9 ms·
Share of total health spending, by percentile
- seba_dos1 2y agoAmerican health system working as expected? That's actually a surprise!
- black6 2y agoand 5% of people are responsible for just over half.
- mseepgood 2y agoMakes sense, probably those who are ill or have other health problems.
- jpm_sd 2y agoSource link https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/#Share%20of%20total%20health%20spending,%20by%20percentile,%202021 https://www.healthsystemtracker.org/chart-collection/health-... Don't assume high spending necessarily means poor overall health. Two people in my household are on modern fancy drugs for autoimmune conditions (upadacitinib and etanercept). They work spectacularly well and cost our insurance company thousands of dollars a month. And the family members taking them are doing great!
- voidwtf 2y agoboth my cousins have a similar condition, one of my cousins cannot live without these drugs/transfusions. his prior insurer cut him off once he hit 1m lifetime care, he had a rough childhood
- whynotminot 2y agoWow, didn’t know that kind of “max cost” cutoff existed. I thought the whole point of insurance was “I’ll probably be fine but if things really go south, good thing I have insurance.”
- apwell23 2y agoyes you have to go to india on medical visa after that
- ceejayoz 2y agoThe ACA banned lifetime caps.
- reverius42 2y agoThanks Obama!
- carso 2y agoOne of the underappreciated accomplishments of Obamacare was the end of those 1m caps. One of the ongoing failures in health care policy is out of control drug costs.
- ceejayoz 2y agoYeah; I'm on a biologic for psoriasis. $25k buys me a single milliliter of fluid that I self-inject once every twelve weeks. It works wonders, but yikes.
- switch007 2y agoWoah is that a typo? $108,000 a year for psoriasis? Would it be cheaper to fly somewhere?
- ceejayoz 2y agoThat's why I have the health insurance. I pay a $5 copay on it. I don't think it's sustainable on the national scale much longer; the insurance premium costs me twice my mortgage each month.
- switch007 2y agoOh the wording was ambiguous. Sounded like that was what you paid. $5 is more reasonable!
- s1artibartfast 2y agoI assume this is sarcasm. Either way, it highlights the fundamental challenge with how healthcare incentives are set up in the US
- switch007 2y agoI'm lost. Just a confused European trying to understand US healthcare
- s1artibartfast 2y agoOh, in that case your comment highlights the difference between the obvious and direct cost to the patient $5, and the less direct cost of $100k/yr which the patients are also paying. In the US you might have the copay $5, but you also pay for your insurance plan, which might be like $30k/year for a good family plan.
- voidwtf 2y agoI’m not sure how i feel about this statistic. In America we have some pretty bed economics around health, i could easily see this number inflated by the exorbitant cost of insulin, or HIV meds, or cancer meds. life saving medications whose costs are quite controversial. also, end of life care for the elderly. this is a statistic that needs some serious context and fact checking IMO
- voidwtf 2y agojpm_sd posted the source while i was writing this, which contains a wealth of information, definitely check it out
- jordanb 2y agoYep. Probably people who are on drugs that cost very little to make but are being sold for enormous amounts of money. The medical industry seems to operate a lot like gambling where outsize profits are available from a small percentage of "whales". These whales have the combination of some condition, the treatment of which can be made very expensive, combined with access to the financial resources to pay for the treatment.
- gruez 2y ago>Yep. Probably people who are on drugs that cost very little to make but are being sold for enormous amounts of money. This entirely ignores the cost of R&D, clinical trials, and most importantly, all the other drugs that didn't make it to market.
