HealthDay News – The highest healthcare expenditures in the US were seen in the wealthiest population quintile, suggesting that care has been redistributed, according to research published in Health Affairs.

Samuel L. Dickman, from Harvard Medical School in Boston, and colleagues assessed trends in health expenditures by people in each quintile of the US population using data from 22 national surveys conducted between 1963 and 2012. “We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012,” they stated.

The researchers found that before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures despite their worse health, compared with other income groups. The unadjusted expenditures for the lowest quintile exceeded those for all other income groups by 1977, a pattern that persisted until 2004. 

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After 2004, expenditures fell for the lowest quintile, but rose more than 10% for the middle 3 quintiles and close to 20% for the highest income quintile, which had the highest expenditures in 2012. This post-2004 divergence of expenditure trends occurred only among the nonelderly.

“We conclude that the new pattern of spending post-2004, with the wealthiest quintile having the highest expenditures for health care, suggests that a redistribution of care toward wealthier Americans accompanied the health spending slowdown,” the researchers wrote.


  1. Dickman SL, Woolhandler S, Bor J, McCormick D, Bor DH, Himmelstein DU. Health Spending For Low-, Middle-, And High-Income Americans, 1963–2012. Health Aff. 2016;35(7):1189-1196. doi:10.1377/hlthaff.2015.1024.