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Comprehensive Evaluation of US Healthcare Spending on Injuries: First All-Payer, All-Setting, All-Mechanism Analysis of Billion in Annual Spending
*John Scott1, Eileen M. Bulger
1, *Sawyer Crosby
2, *Haley Lescinsky
2, *Joseph L. Dieleman
21Department of Surgery, University of Washington, Seattle, Washington; 2Department of Health Metric Sciences, University of Washington, Seattle, Washington
Background: Injury is a leading cause of death and disability affecting all ages, payers, and care settings accounting for nearly $100B in healthcare spending. However, existing data sources capture only isolated fragments (single payers, single settings, or facility charges without professional fees), leaving policymakers and trauma centers without comprehensive understanding of resource demand. This fragmented view undermines trauma system planning, exacerbates funding inequities, and limits investment in evidence-based prevention. We performed the first all-payer, all-setting, injury-stratified analysis of annual U.S. healthcare spending on traumatic injuries.
Method: Using data from the Institute for Health Metrics and Evaluation's US Disease Expenditure Project, we harmonized 40+ billion claims from Medicare, Medicaid, commercial payers, and HCUP. Injuries were classified by external cause after harmonizing Global Burden of Disease and CDC taxonomies. Spending was stratified by age, sex, payer, and care setting (ambulatory, ED, inpatient, nursing facility, home health).
Results: US injury spending totaled $98 billion in 2019. Falls dominated ($48.5B, 50%), followed by other injuries ($24.6B, 25%), road traffic injuries ($18.4B, 19%), burns ($2.0B, 2%), assault ($2.0B, 2%), firearm injuries ($1.5B, 1.5%), and self-harm ($0.8B). Figure 1 demonstrates three findings: First, spending distributes nearly equally across acute and post-acute care: inpatient + ED accounted for $50.5B (52%); ambulatory + post-acute care accounted for $47.3B (48%). Falls drove post-acute spending; firearms and assaults were acute-phase intensive. Second, payer burden stratifies by mechanism: private insurance funded 48% ($47.0B, working-age injuries), Medicare 28% ($27.7B, elderly falls), Medicaid 14% ($13.2B, violence), out-of-pocket 10% ($9.8B). Third, mechanism heterogeneity drives resource mismatches: firearms (1.5% of spending) concentrate in high-acuity inpatient/ED care with public financing, while falls (50%) distribute across lower-intensity post-acute settings, nuance that per-population planning misses.
Conclusions: This first all-payer, all-type, mechanism-stratified analysis of US spending on injuries has important health-systems implications. First, post-acute spending equals acute spending, revealing trauma as a health-system-wide problem and optimizing acute care to reduce downstream disability represents high-leverage investment. Second, payer-mechanism heterogeneity creates funding mismatches. Trauma centers serving publicly-insured high-acuity injuries may face revenue shortfalls despite equivalent number of admissions compared to centers treating older adults after falls. Third, mechanism-blind planning undermines efficiency; demographic-specific demand modeling should replace per-population metrics. These data provide the evidence base for injury prevention policy, trauma system resource allocation, and care redesign to optimize outcomes nationwide.
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