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Overview

NHEA provides estimates of aggregate healthcare expenditures in the United States from 1960 onward. NHEA contains all the main components of the healthcare system within a unified, mutually exclusive, and exhaustive structure. The accounts measure spending for health care in the United States by type of goods or services delivered (for example, hospital care, physician and clinical services, or retail prescription drugs) and by the source of funds that pays for that care (for example, private health insurance, Medicare, Medicaid, or out of pocket). A consistent set of definitions is used for healthcare goods and services and for sources of funds that finance healthcare expenditures, allowing for comparisons over time.

Methodology

NHEA estimates healthcare spending using an expenditures approach to national economic accounting. Expenditures are estimated for the payers as well as the categories of medical goods and services. A common set of definitions allows comparison among categories and over time. In addition, estimates are benchmarked to revenue estimates from the U.S. Census Bureau’s 5-year Economic Census.

An assortment of government and private sources are used to create NHEA. In addition to the Economic Census, government sources include data from the U.S. Census Bureau’s Services Annual Survey, the Bureau of Economic Analysis’ National Income and Product Accounts, and Medicare claims data. Private data sources include the American Hospital Association’s Annual Survey and the Kaiser Health Research and Educational Trust’s survey of Employer-Sponsored Health Benefits.

For example, private health insurance spending for healthcare goods and services is derived using data from the U.S. Census Bureau, American Medical Association, American Hospital Association, IQVIA (formerly IMS Health), National Medical Care Expenditure Survey of the National Center for Health Services Research (1987), and Medical Expenditure Panel Surveys of the Agency for Healthcare Research and Quality (1996–2022). For a matrix of data sources used for NHEA, see Exhibit 4 of “.”

Issues Affecting Interpretation

Every 5 years, NHEA undergoes a comprehensive revision that includes the incorporation of newly available source data, methodological and definitional changes, and benchmark estimates from the Economic Census. During these comprehensive revisions, the entire NHEA time series is opened for revision.

References

• Hartman M, Martin AB, Whittle L, Catlin A. . Health Aff (Millwood) 43(1):6–17. 2023.
• Centers for Medicare & Medicaid Services. . 2024.
• Centers for Medicare & Medicaid Services. . 2020.