Patient-Centered Care Categorization of U.S. Health Care Expenditures

The traditional method of reporting health care costs in the United States is by setting or payer, such as the National Health Expenditure Accounts (NHEA), produced by the Centers for Medicare & Medicaid Services (CMS) (Centers for Medicare and Medicaid Services 2009). International comparisons have predominantly focused on overall trends, financing agent, provider, and function, and often provide limited information on specific consumer encounters and spending (Anderson and Hussey 2001; Orosz and Morgan 2004;). The Organization for Economic Co-Operation and Development has examined person-centered categories of health spending. These methods are useful for trends overall and by setting and payer but do not predominantly focus on how consumers actually interact with the health care system. We aimed to combine traditional methods of accounting with a patient-centered viewpoint to more fully identify the underlying factors driving costs and potential levers for efficient allocation of health care resources. The Medical Expenditure Panel Survey (MEPS) collects data on conditions, services, individual characteristics, setting, and payers (Agency for Healthcare Research and Quality 2009). Our objective was to classify all U.S. health care expenditures into patient-centered categories that capture health events in a manner that is closer than conventional methods (e.g., by setting or payer) to how consumers experience and consider their health and health care spending. We used MEPS data to classify medical expenses in 2007 into seven “patient-centered care” categories. This method of examining expenditures can complement traditional methods to provide additional insight into spending. This categorization may better identify the drivers of health care expenditures and suggest more focused policy solutions to improve the value and efficiency of the health care system.