURCE: Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
However, although persons 65 or over represented less than 15 percent of the population (Byerly and Deardorff, 1995), they accounted for 41 percent of total aggregate expenditures. Per capita expenditures were higher for the elderly for every health service and increased with age from $1,946 per person under 65 years to $18,877 at age 85 or over. For all persons age 65 or over, per capita expenditures were $9,301. More was spent on hospital care than any other service except for persons age 85 or over, for whom hospital expenditures were second to expenditures for nursing homes. Although not the sole cause, nursing home care was the leading cause of rising per capita expenditures as age increased. More than three-fourths of nursing home expenditures were incurred at ages 75 or over, and nursing home care was responsible for 23 percent of all expenditures among persons age 75-84 and 46 percent of the total for those 85 or over.
Projections show that the number of elderly, especially the oldest old (85 or over), will grow and constitute an increasing proportion of the population in the coming years as baby boomers age (Waite, 1996). As the number of elderly grows relative to the rest of the population, so too will their share of health care expenditures.
Sex and Health Service Type
Females accounted for 56 percent of aggregate PHCE and males for 44 percent (Table 5). Females had higher aggregate expenditures than males for each type of health service except hospital care, for which there was virtually no difference, but female expenditures for home health care and nursing home care were especially high compared with males (66 and 73 percent of the totals for these services). Only some of the difference in aggregate expenditures between males and females is due to the larger number of females. Total per capita expenditures were 20 percent higher for females compared with a 26-percent difference in total aggregate expenditures. Males spent slightly more per person for hospital care, but spending by females was significantly higher for all other services and was 2.5 times as high for nursing home care. The two sexes differed in their use of various health services, mainly with respect to hospitals and nursing homes. Slightly more than one-half of male expenditures were for hospital care versus 41 percent for females, while nursing home care accounted for 13 percent of total female spending compared with only 6 percent among males.
Table 5. Allocated Personal Health Care Expenditures Aggregate and per Capita Amounts and Percent Distribution, by Health Service and Sex: 1995.
| Sex | Total | Hospital Care | Professional Services | Home Health Care | Drugs and Medical Durables | Nursing Home Care |
|---|---|---|---|---|---|---|
| Amount in Billions | ||||||
| Both Sexes | $757.8 | $342.7 | $243.0 | $28.4 | $68.5 | $75.2 |
| Male | 335.3 | 171.0 | 105.5 | 9.8 | 28.4 | 20.6 |
| Female | 422.6 | 171.8 | 137.5 | 18.6 | 40.1 | 54.6 |
| Percent Distribution | ||||||
| Both Sexes | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Male | 44.2 | 49.9 | 43.4 | 34.5 | 41.5 | 27.4 |
| Female | 55.8 | 50.1 | 56.6 | 65.5 | 58.5 | 72.6 |
| Per Capita Amount | ||||||
| Both Sexes | $2,884 | $1,304 | $925 | $108 | $261 | $286 |
| Male | 2,613 | 1,332 | 822 | 76 | 221 | 161 |
| Female | 3,143 | 1,278 | 1,023 | 138 | 298 | 406 |
| Percent Distribution | ||||||
| Both Sexes | 100.0 | 45.2 | 32.1 | 3.7 | 9.0 | 9.9 |
| Male | 100.0 | 51.0 | 31.5 | 2.9 | 8.5 | 6.1 |
| Female | 100.0 | 40.7 | 32.5 | 4.4 | 9.5 | 12.9 |
NOTE: Numbers and percents may not add to totals shown because of rounding.
