STATISTICAL BRIEF #546:
Concentration of Healthcare Expenditures and Selected Characteristics of Persons With High Expenses, U.S. Civilian Noninstitutionalized Population, 2020

Introduction

The spread of the COVID-19 pandemic in 2020 considerably disrupted the way people seek out and utilize medical care in the United States and across much of the world. Data from the Medical Expenditure Panel Survey (MEPS) indicate that healthcare expenditures among the U.S. civilian noninstitutionalized population remained highly concentrated in 2020, meaning that a small proportion of persons accounted for a large part of total healthcare expenditures. In fact, about 15% of the U.S. population had no personal healthcare expenses in 2020, while 5% accounted for over half of healthcare expenses during the year. These expenditures include all sources of payment for medical care, including payments by private insurance, Medicare, Medicaid, out-of-pocket expenses, and other sources.

In this Statistical Brief, data from the Agency for Healthcare Research and Quality's (AHRQ's) Medical Expenditure Panel Survey Household Component (MEPS-HC) are used to describe the overall concentration of healthcare expenditures across the U.S. civilian noninstitutionalized population in 2020 compared with previous years. The most commonly treated conditions among persons in the top expenditure groups are identified, and the shares of expenses by age groups, race/ethnicity, type of medical service, and source of payment are illustrated for 2020. All differences discussed in the text are statistically significant at the 0.05 level.

Findings

Table 1. Percentile of population ranked by healthcare expenses during the year

Data Source

Definitions

• Hispanic
• White, non-Hispanic (no other races reported)
• Black, non-Hispanic (no other races reported)
• Asian, non-Hispanic (no other races reported) and other/multiple races, non-Hispanic

• Out-of-pocket: Expenses paid by the user or other family member.
• Private insurance: Payments made by insurance plans covering hospital and medical care (excluding payments from Medicare, Medicaid, and other public sources). Payments from Medigap plans or TRICARE (Armed Forces-related coverage) are included.
• Medicare: Payments by Medicare, which is a federally financed health insurance plan for persons age 65 and older, persons receiving Social Security disability payments, and persons with end-stage renal disease.
• Medicaid/CHIP: Payments by Medicaid and CHIP which are means-tested government programs jointly financed by federal and state funds that provide healthcare to those who are eligible. Medicaid is designed to provide health coverage to families and individuals who are unable to afford necessary medical care. CHIP provides coverage to additional low-income children not eligible for Medicaid. Eligibility criteria for both programs vary significantly by state.
• Other sources: Includes payments from the Department of Veterans Affairs (except TRICARE); other federal sources (Indian Health Service, military treatment facilities, and other care provided by the federal government); various state and local sources (community and neighborhood clinics, state and local health departments, and state programs other than Medicaid/CHIP); Workers' Compensation; and various unclassified sources (e.g., automobile, homeowner's, or other liability insurance, and other miscellaneous or unknown sources).

• Ambulatory: Includes office-based visits (visits to medical providers seen in office settings), hospital outpatient visits, and emergency room visits. Expenses for outpatient and emergency room visits include payments for services covered under the basic facility charge and those for separately billed physician services. Emergency room payments exclude expenses for emergency room services that are included in a hospital inpatient admission.
• Hospital inpatient: Includes room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately billed physician inpatient services, and some emergency room expenses incurred immediately prior to inpatient stays.
• Prescribed medicines: Includes expenses for all prescribed medications that were initially purchased or refilled during the year.
• Home health: Includes expenses for home care provided by agencies and independent providers.
• Dental and other: Includes payments for services to any type of dental care provider as well as expenses for care in all categories not specified as a separate category (e.g., medical equipment and supplies).

About MEPS

References

Suggested Citation