Introduction

As policymakers consider various ways to contain the rising

costs of health care, it is useful to examine the patterns of

spending on health care throughout the United States. In

2004, the United States spent $1.9 trillion, or 16 percent of

its gross domestic product (GDP), on health care. This

averages out to about $6,280 for each man, woman, and

child. 

However, actual spending is distributed unevenly across

individuals, different segments of the population, specific

diseases, and payers. For example, analysis of health care

spending shows that: 

• Five percent of the population accounts for almost half

(49 percent) of total health care expenses.

• The 15 most expensive health conditions account for 44

percent of total health care expenses.

• Patients with multiple chronic conditions cost up to

seven times as much as patients with only one chronic

condition. 

Further detailed analyses of these spending patterns, how

they change over time, and how they affect different payers

such as Medicare, Medicaid, private insurers, employers,

and consumers shed important light on how to best target

efforts to contain rapidly rising health care costs. 

Much of the information included in this report comes from

the Medical Expenditure Panel Survey. (See Box 1.)

Background 

Health care expenses in the United States rose from $1,106

per person in 1980 ($255 billion overall) to $6,280 per

person in 2004 ($1.9 trillion overall).1 During this period,

health care costs grew faster than the economy as a whole.

As a consequence, health spending now accounts for 16

percent of the GDP, compared to 9 percent in 1980. With

the aging of the population and the accelerating pace of

medical innovation, this trend is likely to continue. 

Those struggling to develop strategies to reduce or contain

costs consider whether efforts should be targeted broadly

across the entire health care system or more narrowly at

specific areas or aspects of care. For example, is the

continuing rise in health care expenses due to the increased

The High Concentration of U.S. Health Care Expenditures

Making a Difference

• In 2002, the 5 percent of people with the greatest

health care expenses in the U.S. population spent 49

percent of the overall health care dollar...Page 2

• The lower 50 percent of spenders accounted for 3

percent of the total national health care dollar...Page 2

• The proportion of spenders who remained among the

top 1% of spenders for two years in a row doubled

between 1996-97 and 2002-03 ...Page 5

• The five most expensive health conditions are heart

disease, cancer, trauma, mental disorders, and

pulmonary disorders...Page 6

Issue #19 June 2006

RESEARCH

IN ACTION

Advancing Excellence in Health Care • www.ahrq.gov

Agency for Healthcare Research and Quality

Author: Mark W. Stanton, M.A. 

Managing Editor: Margaret Rutherford

Design and Production: Frances Eisel

Suggested citation: Stanton MW, Rutherford MK. The high concentration of

U.S. health care expenditures. Rockville (MD): Agency for Healthcare

Research and Quality; 2005. Research in Action Issue 19. AHRQ Pub. No.

06-0060.
cost of treatment per case? To the growth and aging of the

population? To the rise in the number of people treated for

the most expensive conditions? 

Examining the distribution of health care expenses among

the U.S. population helps to determine the expenses for

different segments of the population, what diseases cost the

most, and how public and private payers are affected. This

information sheds light on areas where changes in policy

might bring about the greatest savings. 

How are U.S. health care expenses 

distributed?

A small proportion of the total population accounts for

half of all U.S. medical spending 

Half of the population spends little or nothing on health

care, while 5 percent of the population spends almost half

of the total amount.2 In 2002, the 5 percent of the U.S.

community (civilian noninstitutionalized) population that

spent the most on health care accounted for 49 percent of

overall U.S. health care spending (Chart 1). Among this

group, annual medical expenses (exclusive of health

insurance premiums) equaled or exceeded $11,487 per

person. In contrast, the 50 percent of the population with

the lowest expenses accounted for only 3 percent of overall

U.S. medical spending, with annual medical spending

below $664 per person. Thus, those in the top 5 percent

spent, on average, more than 17 times as much per person

as those in the bottom 50 percent of spenders.2

From 1977 to 1996, the overall distribution of health care

expenses among the U.S. population remained remarkably

stable (Table 1), according to data from MEPS and its

predecessor surveys.3,4 In 1977, the 1 percent of the

population with the highest expenses accounted for 27

percent of all expenses, the top 5 percent accounted for 55

percent, and the bottom 50 percent accounted for 3 percent.

