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Past Consumer Expenditure Survey (CE) biennial reports included comparisons of CE data to those from other sources to check for consistency of results. Personal Consumption Expenditures (PCE) from the Bureau of 

Economic Analysis were used to make detailed comparisons 

with a range of CE spending categories. Less-detailed comparisons of CE out-of-pocket health care expenditures were 

made with those from the National Health Expenditure Accounts (NHEA) of the Centers for Medicare and Medicaid 

Services of the Department of Health and Human Services. 

The purpose of this article is to examine the latest CE estimates of aggregate health-care expenditures and how they 

compare with NHEA data, but in more detail than previously 

shown.

Published by the Centers for Medicare and Medicaid 

Services of the U.S. Department of Health and Human 

Services, the National Health Expenditure Accounts (NHEA) 

are the official estimates of total health care spending in the 

United States. Dating back to 1960, the NHEA measures annual 

aggregate U.S. spending for health care goods and services, 

public health activities, program administration, the net 

cost of private insurance, and research and other investment 

related to health care. 

The Consumer Expenditure Survey (CE) and the NHEA 

differ in the population covered. The CE is designed to be 

representative of the U.S. civilian noninstitutuionalized population which includes everyone living in the U.S., who is not 

in an institution, such as a nursing home or prison, and who is 

not living on a military base. The NHEA covers a larger population because all persons, both military and civilian, living in 

the U.S. are part of the resident population.

CE health care data are direct out-of-pocket expenditures 

net of any reimbursements. These data include payments 

directly to the providers of care, such as hospitals, and to third 

parties, such as insurance companies for private group or 

individual health insurance coverage and the Federal Government for premiums to the Medicare Supplementary Trust 

Fund (Part B, C, and D coverage). In the NHEA, household 

spending for health care also includes direct spending and 

amounts paid to third party insurers. 

The CE obtains information from individual consumer 

units, while the NHEA uses many secondary data sources, 

such as the American Hospital Association Annual Survey 

and the Census Bureau’s Services Annual Survey. The CE 

and NHEA also differ in how spending is categorized. In the 

NHEA, the type of establishment providing a service generally determines what is included in a spending category, while 

CE usually categorizes spending by the type of service provided. For example, the CE has separate categories for inpatient hospitalization and other medical services (outpatient 

hospital care, emergency room services, etc.), but the NHEA 

places these services in its Hospital Care category.6

The two data sources differ somewhat in the items covered. 

For example, the CE does not have a category that specifically 

requests information about home health-care outlays. In the 

NHEA, the Home Health Care category includes freestanding home health agencies, while hospital-based home health 

care is in the Hospital Care category. The NHEA includes 

employee and self-employment contributions to the Medicare 

Hospital Insurance Trust Fund (Part A coverage) in household 

spending for insurance coverage, in addition to premiums to 

the Medicare Supplementary Insurance Trust Fund, while the 

CE only includes the latter in its health insurance estimates. 

 Text table 3 shows CE estimates of aggregate expenditures 

for healthcare and CE/NHEA out-of-pocket spending ratios. 

Categories have been aligned to make them as comparable 

as possible. In 2007, CE aggregate medical care expenditures 

(excluding nursing home care) were $340.9 billion, or 67 percent of the NHEA out-of-pocket estimate of $506.1 billion 

(excluding nursing home and home health care expenditures). 

Of the CE total, $185.6 billion was spent on health insurance, 

$72.0 billion on medical commodities, and $83.3 billion on 

medical services. These amounts were 67 percent, 72 percent, 

and 64 percent, respectively, of the NHEA estimates. 

For all expenditure categories, CE-to-NHEA ratios varied 

over the 2004–07 period. These results may reflect the variability of health care expenses and/or year-to-year fluctuations, due to random sampling variation which affects survey 

data bases. The differences between CE and NHEA estimates 

may also reflect survey differences in population, concepts, 

and scope.

Consumer Expenditure Survey

compared with National Health

Expenditure Accounts

6 The NHEA defines the population used in its data tables as the U.S 

Census resident population plus the net undercount. For more information about 

the National Health Expenditure Accounts see “National Health Expenditure

Accounts, Definitions, Sources and Methods, Department of Health and 

Human Services, Centers for Medicare and Medicaid Services, Baltimore, 

Md., www.cms.hhs.gov/NationalHealthExpendData/downloads/dsm-07.pdf 

and “Health Expenditures by Sponsors: Business, household and government, 

www.cms.hhs.gov/NationalHealthExpendData/06_NationalHealthAccountsBusinessHouseholdGovernment.asp#TopOfPage
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Text table 3. Comparison of aggregate health care expenditures: Consumer Expenditure Survey and National Health

Expenditure Accounts, 2004–07

Expenditure category

Aggregate consumer expenditures

Consumer Expenditure Survey

(in billions)

Ratio of Consumer Expenditure

Survey to National Health

Expenditure Accounts1

2004 2005 2006 2007 2004 2005 2006 2007

Health care, total2 ...................... 294.6 309.4 326.7 340.9 .70 .70 .68 .67

 Health insurance3 .................... 154.9 159.7 174.1 185.6 .70 .68 .67 .67

 Medical commodities, total ...... 69.1 73.7 75.6 72.0 .77 .73 .74 .72

 Prescription drugs.................. 40.6 47.6 46.7 43.2 .88 .83 .87 .85

 Medical supplies and ............

 nonprescription drugs......... 18.9 17.0 18.2 18.4 .62 .53 .55 .53

 Medical equipment ................ 9.6 9.1 10.7 10.4 .73 .70 .69 .69

Medical services, total ............... 70.6 76.1 77.0 83.3 .65 .66 .63 .64

 Professional services.............. 54.1 58.3 58.8 63.2 .60 .61 .58 .59

 Physicians services ............. 17.0 18.1 20.0 20.6 .42 .42 .43 .42

 Dental services.................... 28.0 29.8 28.4 29.4 .73 .78 .71 .70

 Other professional

 services .............................

9.1 10.3 10.5 13.3 .66 .72 .70 .84

 Hospital care........................... 16.4 17.8 18.2 20.0 .88 .90 .85 .86

1National Health Expenditure Accounts data exclude nursing home 

and home health care spending. 2Consumer Expenditure Survey data exclude nursing home care 

spending. 3 Includes premiums for private health insurance and premiums paid 

to the Medicare Supplementary Insurance Trust Fund.

NOTE: Sums may not equal totals due to rounding. Expenditure categories have been adjusted to make the two surveys as comparable 

as possible. 

SOURCE: The National Health Expenditure Accounts (NHEA) data 

used to compute the CE/NHEA ratios are from U.S. Department of 

Health and Human Services, Centers for Medicare and Medcaid Services, “National Health Expenditures by Type of Service and Source 

of Funds: Calendar Years 1960-2007,” http://www.cms.hhs.gov/

NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage and Health Expenditures by Sponsors: Business, Household, and Government,” http://www.cms.hhs.gov/

NationalHealthExpendData/06_NationalHealthAccountsBusinessHouseholdGovernment.asp#TopOfPage. Because retrospective adjustments to NHEA data are made when new data are issued, 

CE/NHEA ratios may differ from those published in previous years.