Health Care Satellite Account
Health care is a large and growing share of the U.S. economy – 17.4% of GDP in 2013. In order to provide more detail on this important sector, BEA has developed the Health Care Satellite Account (HCSA). With this new account, BEA aims to improve the measurement of health care spending, and help researchers and policymakers better understand this sector’s spending and trends.
The principal contribution of the HCSA is that it redefines the commodity provided to patients as the treatment of disease (for example, cancer or diabetes) rather than the specific types of medical care that individuals purchase (such as visits to a doctor’s office or the purchase of a drug), as is currently published. The redefinition of the output of the health sector as the treatment of disease implies a different allocation of consumer spending for health care services (across diseases rather than goods and services) and also different price indexes than those published in the NIPAs.
This first release of the HCSA presents two versions of the accounts for the 2000 to 2010 period. One version uses data from the Medical Expenditure Panel Survey (MEPS) – referred to as the “MEPS Account” - which is the only nationally representative survey that contains detailed expenditure information by disease. Due to the relatively small sample size the MEPS Account produces more volatile estimates across years. To address this issue, we present a second version of the satellite account – referred to as the “Blended Account” - which blends together data from multiple sources, including large claims databases that cover millions of enrollees and billions of claims. Both the data and more detailed descriptions of these accounts are available below.
Providing statistics for health care spending by disease is the first step in developing an account that would allow one to better assess the value in health care spending. As part of this project, BEA staff continues to conduct research to improve the HCSA going forward.
Publications and Working Papers
National Accounting - Methodology and Application
- Toward a Health Care Satellite Account (PDF)Ana Aizcorbe, Bonnie Retus, and Shelly Smith - Survey of Current Business, May 2008
- A Reconciliation of Health Care Expenditures in the National Health Expenditure Accounts and in Gross Domestic Product (PDF)Caitlin (CMS), Hartman (CMS), Kornfeld (BEA) - Survey of Current Business, September 2010
- Household Consumption Expenditures for Medical Care: An Alternate Presentation (PDF)Ana Aizcorbe, Eli B. Liebman, David M. Cutler, and Allison B. Rosen - Survey of Current Business, June 2012
- Recent Research on Disease-Based Price Indexes: Where Do We Stand? (PDF)Ana Aizcorbe - Survey of Current Business, July 2013
Measurement - Price and Utilization Growth
- Estimating Regression Based Medical Care Expenditure Indexes for Medicare Advantage EnrolleesAnne Hall
- Do Physicians Possess Market Power?Abe Dunn and Adam Hale Shapiro - Journal of Law and Economics vol. 57, no. 1 (February 2014):159-193
- Implications of Utilization Shifts on Medical-Care Price MeasurementAbe Dunn, Eli Liebman and Adam Hale Shapiro (2014) - Health Economics - doi: 10.1002/hec.3036
- Medical Care Expenditure Indexes for the US, 1980-2006Ana Aizcorbe and Tina Highfill - Paper presented at the Society of Economic Measurement conference, Aug 2014
- Defining Disease Episodes and the Effects on the Components of Expenditure Growth (PDF)Abe Dunn, Eli Liebman, Lindsey Rittmueller, and Adam Shapiro - BEA Working Paper (WP2014-4)
- A Regression-Based Medical Care Expenditure Index for Medicare Beneficiaries (PDF)Anne E. Hall, Tina Highfill - BEA Working Paper (WP2013-4)
- Decomposing Medical-Care Expenditure Growth (PDF)Abe Dunn, Eli Liebman, and Adam Hale Shapiro - BEA Working Paper (WP2012-10)
- Implications of Utilization Shifts on Medical-Care Price Measurement (PDF)Abe Dunn, Eli Liebman, and Adam Hale Shapiro - Health Economics, Forthcoming
- Developing a Framework for Decomposing Medical-Care Expenditure Growth: Exploring Issues of Representativeness (PDF)Abe Dunn, Eli Liebman, and Adam Hale Shapiro - Forthcoming in Measuring Economic Sustainability and Progress, NBER Book Series Studies in Income and Wealth. Dale Jorgenson, Steven Landefeld, and Paul Schreyer, eds.
- Changing Mix of Medical Care Services: Stylized Facts and Implications for Price Indexes (PDF)Ana Aizcorbe and Nicole Nestoriak - Journal of Health Economics, 30 (3): 568-574 (May 2011) - BEA Working Paper (WP2010-08)
- Medical Care Price Indexes for Patients with Employer-Provided Insurance: Nationally-Representative Estimates from MarketScan Data(PDF)Abe Dunn, Eli B. Liebman, Sarah Pack, Adam Shapiro - Health Services Research, October 2012
- Alternative Price Indexes for Medical Care: Evidence from the MEPS SurveyAizcorbe, Bradley (BLS), Herauf, Kane, Liebman, Pack, Rozental (BLS) - BEA Working Paper (WP2011-01)
- Price Indexes for Prescription Drugs: A Review of the Issues(PDF)Ana Aizcorbe and Nicole Nestoriak - In The Oxford Handbook of the Economics of the Biopharmaceutical Industry, Danzon and Nicholson, eds. March 2012
- Drug Innovations and Welfare Measures Computed from Market Demand: The Case of Anti-Cholesterol Drugs (PDF) (Article Summary | PDF)Abe Dunn - American Economic Journal: Applied Economics , 4 (3): 167-89 (July 2012) - BEA Working Paper (WP2010-15)
Prices and Utilization - Regional Differences
- Health Insurance and the Demand for Medical Care: Instrumental Variable Estimates Using Health Insurer Claims Data (PDF)Abe Dunn - BEA Working Paper (WP2014-03)
- Physician Market Power and Medical-Care Expenditures(PDF) (Article Summary | PDF)Abe Dunn and Adam Shapiro - BEA Working Paper (WP2012-06)
- Geographic Variation in Commercial Medical-Care Expenditures: A Framework for Decomposing Price and Utilization (PDF)Abe Dunn, Adam Shapiro, and Eli B. Liebman - Journal of Health Economics, (2013), 32(6) pgs 1153- 1165. Technical Appendix
Data and Methods
- Calculating Disease-Based Medical Care Expenditure Indexes for Medicare Beneficiaries: A Comparison of Method and Data ChoicesAnne E. Hall and Tina Highfill - Bureau of Economic Analysis Working Paper, November 2013
- Using Disability Adjusted Life Years to Value the Treatment of Thirty Chronic Conditions in the U.S. from 1987-2010Tina Highfill and Elizabeth Bernstein - BEA Working Paper (WP2014-9)
- Developing a Framework for Decomposing Medical-Care Expenditure Growth: Exploring Issues of RepresentativenessAbe Dunn, Eli Liebman and Adam Hale Shapiro - Forthcoming in Measuring Economic Sustainability and Progress, NBER Book Series Studies in Income and Wealth. Dale Jorgenson, Steven Landefeld, and Paul Schreyer, eds.
- Measuring Health Care Costs of Individuals with Employer-Sponsored Health Insurance in the U.S.: A Comparison of Survey and Claims Data (PDF) (Article Summary)Ana Aizcorbe, Eli B. Liebman, Sarah Pack, David M. Cutler, Michael Chernew, Alison B. Rosen - Statistical Journal of the IAOS 28 (2012) 43–51 - BEA Working Paper (WP2010-06)
- Comparing Commercial Systems for Characterizing Episodes of Care(PDF)Allison B. Rosen, Eli Liebman, Ana Aizcorbe, and David M. Cutler - BEA Working Paper (WP2012-7)