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The Distribution of Public Spending for Health Care in the United States on the Eve of Health Reform


  • Didem Bernard
  • Thomas Selden
  • Yuriy Pylypchuk


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.

Suggested Citation

  • Didem Bernard & Thomas Selden & Yuriy Pylypchuk, 2017. "The Distribution of Public Spending for Health Care in the United States on the Eve of Health Reform," NBER Working Papers 23150, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:23150
    Note: HE

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    References listed on IDEAS

    1. McClellan, Mark & Skinner, Jonathan, 2006. "The incidence of Medicare," Journal of Public Economics, Elsevier, vol. 90(1-2), pages 257-276, January.
    2. Selden, Thomas M. & Moeller, John F., 2000. "Estimates of the Tax Subsidy for Employment-Related Health Insurance," National Tax Journal, National Tax Association, vol. 53(4), pages 877-888, December.
    3. Wolfe, Barbara L & Moffitt, Robert, 1991. "A New Index to Value In-Kind Benefits," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 37(4), pages 387-408, December.
    4. Frank A. Sloan & Jingshu Wang & Harold H. Zhang, 2002. "Upstream Intergenerational Transfers," Southern Economic Journal, Southern Economic Association, vol. 69(2), pages 363-380, October.
    5. Bhattacharya, Jay & Lakdawalla, Darius, 2006. "Does Medicare benefit the poor?," Journal of Public Economics, Elsevier, vol. 90(1-2), pages 277-292, January.
    6. Thomas M. Selden & Didem M. Bernard, 2004. "Tax Incidence and Net Benefits in the Market for Employment-Related Health Insurance: Sensitivity of Estimates to the Incidence of Employer Costs," International Journal of Health Economics and Management, Springer, vol. 4(2), pages 167-192, June.
    7. Daniel Feenberg & Elisabeth Coutts, 1993. "An introduction to the TAXSIM model," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 12(1), pages 189-194.
    8. Selden, Thomas M. & Moeller, John F., 2000. "Estimates of the Tax Subsidy for Employment-Related Health Insurance," National Tax Journal, National Tax Association, vol. 53(n. 4), pages 877-88, December.
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    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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