- bluefirebrand 2y agoSure, but are they marked up to "return on investment" prices, or "make all of the executives so enormously wealthy that it's actually disgusting" prices? My bet is the latter
- gruez 2y ago>Sure, but are they marked up to "return on investment" prices, or "make all of the executives so enormously wealthy that it's actually disgusting" prices? The healthcare sector's 5 year profit margins is 10.0%. That puts it in the middle of the pack when it comes to the other sectors. https://insight.factset.com/hs-fs/hubfs/1)Insight/2024/04.2024/04.29.2024_Earnings%20Insight/03-s%26p-500-sector-level-net-profit-margins-q124-vs-5-year-average.png?width=672&height=384&name=03-s%26p-500-sector-level-net-profit-margins-q124-vs-5-year-average.png https://insight.factset.com/hs-fs/hubfs/1)Insight/2024/04.20...
- evv555 2y agoIs this over a lifetime or any given year? If it's the latter it's just a different 1 percent every year which will eventually include you. Clickbait framing of data.
- robertclaus 2y agoWhen I saw it was a chart on X I thought the same thing!
- antisthenes 2y agoIs this total lifetime spending or per-year spending? If it's per-year then the graphs are useless. You can be in the 1% one year, and in the bottom 50% the next.
- bee_rider 2y agoI imagine the typical trajectory that a huge number of people follow would be to suddenly and briefly enter the top 1% near the end of their lives.
- neilv 2y agoYes. Thankfully we're not all seriously ill. And when someone does have that misfortune, we should spread the cost around, so that whomever needs care can get it.
- KeplerBoy 2y agoI doubt it's much different in other more social health care systems. Some people just need a whole lot more aids and meds than most people. Take wheelchairs for example, they are as complex as single speed bicycles but easily cost 10k because reasons.
- FredPret 2y agoSome wheelchairs are custom-fitted
- cqqxo4zV46cp 2y agoYeah, the US difference is in the absolute costs!
- miki123211 2y ago> Because reasons The "reasons" are mostly unit economics, with a bit of regulatory capture thrown into the mix. There are two kinds of costs that go into a product, the costs you have to pay upfront, like factory construction, and the costs you pay per unit, like materials and shipping. Even if those are the same for wheelchairs and bicycles, you make far fewer wheelchairs than you make bicycles, so you have far fewer units to spread the upfront costs over. The per-unit costs are never actually the same, as ordering parts in larger volumes is usually cheaper. Then there's the "regulatory capture" part, you need far fewer permits and far less government paperwork to open up a bicycle company than to open up a wheelchair company, especially if you want to work with insurers and/or national healthcare systems. This means that a bicycle company racking up margins would be quickly outcompeted by others, while overbroad government regulations favor those shenanigans in the healthcare industry.
- techjamie 2y agoIt's probably roughly the same as how hospital bills work. Drug maker says they want $25,000 for this drug. Insurance company says they'll only pay 5,000. Drug company takes $5,000 for the drug and writes the other $20,000 off as a loss so they don't pay taxes.
- delichon 2y agoAs I age I find myself increasingly becoming a healthcare spender. For a lot of people that's just a part of the chromosome shuffle and not so much about their life choices. But I can't say that. I've made very bad choices, over and over and over, knowing the consequences, across more than five decades now. My chromosomes are far from perfect but they would have done fine without my indulgences. Therefore I don't think it's right to impose my higher spending on the rest of you. I should just suck it up, walk it off, or suffer and die early, because it isn't fair for me to charge you for my pleasures. You don't owe me. I identify with the Inuit grandma choosing to drift off on an ice flow. But she has a much better claim on the support of her tribe.
- showerst 2y agoThe problem is that there’s nobody I trust to do the deciding on whose choices were bad. So I say we just save them all, and let god sort ‘em out.
- giantg2 2y agoItaly has a system where if it's genetic it's covered and if it's influenced by lifestyle you pay a tax. Even in the US, insurance still decides what is covered and what's not. There's always someone deciding in any system unless it's cash.
- monktastic1 2y agoI mean you can personally refuse care, but the subtext I get is that others should martyr themselves similarly. That's not a choice you get to make for them.
- Kinrany 2y agoIf the idea is that bad choices should be disincentivized, then this should be limited to people capable of planning far enough.
