Measuring healthcare spending by race and ethnicity to observe patterns and utilize treatments has possibly never been more important than now in the U.S., as the country becomes more diverse each day. The Journal of the American Medical Association (JAMA) published a study on Aug. 17 titled “U.S. Health Care Spending by Race and Ethnicity, 2002-2016” found that “age-standardized per-person spending was significantly greater for White individuals than the all-population mean for ambulatory care; for Black individuals for emergency department and inpatient care; and for American Indian and Alaska Native individuals for emergency department care. Hispanic and Asian, Native Hawaiian, and Pacific Islander individuals had significantly less per-person spending than did the all-population mean for most types of care, and these differences persisted when controlling for underlying health.”
The study included data from 7.3 million health system visits, admissions, or prescriptions. Researchers wrote that “Black and Indigenous individuals and other people of color face significant barriers to obtaining quality healthcare services in the U.S. Inequalities by race and ethnicity in access to care have been attributed to variation in insurance coverage; socioeconomic and geographic inequities that affect health and access to healthcare; and structural, institutional, and interpersonal racism within the healthcare system. These barriers to healthcare utilization and treatment reflect and perpetuate structural racism in U.S. society more broadly.”
Further, “The objective of this study was to estimate healthcare spending for six race and ethnicity groups from 2002 through 2016 in the U.S. The study focused on differences in spending across six types of care (ambulatory, emergency, inpatient, nursing facility, prescribed pharmaceuticals, and dental). It assessed whether differences in utilization or differences in price and intensity accounted for differences in spending, and it also assessed whether spending differences persisted even after controlling for the number of people with specific health conditions.”
Key results from the study include:
- In 2016, an estimated $2.4 trillion (95 percent uncertainty interval [UI], $2.4 trillion-$2.4 trillion) was spent on healthcare across the six types of care included in this study
- The estimated age-standardized total healthcare spending per person in 2016 was:
- $7,649 (95 percent UI, $6129-$8814) for American Indian and Alaska Native (non-Hispanic) individuals
- $4,692 (95 percent UI, $4,068-$5,202) for Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals
- $7,361 (95 percent UI, $6,917-$7,797) for Black (non-Hispanic) individuals
- $6,025 (95 percent UI, $5,703-$6,373) for Hispanic individuals
- $9,276 (95 percent UI, $8,066-$10,601) for individuals categorized as multiple races (non-Hispanic)
- $8,141 (95 percent UI, $8,038-$8,258) for White (non-Hispanic) individuals, who accounted for an estimated 72 percent (95 percent UI, 71 percent-73 percent) of healthcare spending.
- After adjusting for population size and age in 2016:
- White individuals received an estimated 15 percent (95 percent UI, 13 percent-17 percent; P < .001) more spending on ambulatory care than the all-population mean
- Black (non-Hispanic) individuals received an estimated 26 percent (95 percent UI, 19 percent-32 percent; P < .001) less spending than the all-population mean on ambulatory care but received 19 percent (95 percent UI, 3 percent-32 percent; P = .02) more on inpatient and 12 percent (95 percent UI, 4 percent-24 percent; P = .04) more on emergency department care
- Hispanic individuals received an estimated 33 percent (95 percent UI, 26 percent-37 percent; P < .001) less spending per person on ambulatory care than the all-population mean
- Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals received less spending than the all-population mean on all types of care except dental (all P < .001),
- American Indian and Alaska Native (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 90 percent more; 95 percent UI, 11 percent-165 percent; P = .04)
- Multiple-race (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 40 percent more; 95 percent UI, 19 percent-63 percent; P = .006)
The researchers wrote that “All 18 of the statistically significant race and ethnicity spending differences by type of care corresponded with differences in utilization. These differences persisted when controlling for underlying disease burden.”
The researchers concluded that “In the U.S. from 2002 through 2016, healthcare spending varied by race and ethnicity across different types of care even after adjusting for age and health conditions. Further research is needed to determine current healthcare spending by race and ethnicity, including spending related to the COVID-19 pandemic.”