However, the concentration of expenses at the top has

decreased in recent years. The total expenses accounted for

by the top 1 percent of spenders declined from 28 percent

in 1996 to 22 percent in 2002, and the amount for the top 5

percent dropped from 55 to 49 percent in the same time

period.4 The lower 50 percent of spenders remained at 3 to

4 percent of total expenditures during this period. 

2 www.ahrq.gov

Box 1. The Medical Expenditure Panel Survey (MEPS)

The Medical Expenditure Panel Survey (MEPS) is a

large, ongoing nationally representative survey of

households, medical providers, and employers

conducted by the Agency for Healthcare Research and

Quality (AHRQ). Data derived from MEPS and

analyzed by AHRQ-funded and other researchers show

where health care expenses are concentrated and how

this distribution has changed over time. The

distribution of medical expenses is determined by

ranking individuals in descending order according to

their total medical expenses and then determining

aggregate spending at specific percentiles of the

population. 

MEPS is unique in its ability to link data on

individuals and households (including demographics,

health status, health conditions, health insurance,

employment, and income) to detailed information on

their use of and expenses for health care. MEPS

interviewers ask households for detailed information

about each health care visit, hospital stay, prescription

drug fill, and other medical services, including out-ofpocket expenses and sources of payment. Followback

surveys of the hospitals, physicians, and home health

agencies used by MEPS households provide further

information about payments made by Medicaid,

Medicare, private health plans, and other sources.

MEPS has been continuously conducted since 1996,

and its design makes it possible to examine how health

care use, expenses, sources of payment, and insurance

coverage change over time. No other survey contains

such a wide range of data essential for relating health

spending and insurance coverage to individual and

family characteristics such as age, race and ethnicity,

health conditions and health status, and family

income.

MEPS estimates of health care expenses differ from

the aggregate spending estimates contained in the

National Health Accounts (NHA), primarily because

MEPS covers the civilian noninstitutionalized

population and excludes some populations with high

expenses such as people residing in nursing homes. 
Older people are much more likely to be among the

top-spending percentiles 

The elderly (age 65 and over) made up around 13 percent

of the U.S. population in 2002, but they consumed 36

percent of total U.S. personal health care expenses. The

average health care expense in 2002 was $11,089 per year

for elderly people but only $3,352 per year for working-age

people (ages 19-64).5 Similar differences among age

groups are reflected in the data on the top 5 percent of

health care spenders. People 65-79 (9 percent of the total

population) represented 29 percent of the top 5 percent of

spenders. Similarly, people 80 years and older (about 3

percent of the population) accounted for 14 percent of the

top 5 percent of spenders (Chart 2).2 However, within age

groups, spending is less concentrated among those age 65

and over than for the under-65 population. The top 5

percent of elderly spenders accounted for 34 percent of all

expenses by the elderly in 2002, while the top 5 percent of

non-elderly spenders accounted for 49 percent of expenses

by the non-elderly.4 A principal reason why health care

spending is spread out more evenly among the elderly is

that a much higher proportion of the elderly than the nonelderly have expensive chronic conditions.

Studies show initial persistence of expenses 

The data just cited show that health care expenses are

heavily concentrated in a single year. Over a 2-year period,

there is a fairly high degree of persistence of expenditures.6

Of those individuals ranked at the top 1 percent of the

health care expenditure distribution in 2002, 25 percent

maintained this ranking with respect to their 2003 health

care expenditures (Chart 3). The proportion of the

population that remained in the top 1 percent from 1996 to

www.ahrq.gov 3

Top 1%

(≥$35,543)

Top 5%

(≥$11,487)

Top 10%

(≥$6,444)

Top 20%

(≥$3,219)

Top 50%

(≥$664)

Bottom 50%

(<$664)

0

20

40

60

80

100

22%

49%

64%

80%

97%

3%

Percent of population

Top 1%

(≥$35,543)

Top 5%

(≥$11,487)

Top 10%

(≥$6,444)

Top 20%

(≥$3,219)