- HPsquared 2y agoThe Inuit grandmother is directly helping her family by drifting off. The health insurance customer, not so much. Probably not a good deal for you and yours to take the ultimate sacrifice in service of 0.0001% lower insurance premiums.
- cagenut 2y agoI mentally translate these headlines as "journalist discovers yet another thing follows a power-law/pareto-ish distribution".
- comboy 2y agoEven within tech circles surprisingly few people are aware how ubiquitous power law distributions are.
- aqme28 2y agoIs this year by year? I’ve heard that we use something like half of our lifetime healthcare spending in our last years life. Which explains the numbers in the headline, but also shows why it’s misleading.
- deleted 2y ago[deleted]
- HPsquared 2y agoIt probably is similar if you look at "final year spending". Some people have very expensive conditions, some are otherwise healthy (or appear so) and suddenly drop dead.
- GeoAtreides 2y agoah, if only people would read the post, so many questions they have would be answered
- HPsquared 2y agoProbably another Pareto distribution.
- sandworm101 2y agoCareful. I smell inadvertant eugenics arguments approaching. <1% of people commit 99% of all murders. <1% of people cause 99% of fatal trafic accidents. <1% of people are responsable for 99% of tax fraud. <1% of people ride those stupid three-wheel bikes. If only we found and isolated 1% of people, all our problems would go away!
- soraminazuki 2y agoRinse and repeat. https://www.wolframalpha.com/input?i2d=true&i=Limit%5BPower%5BDivide%5B99%2C100%5D%2Cn%5D%2Cn-%3E%E2%88%9E%5D https://www.wolframalpha.com/input?i2d=true&i=Limit%5BPower%...
- Dylan16807 2y agoYou know there's a thing called "babies" right?
- soraminazuki 2y agoWell, you kind of disincentivize making one with a crappier healthcare system.
- chrismorgan 2y ago> <1% of people ride those stupid three-wheel bikes. I’m curious what you have against tricycles or tricyclists. (I was a tricyclist for just shy of ten years, but just gave it up this month as part of moving to India to marry, loving a particular woman considerably more than my Greenspeed GT3. And I’m rather surprised to encounter tricycles grouped along with murders, fatal traffic accidents and tax fraud, because in cumulatively several months of solo cycle touring in AU, US, CA and NZ, I think I encountered a negative reaction expressed about six times, whereas positive or curious reactions happen multiple times per day.)
- sandworm101 2y agoTo illustrate the absurdity of the situation. Virtually everything, good or bad, is only done by a small subset of the population.
- draw_down 2y agoWow, that’s a lot. Just think how much money we could save if we stopped caring for them.
- sam_goody 2y agoSo, roughly 1 in twenty are old /infirm, and one in 100 are really old / infirm? Makes sense to me. Is that supposed to be surprising?
- glasss 2y agoFor most commercial companies you'll see pharmacy benefits split similarly: 1% - 2% of people on the health plan will account for ~50% of the pharmacy drug spend. That's regardless of overall health of the rest of the members. It's great there's been a lot of innovations for newer drugs that help more people with rare diseases, but specialty drugs just cost a lot. It takes a long time for generics or biosimilars can make it to market.
- ceejayoz 2y ago> It takes a long time for generics or biosimilars can make it to market. Especially considering the pharmaceutical companies pay the generic manufacturers to stay out of the market. https://www.theatlantic.com/ideas/archive/2023/06/pharmaceutical-generic-drugs-pay-for-delay/674410/ https://www.theatlantic.com/ideas/archive/2023/06/pharmaceut...
- EcommerceFlow 2y agoTop 5% account for 50% of all healthcare spending. https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population https://www.healthsystemtracker.org/chart-collection/health-...