SOURCE: Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
Expenditures by Diagnosis
Diseases of the circulatory system (including, for example, heart disease, stroke, and hypertension) were the most expensive category, costing $127.8 billion and accounting for 17 percent of all PHCE (Figure 1). Diseases of the digestive system, including all dental expenditures, were a distant second at $86.7 billion and 11 percent of aggregate PHCE. Rounding out the six most costly disease categories in descending order were mental disorders ($71.4 billion and 9 percent), injuries and poisonings ($69.0 billion and 9 percent), nervous system and sense organ diseases ($63.3 billion and 8 percent), and respiratory diseases ($59.3 billion and 8 percent). Together, these six disease groups accounted for almost two-thirds of all PHCE. Nevertheless, despite this apparent concentration, medical care expenditures were fairly widely distributed across the spectrum of illness and disease. Except for circulatory and digestive diseases, each including a variety of specific conditions, no other category was responsible for as much as 10 percent of aggregate PHCE. Neoplasms, including all cancers, for example, represent only 5 percent of total PHCE.
Figure 1. Allocated Personal Health Care Expenditures, by Age and Diagnosis: 1995.
Age, Sex, and Diagnosis
For most disease categories, aggregate expenditures were higher for those under 65 years. More than 70 percent of aggregate PHCE for infectious and parasitic diseases, diseases of the digestive system (due in large measure to high expenditures for dental care), injury and poisoning, and supplementary classifications were for those under age 65. And the younger age group had two-thirds of the expenditures for mental disorders, diseases of the genitourinary system, and diseases of the skin and subcutaneous tissue. The elderly had slightly higher expenditures for neoplasms and diseases of the blood and blood-forming organs and accounted for 71 percent of expenditures for diseases of the circulatory system. Females had higher expenditures for all conditions except injury and poisoning, which were only slightly higher for males. But differences in expenditures between males and females for each diagnosis were not as large as differences between persons under and over 65 years.
However, when population size is taken into account, with few exceptions, per capita expenditures increase with age, regardless of diagnosis, for males and females (Table 6). Diagnoses in Table 6 are arranged in descending order of aggregate expenditures as in Figure 1. This order is roughly followed for males and females at different ages, but there are some notable differences. Circulatory diseases are far and away the most expensive diseases for those age 65 or over but rank fourth and ninth, respectively, for younger males and females. Neoplasms are second most expensive for elderly males but only tenth among younger males. On the other hand, injuries and poisonings are relatively more expensive for persons under age 65, especially among males.
Table 6. Allocated Personal Health Care Expenditures per Capita Amounts and Percent Distribution by Diagnosis, According to Sex and Age: 1995.