Top 50%

(≥$664)

Bottom 50%

(<$664)

Top 1%

(≥$35,543)

Top 5%

(≥$11,487)

Top 10%

(≥$6,444)

Top 20%

(≥$3,219)

Top 50%

(≥$664)

Bottom 50%

(<$664)

Percent of total expenditures

Table 1. Distribution of health care expenses for the

U.S. population, by percent of total: Selected years,

1977-2002

Percent of U.S. population

ranked by expenses 1977 1980 1987 1996 2002

Top 1 percent 27% 29% 28% 28% 22%

Top 5 percent 55% 55% 56% 56% 49%

Bottom 50 percent 3% 4% 3% 3% 3%

Sources: Berk ML, Monheit AC. The concentration of health expenditures: an update.

Health Aff (Millwood) 1992 Winter; 145-9. Yu WW, Ezzati-Rice TM. Concentration of

health care expenses in the U.S. civilian noninstitutionalized population. Statistical Brief

#81. May 2005. Agency for Healthcare Research and Quality, Rockville, MD Web site:

http://www.meps.ahrq.gov/PrintProducts/PrintProdLookup.asp?ProductType=

StatisticalBrief. Accessed April 7, 2006.

Chart 1. Percent of total health care expenses incurred by different percentiles of U.S. population: 2002

Source: Conwell LJ, Cohen JW. Characteristics of people with high medical expenses in the U.S. civilian noninstitutionalized population, 2002. Statistical Brief #73. March 2005. Agency for

Healthcare Research and Quality, Rockville, MD. Web site: http://www.meps.ahrq.gov/PrintProducts/PrintProdLookup.asp?ProductType=StatisticalBrief. Accessed April 7, 2006.

Note: Figures in parentheses are expenses per person.
4 www.ahrq.gov

Top 1% Top 5% Top 10% Top 20% Top 30% Top 50% Lower 50%

0

20

40

60

80

100

25.3%

41.8%

54.4%

62.8%

Percentile rank by health care expenses, 2002

34.0%

73.8% 72.8%

Percent of population with same percentile rank, 2003

Chart 3. Persistence in the level of health care expenses: United States, 2002-03

Source: Cohen SC, Yu W. The persistence in the level of health care expenditures over time: estimates for the U.S. population, 2002-2003. Statistical Brief #124. May 2006. Agency for

Healthcare Research and Quality, Rockville, MD. Web site: http://www.meps.ahrq.gov/PrintProducts/PrintProdLookup.asp?ProductType=StatisticalBrief. Accessed May 15, 2006.

18 and under 19-34 35-44 45-54 55-64 65-79 80 and over

0

10

20

30

5%

10%

15%

18%

29%

Age in years

9%

14%

Chart 2. Percent of health care expenses incurred by the top 5 percent of health care spenders within different age

groups: United States, 2002

Source: Conwell LJ, Cohen JW. Characteristics of people with high medical expenses in the U.S. civilian noninstitutionalized population, 2002. Statistical Brief #73. March 2005. Agency for

Healthcare Research and Quality, Rockville, MD. Web site: http://www.meps.ahrq.gov/PrintProducts/PrintProdLookup.asp?ProductType=StatisticalBrief. Accessed April 7, 2006.
www.ahrq.gov 5

1997 was only 14 percent. This means that the proportion

of the population in the highest percentile of the health care

expenditure distribution that retained this ranking from

2002 to 2003 was nearly double the proportion in the 

1996-97 period.7 

In 2002, the top 5 percent of the population accounted for

49 percent of health care expenditures. Of people ranked in

the top 5 percent of the health care expenditure distribution,

34 percent retained this ranking with respect to their 2003

health care expenditures. Similarly, the top 10 percent of

the population accounted for 64 percent of overall health

care expenditures in 2002, and 42 percent of this subgroup

retained the top decile ranking with respect to their 2003

health care expenditures. 

