Infographic — US Health Care Spending: Who Pays?

Between 1960 and 2018, there have been major shifts in who pays for hospital care, physician services, long-term care, prescription drugs, and other health care services and products in the US. In 1960, only half of hospital care was paid for by insurance, and 96% of spending on prescription drugs came out of the consumer’s pocket. The creation of Medicare and Medicaid in 1966 and the rise of private insurance in the following decades led to increasing shares of spending paid for by insurance and decreases in the share of out-of-pocket spending.

This interactive graphic uses data from the Centers for Medicare & Medicaid Services (CMS) to show national spending on personal health care1 from 1960 to 2018 by payer and spending category.

Source: Centers for Medicare & Medicaid Services (CMS), Office of the Actuary, National Health Expenditure historical data (1960-2018).

Data for this visualization were updated in May 2020. A data file is available for download below. These materials are part of CHCF’s California Health Care Almanac, an online clearinghouse for key data and analyses describing the state’s health care landscape. See our entire collection of current and past editions of Health Care Costs 101.


  1. Personal health care, as defined by CMS, includes goods and services such as hospital care and eyeglasses but excludes administration, public health activity, and investment.