National healthcare spending in the United States reached about $5.3 trillion in 2024, which is about 18% of the nation's GDP based on the CMS’s NHE data, yet aggregate totals alone do not show where reimbursement pressure, access disparities, or telehealth utilization intensity are concentrated by state and payer market.56 This brief connects NHE macro totals from the CMS NHE historical program with Medicare FFS telehealth geography from the ASPE Medicare Telehealth Trends Dashboard and CMS telehealth useful links so operators do not mistake a national average for a market-level operating picture.
- Macro vs. market. NHE answers economy-wide sponsor and service-line scale (including federal components in the COVID era); it does not replace state market intelligence or hospital financial statements.
- Hospital slice. The NHE hospital line crossed roughly $1.6 trillion in 2024—high utilization intensity and price/wage dynamics can move that line even when headline GDP growth is uneven.
- Telehealth is programmatically local. Medicare FFS telehealth statistics are published with beneficiary state of residence and urban/rural cuts—reimbursement dynamics and access disparities differ by place; do not read a national waiver-era curve as commercial telemedicine share.
- Next step for operators. Align capital, network, and benefit design reviews to the same dataset vintage (CMS ZIP month/year + ASPE dashboard version) and document sponsor mix when interpreting cost growth.
Exhibits in this article are drawn from published CMS NHE tables and fact sheets and ASPE/CMS-linked Medicare FFS telehealth products. Care Intel’s production stack materializes additional facility, claims, and graph-backed metrics elsewhere in the workbench; this page does not claim proprietary claims row counts or county coverage unless those metrics are published as governed catalog entries for the same refresh cycle.
U.S. healthcare spending growth is not adequately explained by national averages alone. The operational burden of growth is shaped by localized utilization intensity, payer mix, telehealth reimbursement behavior, and geographic care delivery variation.
Executive summary
| Finding | Operational implication |
|---|---|
| Total U.S. healthcare spending exceeded $5.3T in 2024 (CMS NHE) | Financing pressure propagates across employers, state programs, hospitals, and commercial insurers simultaneously—budget models need sponsor-aware views. |
| Hospital care surpassed $1.63T | Hospital spending in NHE is a dominant service line; it is not the same object as hospital margins—finance still needs cost reports and audited statements. |
| Telehealth utilization is geographically uneven (Medicare FFS) | Network adequacy, reimbursement, and access policy must be stress-tested regionally, not only at a national curve. |
| Per-capita PHC spending differs sharply across states | Population-health and payer forecasting require localized economics and explicit residence geography. |
| COVID-era federal components moved NHE composition | 2020–2022 baselines need CMS’s federal COVID-in-NHE framing before forecasting “new normal” growth. |
What Changed After 2020 And Why Year-to-Year Growth Rates Moved
Between 2020 and 2024, U.S. health spending growth alternated between very high increases driven by the COVID-19 period (including federal supplements captured inside NHE accounting) and mid-decade years where slower growth reflected the roll-off of some temporary federal funding even as utilization rebounded. Therefore, interpreting any one year in isolation is risky: the level of hospital spending can rise briskly while the growth rate moderates, because the denominator is already large. The exhibits below keep those dynamics visible.
Exhibit A — NHE and Hospital Spending Trajectory (2020–2024)
Amounts are nominal U.S. dollars from the CMS National Health Expenditure Accounts as summarized in peer-reviewed NHE articles in Health Affairs (for example 2022 NHE, 2023 NHE, and 2024 NHE) and the CMS NHE historical downloads page; 2024 headline totals align with the CMS NHE fact sheet.
| Calendar year | Total NHE ($ billions) | YoY growth (total NHE) | Hospital care ($ billions) | YoY growth (hospital care) | Notes (what moved the year) |
|---|---|---|---|---|---|
| 2020 | 4,153.9 | 10.4% | 1,267.6 | 6.2% | Pandemic shock + federal public-health and supplemental components inside NHE; hospital utilization mixed (deferrals vs. COVID admissions). Growth rates from CMS NHE/Health Affairs tables. |
| 2021 | 4,327.7 | 4.2% | 1,334.0 | 5.2% | Rebound in non-COVID utilization; slower total growth as some temporary federal funding declined while service use strengthened. |
| 2022 | 4,525.8 | 4.6% | 1,376.7 | 3.2% | Hospital spending growth cooled versus 2021; insurance enrollment remained high across Medicaid and private coverage. |
| 2023 | 4,866.5 | 7.5% | 1,519.7 | 10.4% | Acceleration tied to stronger non-price factors (use/intensity) in major categories; Medicaid enrollment still elevated before unwinding effects fully register in state data. |
| 2024 | ≈5,300 (CMS: $5.3 trillion) | 7.2% | 1,634.7 | 8.9% | CMS NHE fact sheet headline vintage; use the published tables for exact rounding and benchmark revisions. |
| 2025 | Official calendar-year 2025 NHE totals are not included in the published CY 1960–2024 historical ZIP at the time of this article’s refresh cycle. | For forward-year planning, use CMS Projected National Health Expenditure Accounts. | |||
Same source series as Exhibit A.
Comparative Read of Exhibit A
Scale vs. slope. Hospital spending crossed roughly $1.6 trillion in 2024, which is about 31% of headline total NHE in the same vintage, large enough that even a “moderate” percentage change is a very large dollar flow into financing systems, capital planning, and labor markets. That is why executives often want both the growth rate and the incremental dollars on the same page.
COVID-era composition. 2020’s elevated NHE growth is not only “more hospital visits”. NHE explicitly includes categories such as federal public health activity and other non-personal-health-care components that moved sharply during the emergency period. Readers comparing 2019 to 2022 should use CMS’s Accounting for Federal COVID Expenditures in the National Health Expenditure Accounts (PDF) to avoid mis-attributing all changes to hospitals.