Over longer periods of time, a considerable leveling of

expenses takes place. In a study of Medicare enrollees,

researchers found that although the top 1 percent of

spenders accounted for 20 percent of expenses in a

particular year, the top 1 percent of spenders over a 16-year

period accounted for only 7 percent of expenses.8 The

researchers concluded that there is a substantial leveling of

expenses across a population when looking over several

years or more compared to just a single year. An acute

episode of pneumonia or a motor vehicle accident might

lead to an expensive hospitalization for an otherwise

healthy person, who might be in the top 1 percent for just

that year but have few expenses in subsequent years.

Similarly, many people have chronic conditions, such as

diabetes and asthma, which are fairly expensive to treat on

an ongoing basis for the rest of their lives, but in most years

will not put them at the very top of health care spenders.

However, each year some of those with chronic conditions

will have acute episodes or complications requiring a

hospitalization or other more expensive treatment.

The Medicare study just discussed8 did not control for

factors such as the overall increase in the quantity and

intensity of services over time. Another study controlled

for these factors in examining how the distribution of

expenses changes over the major phases of an average

person’s lifetime.9 The study used insurance company data

on 3.75 million enrollees and data from the Medicare

Current Beneficiary Survey.a It found that 8 percent of

health care expenses occurred during childhood (under age

20), 13 percent during young adulthood (20-39 years), 31

percent during middle age (40-64 years), and nearly half

(49 percent) occurred after 65 years of age. Among people

age 65 and older, three-quarters of expenses (or 37 percent

of the lifetime total) occurred among individuals 65-84 and

the rest (12 percent of the lifetime total) among people 85

and over. The total per capita lifetime expense was

calculated to be $316,600. 

People with high overall health expenses also have

high out-of-pocket expenses relative to income

Out-of-pocket costs can impose a significant financial

burden on individuals and families. These expenses include

deductibles, copayments, and payments for services that are

not covered by health insurance. Over half the people in

the top 5 percent of all health care spenders had out-ofpocket expenses (not including out-of-pocket health

insurance premiums) over 10 percent of family income.

More specifically: 

• Thirty-four percent had out-of-pocket medical expenses

that exceeded 10 percent of family income. 

• Eighteen percent had out-of-pocket expenses in excess

of 20 percent of family income. 

People in the bottom 50 percent of the distribution were

much less likely to have financial burdens from medical

care. For example: 

• Five percent of people in the bottom 50 percent had

out-of-pocket expenses that exceeded 10 percent of

family income.

• Three percent had out-of-pocket expenses greater than

20 percent of family income.2

People with high health care expenses have lower

health status

How people view their own health is strongly correlated

with their level of health care expenses. Using a

respondent-reported overall health status measure (ranging

from poor to excellent), a study based on MEPS 2002 data

found that people in the highest 5 percent of the

distribution of medical expenses were 11 times as likely to

be in fair or poor physical health as people in the bottom

half of that distribution (45 percent vs. 4 percent).b

Similarly, 21 percent of people in the top 5 percent were in

a This study used cross-sectional data from 1997 and held constant

factors such as health care technology and price, and the incidence,

severity, and outcomes of disease.

b MEPS respondents were asked to rate the health of each person in the

family by the following categories: excellent, very good, good, fair, and

poor.
6 www.ahrq.gov

fair or poor mental health, compared with 3 percent of

people in the bottom 50 percent.2

Managed care has a neutral effect on the

concentration of health care expenses

The rapid growth of health maintenance organizations

(HMOs) and other forms of managed care from the 1970s

onward as a means to control costs led to major changes in

the delivery of health care in the United States. But did

managed care change the concentration of health care

expenses? According to a study using 1996 MEPS data, the

answer is no.10 Looking at the under-65 population with

employer-provided health insurance, researchers found no

statistically significant differences in concentration between

those enrolled in HMOs and other types of gatekeeper plans

and those enrolled in indemnity or preferred provider

organizations (PPOs). For example, the top 5 percent of

spenders accounted for 51 percent of expenses for those

enrolled in HMOs, compared with 50 percent of expenses

for those in HMOs and other “gatekeeper” managed care

combined and 53 percent of expenses for those in indemnity

plans and some PPOs.c

Despite relatively similar distributions, the privately

insured spend much more than the uninsured 

In relative terms, health care expenses are distributed

comparably among the uninsured and those with private

insurance. For example, in 1996, the top 5 percent of

spenders accounted for 51 percent of all expenses among

those with private insurance and 60 percent of spending by

the uninsured. However, the top 5 percent with private

insurance spent an average of $17,800, compared to $6,700

for the top 5 percent of the uninsured.10

What are the most expensive conditions?