- ineedasername 2y agoOf course: the sickest 1% will always spend more money than everyone else on an average per capita basis
- Eddy_Viscosity2 2y agoThis was going to be my comment as well. Same with insurance, those that have car accidents or house fires or floods will disproportionately account for the cost of insurance. This is how it works. I don't have a link, but I remember a study that looked at this specific issue for the few outliers in health care that were a causing the use of the most resources. It turns out that identifying them and giving them a more holistic care approach dramatically reduced costs and improved outcomes for those people. Part of the problem was the segmented approach to healthcare.
- zug_zug 2y agoWell are the "people" responsible, or are outrageous-prices (e.g. one subscription costs 50k) responsible? Or is it just like 1% of people have cancer? Would love to see a good-faith analysis by somebody who has 50 hours to commit to it, a good grasp of statistics, and no interest in politics.
- airstrike 2y ago> Would love to see a good-faith analysis by somebody who has 50 hours to commit to it, a good grasp of statistics, and no interest in politics. I'd like a unicorn too!
- a2800276 2y agoThis comes as a surprise to whom exactly? Seems like the ideal scenario for ... insurance. Good health almost always costs nothing, but when an intervention is required, it's crazy expensive. -> everybody pays a negligible amount into the kitty. Since everyone pays in and almost noone takes anything out, there's enough there to cover crazy expensive treatments for the few who need them.
- hobs 2y agoNo it seems the ideal scenario for cost controlling absurdly over priced medical care.
- toomuchtodo 2y agoThis. Why are we blaming people who need medical care for the fact that the system won’t contain costs and is built to maximize extraction and profit? Should these people go without care? Start with destroying pharma benefit managers and Medicare Advantage, and continue hacking and slashing based on cost/time/benefit ratio. https://www.wsj.com/health/healthcare/medicare-health-insurance-diagnosis-payments-b4d99a5d https://www.wsj.com/health/healthcare/medicare-health-insura... | https://archive.is/de2f3 https://archive.is/de2f3 (“Insurers Pocketed $50 Billion From Medicare for Diseases No Doctor Treated”) https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing https://www.thebignewsletter.com/p/inside-the-mafia-of-pharm... (“Inside the Mafia of Pharma Pricing”) “Your margin is our opportunity.”
- astromaniak 2y ago> Why are we blaming people who need medical care We don't blame them, but without any control we have the highest prices and not so good overall results. Add to that Trump with his industry 'self regulation' idea and you know what's coming...
- s1artibartfast 2y agoThere is a fundamental conflict between first line care and financial efficiency. Countries with successful healthcare institutions use purchasing controls to negotiate. They dont rely on the charity or good nature of suppliers. Instead, they say "thats too expensive, lower the price or we will take the option 90% as good for 10% the cost".
- FfejL 2y agoThis is a horrible way to frame the study's finding. "1% of people are responsible" sounds like some group is wasting resources, or taking up an uneven share. The study looks at one year, and finds in that one year 24% of spending was on 1% of the people receiving care. That's not very surprising. 30 years ago I was in a bad car accident. I'm sure the cost of the ambulance, the emergency surgery, and the after-care was WAY more than most people average that year, and easily the most expensive medical year of my life. But it was just that one time.
- whythre 2y agoThe framing immediately put me on guard. It feels like clear manipulation to direct hostility at this ‘1%.’
- deleted 2y ago[deleted]
- karmakaze 2y ago'Health spending' doesn't specify the source of payment so much of that responsibility could have been borne out-of-pocket.
- s1artibartfast 2y agoThere are actually two charts. One is for total and one is for out of pocket. https://www.kff.org/health-policy-101-health-care-costs-and-affordability/?entry=table-of-contents-how-does-health-care-spending-vary-across-the-population https://www.kff.org/health-policy-101-health-care-costs-and-...
