The Sickest 5% of Americans Use 50% of All Healthcare Spending

The sickest 5% of Americans Cost 50% of our Healthcare Dollars

The sickest 5% of Americans Cost 50% of our Healthcare Dollars

According to an AHRQ report, only 5% of the population make up half of the healthcare spending. This is a group of Americans with serious and often multiple conditions who require complex and expensive care and treatment.  This topic is important because the cost of healthcare in the US is growing beyond what our economy can sustain and the political conversation around healthcare reform is picking up steam.

What should Congress and our policy-makers know about this group when they write new healthcare laws?

How about:

  • They use medical resources whether or not they can pay the bill.   If we keep our most vulnerable patients insured, it will help keep our healthcare industry healthy.
  • At $1.6 trillion dollars per year, this group will bust any high-risk insurance pool.
  • Pooling this group with the bottom 50% of healthcare users (the healthy ones who cost little to nothing) is going to make them mad, says Captain Obvious.
  • This group is currently segmented across the uninsured, Medicaid, Medicare, VA/Military, and private insurance.

Stay tuned: we will have to wait and see the details of the AHCA.



Cohen, S. B. (2016). The Concentration of Health Care Expenditures in the U.S. and Predictions of Future Spending. Journal Of Economic And Social Measurement, 41(2), 167-189.


Dr. Jonathan P. DeShazo is an expert on health information technology, clinical data, and consumer informatics. He is currently an Assistant Professor in the Department of Health Adminstration and serves as Scientific Director of the Biomedical Informatics Core at Virginia Commonwealth University.

Leave a Reply

Your email address will not be published. Required fields are marked *