Some diseases are very costly to treat 

In 2002, the five most expensive health conditions were

heart disease, cancer, trauma, mental disorders, and

pulmonary conditions (Chart 4). Heart disease and trauma

ranked first and second as the two most expensive

conditions in terms of total health care spending; however,

with respect to per-person costs, cancer was the most

expensive and heart disease the second most expensive.11

Taken together, these five conditions accounted for a

substantial proportion of total health expenditures in 2002.

Heart conditions Cancer Trauma Mental disorders Pulmonary conditions

0

2

4

6

8

10

8.3%

6.0%

6.9%

5.9% 5.6%

Chart 4. The five most costly conditions as a percentage of total health expenditures: United States, 2002

Source: Olin GL, Rhoades JA. The five most costly medical conditions, 1997 and 2002: estimates for the U.S. civilian noninstitutionalized population. Statistical Brief #80. Agency for

Healthcare Research and Quality, Rockville, MD. Web site: http://www.meps.ahrq.gov/PrintProducts/PrintProdLookup.asp?ProductType=StatisticalBrief. Accessed April 7, 2006.

c The PPOs included were those that billed on a fee-for-service basis.
The 15 most costly medical conditions in the United States

accounted for 44 percent of total U.S. health care spending

in 1996.12

Chronic conditions contribute to higher health care

costs

Twenty-five percent of the U.S. community population were

reported to have one or more of five major chronic

conditions: mood disorders, diabetes, heart disease, asthma,

and hypertension. Spending to treat these five conditions

alone amounted to $62.3 billion in 1996.13 Moreover,

people with chronic conditions tend to have other

conditions and illnesses. 

When the other illnesses are added in, total expenses for

people with these five major chronic conditions rise to

$270 billion, or 49 percent of total health care costs,

according to 1996 MEPS data. On an individual level,

treatment for the average patient with asthma was $663 per

year in 1996, but when the full cost of care for asthma and

other coexistent illnesses is taken into account, the average

cost was $2,779. Expenses for people with one chronic

condition were twice as great as for those without any

chronic conditions. Spending for those with five or more

chronic conditions was about 14 times greater than

spending for those without any chronic conditions.14

Persons with five or more conditions also have high

hospital expenditures. In New York State during 2002, of

the 1.3 million different persons admitted to the hospital,

the 27 percent with five or more chronic conditions

accounted for 47 percent of all inpatient costs.15

Expensive conditions contribute to the growth in

health care costs

One study found that a small number of conditions

accounted for most of the growth in total health care

spending between 1987 and 2000—with the top five

medical conditions (heart disease, pulmonary disorders,

mental disorders, cancer, and trauma) accounting for 31

percent.16 For 7 of the top 15 conditions, a rise in the

proportion of the U.S. population being treated, rather than

rising treatment costs per case or population growth,

accounted for the greatest part of the spending growth.d

How much does the rise in number of people being

treated explain the overall growth in private

insurance spending? 

The rise in the number of people being treated for

expensive conditions has had an impact on the growth in

private insurance spending similar to that on overall health

care spending. The rise in the number of people being

treated, rather than the rise in spending per treated case,

was the most important determinant of the growth in

private insurance spending between 1987 and 2002,

according to a recent study.17 For 16 of the 20 most

expensive conditions, the rise in the number of people

being treated accounted for more than half the growth in

private insurance health care spending. Researchers

attribute the additional numbers of people being treated to

three factors: (1) the continued rise in the share of privately

insured adults classified as obese, (2) changes in clinical

treatment guidelines and standards for treating patients

without symptoms or with mild symptoms only, and (3) the

availability of new medical technologies to diagnose and

treat patients.

Especially important is the increase in the number of

people treated for conditions clinically linked to obesity.

