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Health Care Costs and Financing

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AHRQ researchers examine trends in health care costs

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 are featured in the March/April 2001 issue of Health Affairs. The authors 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.

For the past 20 years, the U.S. health care system has been undergoing tremendous change. Although there have been a multitude of empirical studies that have quantified and qualified this reshaping of health care in America, they have not provided substantial information on the long-term consequences of these changes. To begin to address this lack of information, AHRQ provided substantial support for the publication of the March-April 2001 issue of Health Affairs. In addition to the three AHRQ staff-authored articles, it also includes many other papers that analyze long-term trends in the health care system, further explore the practices of the pharmaceutical industry, and examine Federal policy as it relates to graduate medical education. The articles authored by AHRQ staff are summarized here.

Berk, M.L., and Monheit, A.C. (2001, March/April). "The concentration of health care expenditures revisited." Health Affairs 20, pp. 204-213.

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 the aggregate on behalf of high-cost illnesses.

Authors Marc L. Berk, Ph.D., director of Project HOPE's Center for Health Affairs, and Alan C. Monheit, Ph.D., of AHRQ, found that the concentration of health care expenditures has remained stable since 1987. One percent of the population accounts for 27 percent of health expenditures for the noninstitutionalized population. Those who are privately insured continue to use resources intensively, while the uninsured incur much lower expenditures, even when they are among 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.

Reprints (AHRQ Publication No. 01-R049) are available from the AHRQ Publications Clearinghouse.

Zuvekas, S.H. (2001, March/April). "Trends in mental health services use and spending: 1987-1996." Health Affairs 20, pp. 214-224.

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 significant 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. He also found that out-of-pocket costs remain high, likely deterring many people from seeking treatment for their mental and addictive disorders.

Reprints (AHRQ Publication No. 01-R048) are available from the AHRQ Publications Clearinghouse.

Monheit, A.C., Vistnes, J.P., and Eisenberg, J.M. (2001, March/April). "Moving to Medicare: Trends in the health insurance status of near-elderly workers, 1987-1996." Health Affairs 20, pp. 204-213.

Alan C. Monheit, Ph.D., Jessica Vistnes, Ph.D. and John M. Eisenberg, M.D., considered how the health insurance status of near-elderly workers has changed over the past decade. In particular, they looked at enrollment, offer, and take-up rates over the last decade for workers by age and sex.

They found that 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.

Reprints (AHRQ Publication No. 01-R047) are available from the AHRQ Publications Clearinghouse.

These three articles are based on a comparison of data from two large-scale nationally representative surveys of the civilian, noninstitutionalized population, AHRQ's 1987 National Medical Expenditure Survey (NMES) and its successor, the 1996 Medical Expenditure Panel Survey (MEPS). Select for more information on MEPS.

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