- wjnc 2y agoTotally true. For a car insurer you are looking at what, 500 years of premium for a serious total loss collision? That means 499 people get nothing (drama?!). Actually this percentage (the “24%”) gets higher the more extreme the covered events are. Daresay, a low percentage suggests something shouldn’t be insured, since it’s a regular event and people shouldn’t pay the insurers overhead and margin for something they could save for. So the suggestion that “1%”-“24%” is a wrong combination gets the nature of insurance exactly wrong. I read the 5% in OP that once in twenty years you get a serious condition where no expenses are spared to save you. That’s amazing. (Opinions on absolute US health spending are another topic.)
- jonstewart 2y agoThis is how insurance works...
- 0xTJ 2y agoThat's how the spending for anything work out when you have a wide spread in cost. This feels like a very unfair way to present a stat, blaming "people" for consuming more health care resources.
- deleted 2y ago[deleted]
- StopTheWorld 2y agoThat is a statistic on one chart on that. For only those who are 65 and up, total spending of the top 1% drops to 17%. In the charts posted, from the ages of 19 to 44, the amount spent on women is much larger than on men (not sure why - obstetricians?) Then of course, some people get cancer and some do not. With a normal age distribution of 18 year olds and up, it isn't surprising to me that very little is spent on the 18 to 30 year old men, and that one of the 65 and over got cancer and a lot of spending went toward that.
- s1artibartfast 2y agoImage source: https://www.kff.org/health-policy-101-health-care-costs-and-affordability/?entry=table-of-contents-how-does-health-care-spending-vary-across-the-population https://www.kff.org/health-policy-101-health-care-costs-and-... Primary Source: https://meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-233 https://meps.ahrq.gov/mepsweb/data_stats/download_data_files...
- anon291 2y agoThe Pareto distribution never lies.
- jfoutz 2y agoIsn't this just insurance? Medicare takes care of the very very expensive end of life care. but like, we all chip in, Some of us get very sick or hurt and there's no way to know up front who it might be. So, we all pay a little and that 1% is taken care of. Because that 1% might be me. This is how it works. We could save money by sacrificing that 1%, but that's a pretty nauseating idea.
- deleted 2y ago[deleted]
- Imnimo 2y agoI would imagine this is roughly the distribution for anything that we use insurance for. What is the distribution of fire insurance payouts? Of auto insurance? If these thing were uniformly distributed, we wouldn't need insurance for them.
- kube-system 2y ago[flagged]
- jncfhnb 2y agoI would rather see spending based on expected quality years of life remaining
- throwaway984393 2y ago[dead]
- OutOfHere 2y agoIt would be better to separate chronic care expenses from acute care expenses. A lot of people have periods in their life where they need expensive acute care, but it's not chronic.
- ziofill 2y agoWouldn’t this number be analogous (roughly) to any other country? My understanding is who pays differs in the US than e.g. Europe or Canada, but the amount of people in need of care shouldn’t be too different?
- sensanaty 2y agoThat's the point of healthcare isn't it? You pay even when healthy so that if something big happens, you're covered by the system.
- mumblemumble 2y agoI have a family member who used to be the director of an urban area's primary emergency department. (Now retired.) At some point he and his administrative staff saw a similar trend, and also figured out that their top 10 most expensive patients were all people who had chronic health conditions and no health insurance or medicaid. Not having health insurance meant they couldn't effectively manage their conditions, which meant they were repeatedly getting to a crisis point and having a family member call an ambulance. Which is just incredibly expensive - all emergency services are - and of course if they couldn't pay out of pocket for a family physician then they couldn't pay for emergency services, either. The solution was to start just paying out of the ED's own budget for these folks to see regular care providers, buying them their medications, arranging cab rides, etc. It saved the hospital millions per year.
- tech_ken 2y agoTail events are costly, NNT cackles somewhere in the distance
- beej71 2y agoIf I had my way, one single person would be responsible for 100% of healthcare spending, poor bastard.
- deleted 2y ago[deleted]
- david38 2y agoAnother way to phrase is “Modern medical highway robbery sucks 24% of our medical expenses from just 1% of the people”
- kthejoker2 2y agoHealth and hazards are unevenly distributed, inverse power law applies, film at 11?