Figure 3 Prevalence of Health Conditions, Average Spending, and Figure 2 Share of Total Spending Among Individuals With Distribution of Health Spending, 2021 Employment-Based Health Coverage, 2021 $250,000 30% March 9, 2023, #457 Share of Chronic Average Spending Percentage of Condition Conditions Sample per Person Total Spending 25% $200,000 Respiratory Conditions 29% $13,000 30% High-Cost Health Care Claimants: Health Spending and Musculoskeletal Conditions 28% $17,000 36% 20% Skin Disorders 23% $15,000 28% Chronic Condition Prevalence in 2021 $150,000 Heart Disease 22% $17,000 44% Nervous System Disorders 20% $25,000 39% 15% Mental Disorders 20% $15,000 24% Examining the health care claims of 8.6 million individuals enrolled in a group policy in 2021, our research shows Hypertension 15% $20,000 22% $100,000 that: Diabetes 13% $22,000 18% 10% Connective Tissue Disease 6% $20,000 9% • The top 1 percent of spenders accounted for 28 percent of spending, the top 5 percent accounted for 56 Cancer 4% $51,000 14% percent of spending, the top 10 percent accounted for 71 percent of spending, and the top 20 percent $50,000 Endocrine Disease 4% $20,000 6% 5% accounted for 84 percent of total health spending (Figure 1). Pneumonia 2% $54,000 6% Infectious Disease 2% $35,000 5% • The medical spending distribution is highly skewed. The top 1 percent of spenders accounted for 28 Cerebrovascular Disease 1% $51,000 5% $0 0% Top 1% Next 2–5% Next 6–10% Next 11–20% Next 21–100% percent of spending, the next 2–5 percent accounted for 28 percent of spending, the next 6–10 percent Kidney Disease 1% $58,000 5% Percentage of Spending 28% 28% 15% 13% 16% accounted for 15 percent of spending, the next 11–20 percent accounted for 13 percent of spending, and Other 4% $40,000 13% Median Spending per Person $144,000 $44,000 $20,000 $9,000 $900 ® the remaining 21–100 percent accounted for 16 percent of spending (Figure 2). Source: EBRI estimates using 2021 Merative™ MarketScan Commercial Database. Average Spending per Person $200,000 $49,000 $20,000 $9,000 $1,400 *Note: Chronic Conditions sample is enrollees who have at least one of the 14 medical conditions in this ® Source: EBRI estimates using 2021 Merative MarketScan Commercial Database. figure. It represents about 38 percent of all enrollees. • The average spending for an enrollee in the top 1 percent of spending was $200,000 a year, and for ** Average spending for enrollees by condition includes spending on other health conditions. someone in the top 20 percent, the average was $30,000 (Figure 2). *** “Other” category includes liver disease, hemiplegia/paraplegia, AIDS, regional enteritis, ulcerative colitis, and dementia. • About 3 million enrollees, or 54 percent, of all enrollees in group plans have at least one of the conditions A Thank You To Members: This study was conducted through the EBRI Center for Research on Health in Figure 3. Total spending for these enrollees represents 90 percent of all health care spending in group Benefits Innovation (EBRI CRHBI), with the funding support of the following organizations: Aon, Blue Cross plans in 2021. Average spending among these 3 million enrollees was $11,629 per person. Blue Shi eld Association, ICUBA, JP Morgan Chase, Pfizer, and PhRMA. • Among these 3 million enrollees, 29 percent have a respiratory disease, 28 percent have a musculoskeletal Figure 1 The Employee Benefit Research Institute is a private, nonpartisan, and nonprofit research institute based in condition, 23 percent have a skin disorder, 22 percent have heart disease, 20 percent have a nervous Distribution of Health Spending, Among Individuals Washington, D.C., that focuses on health, savings, retirement, and economic security issues. EBRI does not lobby system disorder, 20 percent have a mental disorder, 15 percent have hypertension, 13 percent have With Employment-Based Health Coverage, 2021 and does not take policy positions. The work of EBRI is made possible by funding from its members and diabetes, 6 percent have connective tissue disease, 4 percent have cancer, 4 percent have some “other” Percentage of Percentage of Median Spending Average Spending Minimum Spending sponsors, which include a broad range of public and private organizations. For more information, visit condition, 4 percent have an endocrine disease, 2 percent have pneumonia, 2 percent have an infectious Enrollees Spending per Person per Person per Person www.ebri.org. disease, 1 percent have cerebrovascular disease, and 1 percent have kidney disease. 1% 28% $144,000 $200,000 $93,000 5% 56% $50,000 $79,000 $29,000 • Individuals with any one of these conditions may and likely do have other health conditions, explaining 10% 71% $29,000 $50,000 $15,000 ### their high health spending. 20% 84% $15,000 $30,000 $6,000 ® Source: EBRI estimates using 2021 Merative™ MarketScan Commercial Database. • Average spending for enrollees with any one of the 16 conditions in Figure 3 ranged from $13,000 (those with respiratory conditions) to $58,000 (those with kidney disease). 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