| Diagnosis | Male | Female | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|||||||||
| All Ages | Under 65 Years | 65-74 Years | 75-84 Years | 85 Years or Over | All Ages | Under 65 Years | 65-74 Years | 75-84 Years | 85 Years or Over | |
| Per Capita Amount | ||||||||||
| Total | $2,613 | $1,827 | $6,649 | $10,280 | $17,598 | $3,143 | $2,064 | $5,831 | $10,418 | $19,376 |
| Circulatory Diseases | 478 | 206 | 2,047 | 3,255 | 5,563 | 495 | 121 | 1,358 | 2,975 | 6,902 |
| Digestive Diseases | 303 | 258 | 422 | 566 | 935 | 356 | 291 | 424 | 650 | 1,063 |
| Mental Disorders | 276 | 238 | 332 | 535 | 1,334 | 267 | 172 | 405 | 949 | 2,062 |
| Injuries and Poisonings | 273 | 253 | 298 | 527 | 1,044 | 253 | 175 | 376 | 766 | 1,809 |
| Nervous System and Sense Organs | 215 | 144 | 589 | 994 | 1,414 | 266 | 173 | 595 | 1,002 | 1,087 |
| Respiratory Diseases | 215 | 141 | 590 | 964 | 1,831 | 236 | 165 | 472 | 732 | 1,067 |
| Musculoskeletal and Connective Tissues | 140 | 108 | 319 | 477 | 677 | 228 | 133 | 525 | 818 | 1,621 |
| Supplementary Classifications | 105 | 76 | 282 | 326 | 610 | 255 | 262 | 159 | 248 | 328 |
| Neoplasms | 149 | 67 | 677 | 965 | 1,004 | 164 | 100 | 488 | 602 | 517 |
| Genitourinary System Diseases | 99 | 60 | 315 | 512 | 791 | 174 | 152 | 225 | 319 | 552 |
| Endocrine, Nutritional-Metabolic, and Immunity Disorders | 110 | 75 | 305 | 441 | 844 | 138 | 70 | 402 | 586 | 898 |
| Symptoms, Signs, Ill-Defined Conditions | 74 | 55 | 166 | 280 | 487 | 98 | 66 | 145 | 324 | 677 |
| Skin and Subcutaneous Tissues | 67 | 51 | 162 | 184 | 442 | 72 | 53 | 127 | 183 | 366 |
| Infectious and Parasitic Diseases | 65 | 54 | 100 | 180 | 400 | 65 | 54 | 80 | 175 | 204 |
| Congenital Anomalies | 18 | 19 | 8 | 2 | 10 | 19 | 21 | 8 | 6 | 7 |
| Blood and Blood-Forming Organs | 14 | 9 | 36 | 73 | 212 | 21 | 11 | 43 | 83 | 217 |
| Complications of Pregnancy and Childbirth | 0 | 0 | 0 | 0 | 0 | 25 | 30 | 0 | 0 | 0 |
| Conditions Originating in Perinatal Period | 12 | 14 | 0 | 0 | 0 | 12 | 14 | 0 | 0 | 0 |
| Percent Distribution | ||||||||||
| Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Circulatory Diseases | 18.3 | 11.3 | 30.8 | 31.7 | 31.6 | 15.7 | 5.9 | 23.3 | 28.6 | 35.6 |
| Digestive Diseases | 11.6 | 14.1 | 6.3 | 5.5 | 5.3 | 11.3 | 14.1 | 7.3 | 6.2 | 5.5 |
| Mental Disorders | 10.6 | 13.0 | 5.0 | 5.2 | 7.6 | 8.5 | 8.3 | 6.9 | 9.1 | 10.6 |
| Injuries and Poisonings | 10.4 | 13.8 | 4.5 | 5.1 | 5.9 | 8.0 | 8.5 | 6.4 | 7.4 | 9.3 |
| Nervous System and Sense Organs | 8.2 | 7.9 | 8.9 | 9.7 | 8.0 | 8.5 | 8.4 | 10.2 | 9.6 | 5.6 |
| Respiratory Diseases | 8.2 | 7.7 | 8.9 | 9.4 | 10.4 | 7.5 | 8.0 | 8.1 | 7.0 | 5.5 |
| Musculoskeletal and Connective Tissues | 5.4 | 5.9 | 4.8 | 4.6 | 3.8 | 7.3 | 6.4 | 9.0 | 7.9 | 8.4 |
| Supplementary Classifications | 4.0 | 4.2 | 4.2 | 3.2 | 3.5 | 8.1 | 12.7 | 2.7 | 2.4 | 1.7 |
| Neoplasms | 5.7 | 3.7 | 10.2 | 9.4 | 5.7 | 5.2 | 4.8 | 8.4 | 5.8 | 2.7 |
| Genitourinary System Diseases | 3.8 | 3.3 | 4.7 | 5.0 | 4.5 | 5.5 | 7.4 | 3.9 | 3.1 | 2.8 |
| Endocrine, Nutritional-Metabolic, and Immunity Disorders | 4.2 | 4.1 | 4.6 | 4.3 | 4.8 | 4.4 | 3.4 | 6.9 | 5.6 | 4.6 |
| Symptoms, Signs, Ill-Defined Conditions | 2.8 | 3.0 | 2.5 | 2.7 | 2.8 | 3.1 | 3.2 | 2.5 | 3.1 | 3.5 |
| Skin and Subcutaneous Tissues | 2.6 | 2.8 | 2.4 | 1.8 | 2.5 | 2.3 | 2.6 | 2.2 | 1.8 | 1.9 |
