Medical expenditures for major diseases, 1995.

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:

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,DEstimated Expenditures for Health Service Type H by Sex, Age, and Diagnosis	(UH)S,A,DUtilization of Services for Health Service Type H by Sex, Age, and Diagnosis	(CH)S,A,DCharges 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).