Working Paper: NBER ID: w23150
Authors: Didem Bernard; Thomas Selden; Yuriy Pylypchuk
Abstract: U.S. health care spending in 2012 totaled $2.8 trillion or 17.2 percent of gross domestic product. Given the magnitude of health care spending, the large public sector role in health care, and the reforms being implemented under the Patient Protection and Affordable Care Act (ACA), we believe it useful to examine several basic questions: What was the public share of national spending on the eve of reform? How has the public share evolved over time? And how are the benefits of public spending on health care distributed within the population by age, poverty level, insurance coverage, health status, and ACA-relevant subgroups? The questions we pose, while basic, cannot be answered with commonly-available statistics due to the sheer complexity of health care financing in the U.S. The objective of this paper is to provide answers by combining aggregate measures from the National Health Expenditure Accounts with micro-data from the Medical Expenditure Panel Survey.
Keywords: health care spending; public spending; Affordable Care Act; health reform
JEL Codes: I11; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| introduction of Medicare and Medicaid (I18) | increase in public share of total health spending (H51) |
| age (J14) | proportion of public spending received (H59) |
| income level (D31) | share of public spending received (H59) |
| health status (I12) | level of public spending received (H59) |