National Health Expenditure Accounts (NHEA)

Overview

NHEA provides estimates of aggregate health care expenditures in the United States from 1960 onward. NHEA contains all of the main components of the health care system within a unified, mutually exclusive, and exhaustive structure. The accounts measure spending for health care in the United States by type of goods or services delivered (for example, hospital care, physician and clinical services, or retail prescription drugs) and by the source of funds that pays for that care (for example, private health insurance, Medicare, Medicaid, or out of pocket). A consistent set of definitions is used for health care goods and services and for sources of funds that finance health care expenditures, allowing for comparisons over time.

Methodology

NHEA estimates health care spending using an expenditures approach to national economic accounting. Expenditures are estimated for the payers as well as the categories of medical goods and services. A common set of definitions allows comparison among categories and over time. In addition, estimates are benchmarked to revenue estimates from the U.S. Census Bureau’s 5-year Economic Census.

An assortment of government and private sources are used to create NHEA. In addition to the Economic Census, government sources include data from the Census Bureau’s Services Annual Survey, the Bureau of Economic Analysis’ National Income and Product Accounts, and Medicare claims data. Private data sources include the American Hospital Association’s Annual Survey and the Kaiser Family Foundation/Health Research & Educational Trust’s Employer Health Benefits Survey.

For example, private health insurance spending for health care goods and services is derived using data from the Census Bureau, American Medical Association, American Hospital Association, IQVIA (formerly IMS Health), National Medical Care Expenditure Survey of the National Center for Health Services Research (1987), and Medical Expenditure Panel Surveys of the Agency for Healthcare Research and Quality (1996–2019). For a matrix of data sources used for NHEA, see Exhibit 4 of “National Health Expenditure Accounts: Methodology Paper, 2019.”

Issues Affecting Interpretation

Every 5 years, NHEA undergoes a comprehensive revision that includes the incorporation of newly available source data, methodological and definitional changes, and benchmark estimates from the Economic Census. During these comprehensive revisions, the entire NHEA time series is opened for revision.

References

• Martin AB, Hartman M, Lassman D, Catlin A. National health care spending in 2019: Steady growth for the fourth consecutive year. Health Aff (Millwood) 40(1):14–24. 2021.
• Centers for Medicare & Medicaid Services. National health expenditure accounts: Methodology paper, 2020. Definitions, sources, and methods. 2021. Available from: https://www.cms.gov/files/document/definitions-sources-and-methods.pdf.
• Centers for Medicare & Medicaid Services. Summary of the 2019 comprehensive revision to the National Health Expenditure Accounts. 2020. Available from: https://www.cms.gov/files/document/summary-benchmark-changes-2019.pdf.

For more information, see the CMS National Health Expenditure Accounts website at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.