Overall, total average direct expenditures for persons with musculoskeletal diseases increased from $5,020 in 1996-1998 to $8,206 in 2012-2014, in 2014 dollars, a more than 60% increase. Ambulatory care was the largest cost share and accounted for 34% of total average per person costs for musculoskeletal diseases in 2012-2014.

By Type of Care

Over the 1996-1998 through 2012-2014 periods, the share of total costs associated with ambulatory care rose slightly, from 31 to 34%, while the share for inpatient care declined from 36% to 27%. The share for the residual category also declined, from 18% to 15% of the total. However, medication costs accounted for a far larger share, increasing from 14% to 24% of the total. In 2014 dollars, the average amount spent for medications increased from $691 in 1996-1998 to $1,967 in 2012-2014, or nearly tripled in relative terms. (Reference Table 8.4.1 PDF [3] CSV [4])

bmus_e4_G8.D.1.1.png [5]

[6]

In 2012-2014, incremental expenditures for musculoskeletal diseases averaged $1,510 in 2014 dollars. (Reference Table 8.5.1 PDF [7] CSV [8])

By Condition

Data for specific musculoskeletal conditions has been analyzed through the 2012-2014 time period, and shown in 2014 dollars. Total per person direct medical care expenditures rose for each of the major subconditions between 1996-1998 and 2012-2014. Expenditures for arthritis and joint pain, which rose from $6,642 to $9,554, and osteoporosis, which rose from $8,906 to $12,869 per person, had the smallest relative increases at 44% each, although both conditions had high average per person costs. Costs for spine conditions rose by 80%, from $5,023 to $9,035; for injuries by 93%, from $4,211 to $8,135; and for other musculoskeletal conditions by 62%, from $6,799 to $11,047.

bmus_e4_G8.D.1.2.png [9]

[10]

Detailed data related to per person all-cause direct cost by condition can be found in specific condition data tables and is also discussed under the condition section. See spine (Reference Table 8.4.2 PDF [11] CSV [12]); arthritis and joint pain (Reference Table 8.4.3 PDF [13] CSV [14]); osteoporosis (Reference Table 8.4.4 PDF [15] CSV [16]); injuries (Reference Table 8.4.5 PDF [17] CSV [18]); other musculoskeletal conditions (Reference Table 8.4.6 PDF [19] CSV [20]); and summary (Reference Table 8.7 PDF [21] CSV [22]).

Except for arthritis and joint pain, incremental direct costs by condition grew more slowly than all-cause direct costs. This is likely due to co-morbid conditions which may have a higher healthcare cost than some musculoskeletal diseases. In general, groups of individuals with more expensive conditions who also are older and have more comorbid conditions will have higher per-person all-cause costs, while incremental costs are those attributable to the condition and less affected by age, other demographics, or comorbid conditions.

bmus_e4_G8.D.1.3.png [23]

[24]

Detailed data related to per person incremental direct cost by condition can be found in specific condition data tables and are also discussed under the condition section. See spine (Reference Table 8.5.2 PDF [25] CSV [26]); arthritis and joint pain (Reference Table 8.5.3 PDF [27] CSV [28]); osteoporosis (Reference Table 8.5.4 PDF [29] CSV [30]); injuries (Reference Table 8.5.5 PDF [31] CSV [32]); other musculoskeletal conditions (Reference Table 8.5.6 PDF [33] CSV [34]); and summary (Reference Table 8.7 PDF [21] CSV [22]).

By Demographics

Expenditures for musculoskeletal diseases did not differ substantially by gender and education level in 2015. On an unadjusted basis, women with musculoskeletal diseases had only 3% higher per person average expenditures than men. On the other hand, Hispanics report substantially lower annual per person expenditures than the other race and ethnic groups, for example 40% lower than non-Hispanic whites. Individuals who were married or with partners or who were widowed, separated, or divorced had higher annual per person expenditures than those who were never married, probably due, in part, to age differences.
 
Lack of insurance had the most profound impact on average health expenditures for persons with musculoskeletal conditions. Average per person expenditures on behalf of those without insurance, at $4,065, were about 40% as high as those with public insurance (i.e., Medicaid/Medicare), at $10,564, and about half that of those with private insurance, at $7,967. Again, some of this difference may be due to age, as young people are more likely to be uninsured than older people, but a portion is also due to lack of healthcare resources. Thus, lack of health insurance is inconsistent with the belief that persons who lack insurance are somehow able to obtain care. (Reference Table 8.8 PDF [35] CSV [36])

bmus_e4_G8.D.1.5.png [37]

[38]

By Age

Aging is strongly correlated with increased per person all-cause medical expenditures for persons with a musculoskeletal disease along with other co-morbid conditions, but not necessarily so when attributed directly to musculoskeletal diseases (incremental cost).

Per person all-cause expenditures in 2012-2014 for persons 65 years of age or older, at a mean of $11,760, were about 2½ times the mean per person costs for those under the age of 45.Persons aged 45 to 64 years had mean per person healthcare expenditures at around 75% that of the oldest population.

