Understanding health conditions with the most spending and variation across locations and over time is important for identifying trends, highlighting inequalities, and developing strategies for lowering health spending, say Dieleman, et al. (2025).

The researchers sought to estimate U.S. healthcare spending for each of 3,110 U.S. counties, across four payers (Medicare, Medicaid, private insurance, and out-of-pocket payments), and according to 148 health conditions, 38 age/sex groups, and 7 types of care from 2010 to 2019.

Between 2010 and 2019, 76.6% of personal health care spending was captured by this study. More spending was on type 2 diabetes ($143.9 billion [95% CI, $140 billion-$147.2 billion]) than on any other health condition, followed by other musculoskeletal disorders, which includes joint pain and osteoporosis ($108.6 billion [95% CI, $106.4 billion-$110.3 billion]), oral disorders ($93 billion [95% CI, $92.7 billion-$93.3 billion]), and ischemic heart disease ($80.7 billion [95% CI, $79 billion-$82.4 billion]). Of total spending, 42.2% (95% CI, 42.2%-42.2%) was on ambulatory care, while 23.8% (95% CI, 23.8%-23.8%) was on hospital inpatient care and 13.7% (95% CI, 13.7%-13.7%) was on prescribed retail pharmaceuticals. At the county level, age-standardized spending per capita ranged from $3410 (95% CI, $3281-$3529) in Clark County, Idaho, to $13 332 (95% CI, $13 177-$13 489) in Nassau County, New York. Across counties, the greatest variation was in age-standardized out-of-pocket spending, followed by private insurance spending. Cross-county variation was driven more by variation in utilization rates than variation in price and intensity of care, although both types of variation were substantial for all payers but Medicare.

Broad variation in healthcare spending was observed across U.S. counties, the researchers conclude. Understanding this variation by health condition, sex, age, type of care, and payer is valuable for identifying outliers, highlighting inequalities, and assessing healthcare gaps, they add.

Reference: Dieleman JL, et al. Tracking US Health Care Spending by Health Condition and County. JAMA. Published online February 14, 2025. doi:10.1001/jama.2024.26790