2023 acceleration. The step-up in total NHE growth in 2023 coincided with faster growth in major personal-health-care categories, including hospital care, as utilization strengthened. When you later compare 2023–2024, keep an eye on whether growth is broad-based across payers or concentrated in one sponsor (for example, private insurance), because payer concentration changes who bears incremental costs.
Exhibit A2 — 2024 Snapshot
This companion table is intentionally narrower: it is the “board-ready” slice for finance and policy readers who need sponsor shares alongside the hospital line. Values below follow the CMS NHE fact sheet; reconcile to the downloadable summary tables when CMS revises benchmarks.
| Indicator (2024) | Value | Notes (how to use the number) |
|---|---|---|
| Total national health expenditures | $5.3 trillion (growth 7.2%) | Macro anchor; check CMS vintage for benchmark revisions. |
| NHE as share of GDP | 18.0% | Relates spending to nominal GDP; interpret with GDP volatility in mind. |
| Health spending per person | $15,474 | Population denominator uses Census resident concepts used in NHE. |
| Medicare spending | $1,118.0 billion (~21% of NHE) | Includes Medicare benefit spending as categorized in NHE; not the same as “Medicare telehealth visits.” |
| Medicaid spending | $931.7 billion (~18%) | Enrollment dynamics materially affect year-over-year Medicaid totals. |
| Private health insurance | $1,644.6 billion (~31%) | Includes net cost of insurance components as defined in NHE. |
| Out-of-pocket | $556.5 billion (~11%) | Includes cost sharing and directly purchased services as classified by NHE. |
| Hospital expenditures | $1,634.7 billion (growth 8.9%) | Hospital spending in NHE is not a substitute for audited operating margins; margin analysis requires cost-report or financial-statement sources. |
| Physician & clinical services | $1,109.7 billion | Often co-moves with hospital spending when utilization rises across sites. |
| Retail prescription drugs | $467.0 billion | Mix and price effects can move this line faster than utilization alone. |
Exhibit B — Geographic Dispersion in Personal Healthcare Spending (State of Residence)
State tables answer a different question than Exhibit A: where spending per resident is unusually high or low relative to the U.S. average, before you open a health system income statement. CMS publishes personal health care (PHC) spending by state of residence with illustrative highs and lows; the examples below are drawn from the CMS NHE fact sheet narrative for 2020. See also CMS’s health expenditures by state of residence hub for methodology and downloads.
| Geography (state of residence) | PHC spending per capita (2020) | Spread vs U.S. average ($10,191) | Interpretation notes (non-exhaustive) |
|---|---|---|---|
| New York | $14,007 | +37% | High spending states often combine older age structure, higher prices/wages, and different service intensity; read as descriptive dispersion, not “efficiency ranking.” |
| Utah | $7,522 | −26% | Lower per capita totals can reflect younger demographics and different insurance mix; still require clinical and access context. |
| United States (average) | $10,191 | — | National average referenced alongside state examples in CMS documentation. |
Bar widths scale to the highest value shown (New York $14,007 = 100%). United States average $10,191 ≈ 72.8%; Utah $7,522 ≈ 53.7%. Source: CMS NHE fact sheet narrative / state of residence materials.8
Exhibit B2 — U.S. per capita NHE (national totals, selected years)
Where Exhibit B highlights state dispersion for 2020 PHC, this small national series shows how per person totals evolved across the early 2020s in the same NHE accounting framework (resident population).
| Year | U.S. NHE per capita | Notes |
|---|---|---|
| 2020 | $12,563 | From CMS NHE tables as reproduced in Health Affairs NHE article (2024 release covering 2023). |
| 2021 | $13,068 | Same series; reflects enrollment and utilization rebound dynamics. |
| 2022 | $13,617 | Same series; slower growth year for total spending than 2023. |
| 2023 | $14,570 | Same series; aligns with faster aggregate growth in 2023. |
| 2024 | $15,474 | CMS NHE fact sheet headline per capita figure. |
Comparative read of Exhibit B
Why geography matters for telehealth evidence. Medicare FFS telehealth statistics are often published with beneficiary state of residence and urban/rural dimensions because payment policy, broadband access, specialty supply, and behavioral-health utilization patterns vary by place. That is why analysts pair macro totals (how much the nation spends) with place-based program statistics (how telehealth is used inside Medicare’s rules) when discussing access and capacity.
Sources
- [1] Medicare Telehealth Trends Dashboard, 2019–2021 — ASPE (HHS)
- [2] Medicare / Telehealth — Useful Links — CMS
- [3] Updated Medicare FFS Telehealth Trends (Jul 20, 2023) — ASPE
- [4] Medicare Telemedicine Snapshot — Data.gov catalog
- [5] NHE Fact Sheet — CMS
- [6] NHE Historical tables and downloads — CMS
- [7] Hartman et al., “National Health Expenditures In 2023: Faster Growth As Insurance Coverage And Utilization Increased,” Health Affairs (DOI 10.1377/hlthaff.2024.01375); companion pieces include the 2022 NHE article and the 2024 NHE article—used here for consistent year-to-year levels where the CMS fact sheet rounds.
- [8] Health expenditures by state of residence — CMS
- [9] NHE summary including share of GDP, CY 1960–2024 (ZIP) — CMS
- [10] National health expenditures by type of service and source of funds, CY 1960–2024 (ZIP) — CMS
- [11] Medicare FFS Telehealth Trends 2019–2021 State Data (Excel) — ASPE
- [12] Appendix 1 — Telehealth Dashboard Codes (Excel) — ASPE