| Infectious and Parasitic Diseases | 2.5 | 3.0 | 1.5 | 1.8 | 2.3 | 2.1 | 2.6 | 1.4 | 1.7 | 1.1 |
| Congenital Anomalies | 0.7 | 1.0 | 0.1 | 0.0 | 0.1 | 0.6 | 1.0 | 0.1 | 0.1 | 0.0 |
| Blood and Blood-Forming Organs | 0.5 | 0.5 | 0.5 | 0.7 | 1.2 | 0.7 | 0.5 | 0.7 | 0.8 | 1.1 |
| Complications of Pregnancy and Childbirth | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.8 | 1.5 | 0.0 | 0.0 | 0.0 |
| Conditions Originating in Perinatal Period | 0.5 | 0.8 | 0.0 | 0.0 | 0.0 | 0.4 | 0.7 | 0.0 | 0.0 | 0.0 |
NOTES: Expenditures in Department of Veterans Affairs hospitals are not included in expenditures for ages 65-74, 75-84, and 85 or over. Numbers may not add to totals because of rounding.
SOURCE: Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
Among persons under 65 years, more than 35 percent of expenditures were incurred for just three diagnosis groups, digestive diseases (14 percent), injuries and poisonings (11 percent), and mental disorders (11 percent), although the proportions differ somewhat for males and females, and circulatory diseases were also significant for younger males. For those age 65 or over, circulatory diseases alone accounted for 29 percent of expenditures, and no other category represents as much as 9 percent of the total for the elderly. For females age 85 or over, 36 percent of expenditures were for circulatory diseases.
Although total per capita expenditures were higher for females, there were no consistent patterns by sex among diagnoses. For some conditions, males have higher per capita expenditures at one age and females at another age.
Health Service Type and Diagnosis
Per capita expenditures for the six most costly diagnosis groups, which together account for almost two-thirds of aggregate PHCE, are shown in Table 7 by health service type and age. Per capita expenditures for each diagnosis increase markedly with age, mostly due to increased use of hospitals and nursing homes. But the rate of increase was higher for nursing homes, with a resulting shift in the relative magnitude of expenditures from hospital to nursing home services. This is especially so, even among persons age 65 or over, for circulatory diseases, mental disorders, and to a lesser extent, injuries and poisonings and the nervous system and sense organs. For circulatory diseases, hospital expenditures decrease from 59 percent of total expenditures at 65-74 years to 29 percent at ages 85 or over, while nursing home spending increases from 9 to 54 percent of the total. For mental disorders, as age increases, hospital spending decreases from 49 to 14 percent, and nursing home costs rise from 33 to 82 percent. Respiratory diseases, on the other hand, exhibit different relationships with age. Hospital care accounts for a larger proportion of total spending as patients age, increasing from 40 percent under 65 years to 69 percent at age 85 or over. Nursing home expenditures also increase with age, almost doubling from 65-74 years to age 85 or over, but remain a relatively small share of the total for respiratory conditions compared with other diseases in Table 7.
Table 7. Allocated Personal Health Care Expenditures Aggregate and per Capita Amounts and Percent Distribution, by Diagnosis and Age: 1995.