On the other hand, per person incremental costs in 2012-2014 were highest among those under age 18 and lowest among those 65 or over.  Since this incremental cost is the estimate directly attributed to musculoskeletal conditions, the reversal may reflect the fact that young persons are less likely to have co-morbid conditions, and when they do have a musculoskeletal disease, it accounts for a greater proportion of medical care. Conversely, those aged 65 or over are more likely to have multiple co-morbid conditions, reducing the share of cost attributed to the musculoskeletal condition(s). (Reference Table 8.9 PDF [39] CSV [40]).

bmus_e4_G8.D.1.4.png [41]

[42]

Aggregate all-cause expenditures in 2014 dollars increased from $381.4 billion in 1996-1998 to $882.5 billion in 2012-2014, an increase of more than 130%. (Reference Table 8.6.1 PDF [1] CSV [2]) In 1996-1998, aggregate all-cause expenditures for persons with a musculoskeletal disease, whether for musculoskeletal disease or other conditions, represented 3.2% of the GDP. By 2012-2014, the proportion had grown to 5.2% of the GDP. (Reference Table 8.14 PDF [43] CSV [44])

Aggregate incremental expenditures in 2014 dollars increased from $101.1 billion in 1996-1998 to $162.4 billion in 2012-2014, increasing from 0.25% to 0.57% of the GDP. (Reference Table 8.6.1 PDF [1] CSV [2]; Table 8.14 PDF [43] CSV [44])

bmus_e4_G8.D.2.1.png [45]

[46]

Over the full-time range of 1996-1998 through 2012-2014, the annual average rate of increase in aggregate all-cause and incremental costs for musculoskeletal diseases has been 8.2% and 3.8%, respectively. (Reference Table 8.7 PDF [21] CSV [22])

By Condition

Because of the higher prevalence and relatively high level of expenditures per person, aggregate all-cause expenditures have consistently been greatest for arthritis and joint pain, accounting for $626.8 billion in healthcare costs in 2012-2014. Spine conditions, with an estimated $315.4 billion aggregate cost in 2012-2014, are the second most expensive musculoskeletal healthcare condition.  Aggregate costs for injuries and other musculoskeletal conditions were $213.7 and $214.8 billion, respectively, in 2012-2014. Osteoporosis, with $73.6 billion, accounted for the lowest aggregate of all costs. Totals for subconditions, when summed, exceed the overall total due to the potential for persons to be included in more than one condition group.

Sampling variability limits inference about time trends in incremental expenditures associated with the subcondition groups. However, while estimates do not have the same precision as those for all musculoskeletal diseases, it is fair to conclude that 2012-2014 aggregate incremental expenditures, at $88.7 billion, were largest for arthritis and joint pain. Further, aggregate incremental expenditures have increased substantially since 1996-1998 for all subcondition groups. (Reference Columns D and F, Table 8.6.2 PDF [47] CSV [48]; Table 8.6.3 PDF [49] CSV [50]; Table 8.6.4 PDF [51] CSV [52]; Table 8.6.5 PDF [53] CSV [54]; Table 8.6.6 PDF [55] CSV [56])

bmus_e4_G8.D.2.2.png [57]

[58]

By Insurance and Limitation Status

Unlike other tables on economic costs of musculoskeletal conditions that use an average of three years of data for sequential years, analysis based on demographic characteristics uses a single year, resulting in 2014 costs that are somewhat different than those for 2012-2014.

In 2014, aggregate all-cause expenditures for musculoskeletal conditions totaled $919.4 billion, slightly higher than the 2012-2014 total. Because per person all-cause expenditures were lower among those without insurance ($4,065), aggregate expenditures on behalf of the approximately 7.1 million without insurance were only $29.0 billion; the bulk of the aggregate expenditures occurred among the 71.4 million with private insurance ($568.9 billion) or the 30.4 million with public insurance ($321.5 billion).

Of the almost 109 million persons with musculoskeletal diseases in 2014, 46.3 million (42.5%) reported a limitation in functioning, work, housework, or school, or had a limitation in vision and hearing.  Such persons incurred aggregate all-cause expenditures of $636.0 billion, or 69.2% of all aggregate expenditures for musculoskeletal diseases. Slightly fewer (about 26 million, 23.8% of persons with musculoskeletal diseases) reported only limitation in work, housework, or school; such persons incurred $446.4 billion, or 48.6% of all-cause aggregate expenditures for these conditions. (Reference Table 8.8 PDF [35] CSV [36])

bmus_e4_G8.D.2.3.png [59]

[60]

By Age

Aggregate costs by age group generally reflect the trends previously described in per person expenditures [61], except for total all-cause aggregate costs. Although persons aged 65 and over had the highest mean per person cost, persons aged 45-64 accounted for the largest share of aggregate costs due to the large size of this cohort. (Reference Table 8.9 PDF [39] CSV [40])

bmus_e4_G8.D.2.4.png [62]

[63]