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Three AHRQ Articles Featured in Health Affairs Health Care Trends Theme Issue

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New Information from AHRQ: March 12, 2001

Three articles dealing with trends in the costs of health care services over the last 10 years, and written by researchers from the Agency for Healthcare Research and Quality (AHRQ), are featured in the March/April 2001 issue of Health Affairs. The articles discuss distribution of health care expenditures among the population in general; expenditures for mental health services; and insurance status for the near-elderly worker, defined as between 55 and 64 years of age.

The Concentration of Health Care Expenditures Revisited

Over the last decade, more and more providers have begun operating under managed care arrangements, adding constraints to the way they can provide care, in an effort by the organizations to control costs. But researchers have found that there has been little change in the way resources are expended in treating high cost illness. Authors Marc L. Berk, Ph.D., director of Project HOPE Center for Health Affairs, and Alan C. Monheit, Ph.D., of AHRQ, found that the concentration of health care expenditures has remained very stable since 1987: One percent of the population accounts for 27 percent of health expenditures for the noninstitutional population. Privately insured persons continue to use resources intensively, while the uninsured incur much lower expenditures, even among those in the top 5 percent of users. The authors caution that further efforts to reduce costs will require close examination about the level of care provided to those with the greatest need.

Trends in Mental Health Services Use and Spending: 1987-1996

Ambulatory mental health and substance abuse (MH/SA) services and the use of psychotropic medications in the community population increased substantially between 1987 and 1996. However, despite these apparent gains in access, author Samuel H. Zuvekas, Ph.D. concludes that there is still substantial unmet need for MH/SA treatment. Dr. Zuvekas found that the cost of psychotropic drugs accounts for most of the increased expenditures for MH/SA services in the community. In addition, the study found that out-of-pocket costs remain high, likely deterring many people from seeking treatment for their mental and addictive disorders.

Moving to Medicare: Trends in Health Insurance Status of Near-Elderly Workers, 1987-1996

Alan C. Monheit, Ph.D., Jessica Vistnes, Ph. D. and John M. Eisenberg, M.D., have studied women's ability to pay for coverage, especially the near-elderly with health problems. Near-elderly working women (aged 55 to 64) with health problems are especially at risk to lack employment-based insurance and to be uninsured. In addition, they also are more likely than those without health problems to have incomes less than twice the poverty line, making the purchase of alternative health insurance coverage more difficult.

These articles were based on a comparison of data from two large-scale nationally representative surveys of the civilian, non-institutionalized population, AHRQ's 1987 National Medical Expenditure Survey (NMES) and its successor, the 1996 Medical Expenditure Panel Survey (MEPS). More information about MEPS is available online at

Copies of these articles are available through the AHRQ Publications Clearinghouse, P.O. Box, 8547, Silver Spring, MD 20907, or by calling 1-800-358-9295.

For additional information, please contact AHRQ Public Affairs, (301) 427-1364: Karen Carp, (301) 427-1858 (; Karen Migdail, (301) 427-1855 (


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