| Sex | Total | Hospital Care | Professional Services | Home Health Care | Drugs and Medical Durables | Nursing Home Care |
|---|---|---|---|---|---|---|
| Circulatory Diseases | Per Capita Amount | |||||
| Under 65 Years | $164 | $95 | $38 | $3 | $23 | $4 |
| 65-74 Years | 1,663 | 973 | 253 | 80 | 211 | 146 |
| 75-84 Years | 3,085 | 1,490 | 336 | 266 | 217 | 776 |
| 85 Years or Over | 6,525 | 1,883 | 366 | 533 | 201 | 3,542 |
| Digestive Diseases | ||||||
| Under 65 Years | 274 | 67 | 191 | 1 | 14 | 1 |
| 65-74 Years | 422 | 264 | 79 | 15 | 54 | 10 |
| 75-84 Years | 617 | 407 | 87 | 30 | 44 | 49 |
| 85 Years or Over | 1,027 | 616 | 99 | 32 | 37 | 243 |
| Mental Disorders | ||||||
| Under 65 Years | 205 | 141 | 27 | 1 | 24 | 12 |
| 65-74 Years | 371 | 181 | 33 | 9 | 24 | 124 |
| 75-84 Years | 788 | 232 | 41 | 12 | 15 | 488 |
| 85 Years or Over | 1,858 | 257 | 38 | 31 | 17 | 1,515 |
| Injury and Poisoning | ||||||
| Under 65 Years | 214 | 113 | 90 | 2 | 7 | 1 |
| 65-74 Years | 341 | 233 | 61 | 32 | 8 | 7 |
| 75-84 Years | 672 | 432 | 86 | 69 | 11 | 74 |
| 85 Years or Over | 1,595 | 868 | 121 | 129 | 17 | 460 |
| Nervous System and Sense Organs | ||||||
| Under 65 Years | 158 | 31 | 75 | 5 | 40 | 7 |
| 65-74 Years | 592 | 126 | 273 | 16 | 91 | 86 |
| 75-84 Years | 999 | 207 | 365 | 40 | 107 | 280 |
| 85 Years or Over | 1,178 | 145 | 278 | 37 | 93 | 625 |
| Respiratory Diseases | ||||||
| Under 65 Years | 153 | 62 | 61 | 3 | 27 | 1 |
| 65-74 Years | 525 | 318 | 85 | 17 | 63 | 42 |
| 75-84 Years | 822 | 516 | 89 | 50 | 58 | 109 |
| 85 Years or Over | 1,281 | 878 | 111 | 54 | 42 | 196 |
| Circulatory Diseases | Percent Distribution | |||||
| Under 65 Years | 100.0 | 58.1 | 23.3 | 2.0 | 13.9 | 2.7 |
| 65-74 Years | 100.0 | 58.5 | 15.2 | 4.8 | 12.7 | 8.8 |
| 75-84 Years | 100.0 | 48.3 | 10.9 | 8.6 | 7.0 | 25.2 |
| 85 Years or Over | 100.0 | 28.9 | 5.6 | 8.2 | 3.1 | 54.3 |
| Digestive Diseases | ||||||
| Under 65 Years | 100.0 | 24.5 | 69.7 | 0.4 | 5.1 | 0.4 |
| 65-74 Years | 100.0 | 62.6 | 18.7 | 3.6 | 12.8 | 2.4 |
| 75-84 Years | 100.0 | 66.0 | 14.1 | 4.9 | 7.1 | 7.9 |
| 85 Years or Over | 100.0 | 60.0 | 9.6 | 3.1 | 3.6 | 23.7 |
| Mental Disorders | ||||||
| Under 65 Years | 100.0 | 69.0 | 13.4 | 0.4 | 11.5 | 5.6 |
| 65-74 Years | 100.0 | 48.8 | 8.9 | 2.4 | 6.5 | 33.4 |
| 75-84 Years | 100.0 | 29.4 | 5.2 | 1.5 | 1.9 | 61.9 |
| 85 Years or Over | 100.0 | 13.8 | 2.0 | 1.7 | 0.9 | 81.5 |
| Injury and Poisoning | ||||||
| Under 65 Years | 100.0 | 52.9 | 42.2 | 1.0 | 3.3 | 0.6 |
| 65-74 Years | 100.0 | 68.3 | 17.9 | 9.4 | 2.3 | 2.1 |
| 75-84 Years | 100.0 | 64.3 | 12.8 | 10.3 | 1.6 | 11.0 |
| 85 Years or Over | 100.0 | 54.4 | 7.6 | 8.1 | 1.1 | 28.8 |
| Nervous System and Sense Organs | ||||||
| Under 65 Years | 100.0 | 19.3 | 47.4 | 3.4 | 25.5 | 4.3 |
| 65-74 Years | 100.0 | 21.3 | 46.1 | 2.7 | 15.4 | 14.5 |
| 75-84 Years | 100.0 | 20.7 | 36.5 | 4.0 | 10.7 | 28.0 |
| 85 Years or Over | 100.0 | 12.3 | 23.6 | 3.1 | 7.9 | 53.1 |
| Respiratory Diseases | ||||||
| Under 65 Years | 100.0 | 40.2 | 40.0 | 1.7 | 17.8 | 0.3 |
| 65-74 Years | 100.0 | 60.6 | 16.2 | 3.2 | 12.0 | 8.0 |
| 75-84 Years | 100.0 | 62.8 | 10.8 | 6.1 | 7.1 | 13.3 |
| 85 Years or Over | 100.0 | 68.5 | 8.7 | 4.2 | 3.3 | 15.3 |