From 1987 to 2002, the proportion of the population treated

increased 64 percent for diabetes (accounting for 80 percent

of the increase in costs) and increased 500 percent for

hyperlipidemia (accounting for almost 90 percent of the

increase in costs). A number of factors might explain the

substantial increase in treatment rates for conditions linked

to obesity. These factors include a rise in the number of

people with obesity-related conditions, a rise in the number

of more seriously ill patients, a greater emphasis on

preventive care, and the introduction of broader treatment

options.

The cost of public programs is affected by

highly expensive conditions

Medicare

In 2001, 5 percent of Medicare fee-for-service beneficiaries

accounted for 43 percent of total spending, with 25 percent

accounting for 85 percent of all spending. Chronic

www.ahrq.gov 7

d This is also referred to as “treated prevalence,” or the proportion of the

population currently receiving care for that condition.
conditions were closely linked to high expenditure levels:

more than 75 percent of high-cost beneficiaries (the 25

percent of Medicare beneficiaries with the highest costs)

had one or more of seven major chronic conditions.18 The

top-spending 25 percent of Medicare beneficiaries incurred

average per-person costs of $24,800. In this group, 42

percent had coronary artery disease, 30 percent had

congestive heart failure, and 30 percent had diabetes. 

Medicaid

The elderly and disabled, who constituted around 25

percent of the Medicaid population, accounted for about 70

percent of Medicaid spending on services in 2003. People

with disabilities accounted for 43 percent of Medicaid

spending and the elderly for 26 percent.19 The remaining 75

percent of the Medicaid population, who were not elderly

or disabled, accounted for only 30 percent of spending.

Geographic variation in health care expenses 

Studies point to major differences in health care expenses

by geographic area. One study, which divided the country

into 306 hospital referral regions, or regional markets for

health care, found that patients in the higher spending areas

receive 60 percent more care.20 For example, in 1996,

Medicare fee-for-service patients had average expenses of

$8,414 in the Miami, Florida, region, and $3,341 in the

Minneapolis, Minnesota, region. The authors found that

these differences were due not to differences in prices,

average levels of illness, or socioeconomic status but rather

to the overall quantity of medical services provided and to

the relatively higher proportions of internists and medical

subspecialists in high-cost regions. 

Conclusions

Analyses of health care spending patterns shed important

light on how best to focus efforts to help restrain rising

health care costs. Recognition that a relatively small group

of individuals account for a large fraction of spending in

Medicare, Medicaid, private plans, and the population as a

whole serves to inform more focused cost-containment

strategies. The concentration of health care expenses also

has implications for the effective design of consumer

directed health plans. Research also continues to raise

awareness of the importance of chronic conditions in

overall spending and as a major driver of cost increases,

leading to disease management programs and other efforts

to both improve quality and reduce the costs of conditions

such as diabetes, asthma, hypertension, heart disease, and

obesity. 

References

1. Centers for Medicare & Medicaid Services, Office of

the Actuary: Table 1. National Health Expenses

Aggregate and Per Capita Amounts, Percent

Distribution, and Average Annual Percent Growth, by

Source of Funds: Selected Calendar Years 1980-2003.

Web site: http://www.cms.hhs.gov/

NationalHealthExpendData/02_NationalHealth

AccountsHistorical.asp#TopOfPage Accessed April 7,

2006. 

*2. Conwell LJ, Cohen JW. Characteristics of people

with high medical expenses in the U.S. civilian

noninstitutionalized population, 2002. Statistical

Brief #73. March 2005. Agency for Healthcare

Research and Quality, Rockville, MD. Web site:

http://www.meps.ahrq.gov/PrintProducts/PrintProd

Lookup.asp?ProductType=StatisticalBrief. Accessed

April 7, 2006. 

*3. Berk ML, Monheit AC. The concentration of health

expenditures: an update. Health Aff (Millwood) 1992

Winter; 145-9

*4. Yu WW, Ezzati-Rice TM. Concentration of health care

expenses in the U.S. civilian noninstitutionalized

population. Statistical Brief #81. May 2005. Agency

for Healthcare Research and Quality, Rockville, MD.

