....Health care spending in the US totaled $3.8 trillion in 2019 and is projected to reach more than $7 trillion by 2031.¹ Within the US, spending varies dramatically across states, although many key drivers of health care spending, such as access to care, service prices, disease and injury prevalence, and underlying need for health care, vary at more local levels.^2,3 Understanding how health care resources are distributed across counties, types of care, and health conditions—and identifying the payers funding this care—is essential to informing policy decisions and driving areas of further research. [JAMA}

Currently, most local and disease-specific estimates of US health care spending are incomplete or out of date. Estimates of health care spending are available at the national level through National Health Expenditure Projections¹ and at the state level through State Health Expenditure Accounts,^3,4 but these estimates are broken down only by type of care and payer. Disease-specific spending estimates are available for certain conditions, such as diabetes⁵ and Alzheimer disease,⁶ but typically only for select years and most often for the US as a whole. Health care spending reports are also available for specific payers, such as employer-sponsored insurance⁷ and Medicare,⁸ but they lack further disaggregation. Previous work from the Institute for Health Metrics and Evaluation’s Disease Expenditure Project has contributed to a more complete understanding of health care spending in the US: decomposing changes over time into key drivers of spending increases,⁹ attributing spending to modifiable risk factors,¹⁰ assessing spending effectiveness,¹¹ and considering spending and utilization (eg, the number of visits, admissions, or filled prescriptions) differences by race and ethnicity,¹² but in all of these cases, the analysis was conducted at the national level and is not detailed enough to provide a comprehensive view of health care spending.

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