NOTES: Expenditures in Department of Veterans Affairs hospitals are not included in expenditures for ages 65-74, 75-84, and 85 or over. Numbers and percents may not add to totals because of rounding.
SOURCE: Hodgson, T.A. and Cohen, A.J., National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, 1999.
Although expenditures for individual disease categories may be quite different, over all medical conditions, hospital and nursing home care accounted for 68 percent of total expenditures for persons age 65 or over. There is a considerable shift in institutional utilization and spending from the hospital to the nursing home as the elderly grow older. Spending for hospital care declined with age from 52 percent of total spending at 65-74 years to 35 percent at age 85 or over, while the proportion for nursing home care increased from 9 to 46 percent, reaching 51 percent for females age 85 or over. Spending on various kinds of health services may be determined at least in part by diseases experienced, but spending for health services within a diagnosis group varies significantly by age. Some of this variation may be explained by differences in age-related prevalence and/or incidence of specific conditions within the broad diagnosis groups. An analysis and explanation of these and other relationships mentioned in our brief discussion of estimated expenditures is beyond the scope of this article.
Detailed cross tabulations by sex, age, diagnosis, and health service type are given in Table 8 for aggregate and Table 9 for per capita expenditures.
Discussion
This study reports how PHCE are distributed by sex, age, type of health care service, and diagnosis, with emphasis on expenditures among the elderly, age 65 or over, the segment of the population with the highest per capita expenditures. There are both strengths and weaknesses to this study.
First, the same methods and data are employed to estimate expenditures for each of 18 broad categories of disease. Consistent methods and data ensure that expenditures among diseases can be compared without fear of bias in the relative magnitude of expenditures for different diseases. However, with existing data, diagnosis cannot be assigned to almost 13 percent of PHCE.
Second, disaggregation of HCFA's PHCE means the sum of expenditures across all diseases plus unallocated expenditures total to HCFA's PHCE for each type of service, which are published and widely recognized estimates of health care expenditures. The sum of expenditures across diseases does not exceed total expenditures, which has been known to happen when the results of independent studies using diverse data, methods, and assumptions are aggregated.
However, because health service utilization and expenditures are classified according to the first-listed or primary diagnosis on medical records, the contribution of comorbidities to expenditures is ignored. When individuals suffer from more than one condition, comorbidities raise the cost of medical care. In the physician's office, more tests and procedures are required and more time is spent with the patient. Hospital stays are longer, the charge per day may be higher. When all health services are charged to the first-listed diagnosis, the distribution of expenditures by diagnosis may be distorted. The nature and magnitude of the distortion and which diagnoses are affected and by how much are unknown.
