Expanding the National Health Expenditure Accounts (NHEA) Technical Documentation




The National Health Expenditure Accounts (NHEA) have been produced annually by the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) and its precursor organizations, since 1960.  They track medical expenditure by source of payment (private, public, out-of-pocket) and type of expenditure (hospital, physician, etc.).  Information is summarized and data tables are available to the public via download from the Centers for Medicare and Medicaid Services (CMS) website at http://www.cms.hhs.gov/NationalHealthExpendData.


The NHEAs contribute substantially to our understanding of medical spending.  However, because they focus only on spending, the NHEAs provide no information on the value of health care spending, as they do not track the desired output of investment in health care – improved health.  Further, the data are not necessarily at the right level of aggregation to measure value.  To make these productivity calculations, one needs to understand spending at the same level as health outcomes, which are most naturally measured by disease.  Thus, a central issue in expanding the NHEA and our purpose is adding the more disaggregated (or micro) data needed to estimate prevalence of disease and costs.