How to Read CMS National Health Expenditure Data — Spending by Service, Payer and Sponsor

As of 8 November 2026, 01:23 KST (retrieved by this page at that time); latest listed on the agency page at retrieval: historical National Health Expenditure (NHE) estimates for 1960-2024 from the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS), with the 2024 Highlights. The historical page shows Page Last Modified: 01/14/2026 and the fact sheet 06/24/2026. Primary source: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet^[1][2][3]

Comparison basis: levels are nominal dollars as printed by CMS (rounded to $0.1 billion or to one decimal in trillions); growth rates and shares are CMS's own rounded figures, so this page has not recomputed them from levels. The cited pages give 2024 levels but not 2023 levels, so the previous column shows CMS's stated 2023 growth rates.^[1][3]

In three lines

1. The NHE accounts measure all health care spending in the 50 states and the District of Columbia by service, payer and sponsor, back to 1960.
2. Spending rose 7.2% to $5.3 trillion in 2024, or $15,474 per person and 18.0% of GDP (fact sheet).
3. CMS projects the health share of GDP at 20.6% in 2034 (projected, fact sheet), and the series is revised in full every five years.^[1][4]

Coverage. "Because the NHEA reflect spending based in the U.S. only (50 states plus the District of Columbia), an adjustment is first made to exclude spending for U.S. territories and outlying areas." The accounts are nested: personal health care (PHC) is spending on medical goods and services. "Health consumption expenditures (HCE) equal PHC spending plus spending for government public health activity, government administration, and non-medical insurance expenditures." "National health expenditures (NHE) equal HCE plus investment, which is the sum of medical sector purchases of structures and equipment and expenditures for non-commercial medical research."^[4]

Payers and residual methods. Public payers are measured from program data such as Medicare Trustees Report data and Form CMS-64, and the remainder is allocated to private payers. "Out-of-pocket expenditures are estimated using a residual methodology." Private health insurance is estimated the same way, and premiums are counted there rather than as out-of-pocket: "Premiums paid by individuals for private health insurance are not covered here, but are counted as part of Private Health Insurance."^[4][5]

Sponsors. Sponsors are those ultimately financing care (businesses, households, governments, other private). "The largest shares of total health spending were sponsored by the federal government (31 percent) and the households (28 percent)." The fact sheet's five sponsor shares (31, 28, 18, 16 and 6 percent) add to 99 (this page's calculation), consistent with rounding.^[1][4]

Enrollment. "Medicaid enrollment declined by 8.6 percent (or 7.9 million) to 84.3 million beneficiaries in 2024." CMS reports the insured share of the population at 91.8 percent in 2024 against 92.5 percent in 2023; NHEA enrollment estimates are generally point-in-time, and Medicaid is a person-year estimate.^[3]

CMS's explanations are CMS's. "This two-year trend was largely driven by heightened demand for health care services." The Highlights also attribute Medicaid's 16.6 percent rise in per enrollee spending to enrollment composition, provider rates and state-directed payments. These are CMS's attributions; this page reports them as such and does not test them.^[3]

Listed payers vs total. The fact sheet lists five payer lines: Medicare ($1,118.0 billion), Medicaid ($931.7 billion), private health insurance ($1,644.6 billion), out-of-pocket ($556.6 billion) and "Other Third Party Payers and Programs and Public Health Activity spending declined 7.0% in 2024 to $590.5 billion, or 11 percent of total NHE." The five amounts sum to $4,841.4 billion (this page's calculation), and the shares CMS prints for them sum to 92 percent; this page does not compute an exact combined share from the rounded $5.3 trillion total. The five fact-sheet lines alone cannot itemize the rest; category definitions and an exact reconciliation require the methodology paper and the detailed NHE tables.^[1]

Two descriptions of the hospital benchmark. The 2024 comprehensive revision summary states that hospital care was benchmarked to the 2022 Economic Census; the methodology paper's hospital section still cites the earlier 2012 and 2017 benchmarks, so the two descriptions do not match.^[4][6]

Historical vs projected. The 2024 figures are historical estimates. "Over 2025-34 average NHE growth (5.4 percent) is projected to outpace that of average Gross Domestic Product (GDP) growth (4.1 percent), resulting in an increase in the health spending share of GDP from 18.0 percent in 2024 to 20.6 percent in 2034." "The insured share of the population is expected to be 90.5 percent in 2034, compared to 91.8 percent in 2024." The 2025-34 values are projections, not measurements.^[1][2]

Comprehensive revision. "During these comprehensive revisions, the entire NHEA time series (1960-forward) is evaluated and may be revised." The 2024 vintage is the latest comprehensive revision. "In aggregate, national health spending in 2022 is $60.8 billion, or roughly 1.3 percent, higher than previously reported." So compare figures from the same vintage.^[4][6]

Dates. The historical page was last modified on 01/14/2026 and the methodology paper says Last Updated: January 2026. The Highlights, quick definitions and benchmark summary carry no date of their own. The date of the next historical release (2025 data) is not established by these sources.^{[2][3][4][5][6]}