Third, although the tables only show expenditures for the major categories of health care services for which HCFA publishes annual data, expenditures for hospital care, professional services, and medical durables are each the sum of separately estimated components. For example, total hospital care includes inpatient care, care in outpatient and emergency departments, and home health care provided by hospital-based facilities. Employing the most detailed breakdown of health care services that data allow provides a more accurate distribution of expenditures by diagnosis by taking into account the variation in utilization and charges across components of a health care service. For example, the relative importance of hospital inpatient and outpatient care varies by diagnosis. Accounting for this variation rather than treating all forms of hospital expenditures alike avoids distortion of the distribution of hospital expenditures by diagnosis. Newly available data, such as NHAMCS for hospital outpatient and emergency departments, permits more detailed analysis of health services than was possible in earlier studies.
A limitation here is that PHCE are based on establishment revenue. Hospital expenditures, for example, include not only revenue for services provided to patients, but non-patient operating revenue, such as gift shop and parking lot receipts, and non-operating revenues, such as interest income, contributions, and grants (Lazenby et al., 1992). Revenue for hospital services to patients constitutes the vast majority of hospital expenditures, but the total overstates expenditures for patient services. The overstatement is greatest for hospital care because a larger share of revenue for other services is directly medical in nature.
Fourth, this is the first study of PHCE to report health care expenditures among the elderly, revealing how the relative importance of diagnosis and type of health service used changes with increasing age. It shows, for example, that at age 85 or over, more than 50 percent of all health care expenditures for females is for nursing home care. And just two medical conditions, mental disorders and diseases of the circulatory system, are associated with 60 percent of nursing home expenditures for this group of females. It is projected that in scarcely more than 20 years, the population age 85 or over will double (Waite, 1996). The results of this analysis can inform the decisionmaking process as the Nation confronts the health care needs of a population inexorably growing older.
Because expenditures in a category are for services rendered in that type of establishment, there is some misallocation of expenditures by type of service. Services of salaried professionals employed by hospitals, nursing homes, and some other health care establishments are included with services provided by the respective establishment; care provided by hospital residents is counted as hospital care, etc. (Lazenby et al., 1992). Expenditures for drugs provided to patients in hospitals and nursing homes are included in spending for these providers' services (Lazenby et al., 1992). Discussion of data and methods for estimating PHCE, including periodic revisions and improvements, can be found in several articles (Lindsey and Newhouse, 1986; Health Care Financing Administration, 1990; Haber and Newhouse, 1991; Lazenby et al., 1992; Levit et al., 1997).
Acknowledgments
The authors gratefully acknowledge helpful comments from anonymous reviewers, which improved the presentation of this analysis.
Footnotes
The authors are with the National Center for Health Statistics, Centers for Disease Control and Prevention. Support was provided by an Inter-agency Agreement between the Office of Demography of Aging, National Institute on Aging, National Institutes of Health, and the National Center for Health Statistics, Centers for Disease Control and Prevention. The views expressed in this article are those of the authors and do not necessarily reflect the views of the Centers for Disease Control and Prevention, the National Institutes of Health, or HCFA.
Reprint Requests: Thomas A. Hodgson, Ph.D., National Center for Health Statistics, 6525 Belcrest Road, Hyattsville, MD 20782. E-mail: TAH2@cdc.gov
References
- Berk A, Paringer L, Mushkin SJ. The Economic Cost of Illness Fiscal 1975. Medical Care. 1978 Sep;16(9):785–790. doi: 10.1097/00005650-197809000-00009. [DOI] [PubMed] [Google Scholar]
- Byerly E, Deardorff K. Current Population Reports. Washington: U.S. Government Printing Office; Jul, 1995. National and State Population Estimates:1990 to 1994; pp. 25–1127. U.S. Bureau of the Census. [Google Scholar]
- Cooper BS, Rice DP. The Economic Cost of Illness Revisited. Social Security Bulletin. 1976 Feb;39(2):21–36. [PubMed] [Google Scholar]
- Edwards WS, Berlin M. National Medical Expenditure Survey Methods 2. National Center for Health Services Research and Health Care Technology Assessment; Rockville, Maryland: Sep, 1989. Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives. [Google Scholar]
- Gardocki GJ, McLemore T, DeLozier JE. The National Ambulatory Medical Care Complement Survey: United States, 1980. National Center for Health Statistics Vital and Health Statistics. 1984 May;13(77):1–46. [PubMed] [Google Scholar]
- Haber SG, Newhouse JP. Recent Revisions to and Recommendations for National Health Expenditures Accounting. Health Care Financing Review. 1991 Fall;13(1):111–116. [PMC free article] [PubMed] [Google Scholar]
- Health Care Financing Administration. Revisions to the National Health Accounts and Methodology. Health Care Financing Review. 1990 Summer;11(4):42–54. [PMC free article] [PubMed] [Google Scholar]
- Hodgson TA, Kopstein AN. Health Care Expenditures for Major Diseases in 1980. Health Care Financing Review. 1984 Summer;5(4):1–12. [PMC free article] [PubMed] [Google Scholar]
- IMS America. Information Services Manual. IMS America; Plymouth Meeting, Pennsylvania: 1994. [Google Scholar]
- Lazenby HC, Levit KR, Waldo DR, et al. National Health Accounts: Lessons from the U.S. Experience. Health Care Financing Review. 1992 Summer;13(4):89–103. [PMC free article] [PubMed] [Google Scholar]
- Levit KR, Lazenby HC, Braden BR, et al. National Health Expenditures, 1996. Health Care Financing Review. 1997 Fall;19(1):161–200. [PMC free article] [PubMed] [Google Scholar]
- Levit KR, Sensenig AL, Cowan CA, et al. National Health Expenditures, 1993. Health Care Financing Review. 1994 Fall;16(1):247–294. [PMC free article] [PubMed] [Google Scholar]
- Lindsey PA, Newhouse JP. Summary of a Conference on National Health Expenditures Accounting. Health Care Financing Review. 1986 Summer;7(4):87–96. [PMC free article] [PubMed] [Google Scholar]
- Miller ME, Zuckerman S, Gates M. How Do Medicare Physician Fees Compare with Private Payers? Health Care Financing Review. 1993 Spring;14(3):25–39. [PMC free article] [PubMed] [Google Scholar]
- Mitchell JB, Bubolz T, Paul JE, et al. Using Medicare Claims for Outcomes Research. Medical Care. 1994 Jul;32(7):JS38–JS51. [PubMed] [Google Scholar]
- National Center for Health Statistics. Health, United States, 1996-97 and Injury Chartbook. Washington: U.S. Government Printing Office; Jul, 1997. U.S. Department of Health and Human Services. [Google Scholar]
- National Center for Veteran Analysis and Statistics. Unpublished data from the Biometrics Division. Department of Veterans Affairs; Washington: 1994. [Google Scholar]
- Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical Modification. Washington: U.S. Government Printing Office; Sep, 1980. U.S. Department of Health and Human Services. [Google Scholar]
- Rice DP. Health Economics Series Number 6. Washington: U.S. Government Printing Office; May, 1966. Estimating the Cost of Illness. U.S. Department of Health and Human Services. [Google Scholar]
- Rice DP, Hodgson TA, Kopstein AN. The Economic Costs of Illness: a Replication and Update. Health Care Financing Review. 1985 Fall;7(1):61–80. [PMC free article] [PubMed] [Google Scholar]
- Schappert SM. National Hospital Ambulatory Medical Care Survey: 1992 Emergency Department Summary. National Center for Health Statistics Vital and Health Statistics. 1997 Mar;13(125):1–108. [PubMed] [Google Scholar]
- Waite LJ. The Demographic Face of America's Elderly. Inquiry. 1996 Fall;33(3):220–224. [PubMed] [Google Scholar]