Web site: http://www.meps.ahrq.gov/

PrintProducts/PrintProdLookup.asp?ProductType=

StatisticalBrief. Accessed April 7, 2006. 

5. Keehan SP, Lazenby HC, Zezza MA, et al. Age

Estimates in the National Health Accounts. Health

Care Financing Review 2004 Dec. 2; 1(1); Web

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*6. Cohen S, Yu W. The persistence in the level of health

care expenditures over time: estimates for the U.S.

population, 2002-2003. Statistical Brief #124. May

2006. Agency for Healthcare Research and Quality,

Rockville, MD. Web site: http://www.meps.ahrq.gov

/PrintProducts/PrintProdLookup.asp?ProductType=

StatisticalBrief. Accessed May 15, 2006.

*AHRQ-funded/supported research

8 www.ahrq.gov
www.ahrq.gov 9

*7. Monheit AC. Persistence in health expenditures in the

short run: prevalence and consequences. Med Care

2003; 41(7) suppl:III-53-64. 

8. Gornick M, McMillan A, Lubitz J. A longitudinal

perspective on patterns of Medicare payments. Health

Aff 1993 Summer; 12(2):140-50.

9. Alemayehu B, Warner KE. The lifetime distribution of

health care costs. Health Serv Res 2004; 39(3): 627-

42.

*10. Berk ML, Monheit AC. The concentration of health

expenditures, revisited. Health Aff (Millwood) 2001;

20(2):9-18.

*11. Olin GL, Rhoades JA. The five most costly medical

conditions, 1997 and 2002: estimates for the U.S.

civilian noninstitutionalized population. Statistical

Brief #80. Agency for Healthcare Research and

Quality, Rockville, MD. Web site:

http://www.meps.ahrq.gov/PrintProducts/PrintProd

Lookup.asp?ProductType=StatisticalBrief. Accessed

April 7, 2006.

12. Druss BG, Marcus SC, Olfson M, et al. The most

expensive medical conditions in America. Health Aff

(Millwood) 2002; 21(4): 105-111.

13. Druss BG, Marcus SC, Olfson M, et al. Comparing the

national economic burden of five chronic conditions.

Health Aff (Millwood) 2001; 20(6): 233-41.

14. Partnership for Solutions, Johns Hopkins University.

Chronic Conditions: Making the Case for Ongoing

Care. Prepared for the Robert Wood Johnson

Foundation. Baltimore, MD, 2002. 

*15. Friedman B, Jiang HJ, Elixhauser A, et al. Hospital

inpatient costs for adults with multiple chronic

conditions. Med Care Res Rev 2006; 63(3):1-20.

16. Thorpe KE, Florence CS, Joski P, et al. Which medical

conditions account for the rise in health care spending?

Health Aff (Millwood) 2005 Jul-Dec; Suppl Web

Exclusives: W4-480-6.

17. Thorpe KE, Florence CS, Howard DH, et al. The

rising prevalence of treated disease: effects on private

health insurance spending. Health Aff (Millwood)

2005 Jan-Jun; Suppl Web Exclusives: WS-317-

WS-325.

18. Congressional Budget Office. High-cost Medicare

beneficiaries. A CBO Paper. May 2005. Web site:

http://www.cbo.gov/showdoc.cfm?index=6332&

sequence=0. Accessed April 7, 2006. 

19. Kaiser Commission on Medicaid and the Uninsured.

Medicaid: A Primer. Washington. July 2005.

20. Fisher ES, Wennberg DE, Stukel TA, et al. The

implications of regional variations in Medicare

spending. Part 1: The content, quality, and accessibility

of care. Ann Intern Med 2003;138(4): 273-87.

*AHRQ-funded/supported research
www.ahrq.gov 11

Previous issues of Research in Action are available for free from the AHRQ Publications Clearinghouse: 1-800-358-9295.

Please specify the AHRQ publication number when you call.

Issue Title Publication Number

18 Chronic Care for Low-Income Children with Asthma: AHRQ 05-0073

Strategies for Improvement

17 Employer-Sponsored Health Insurance: Trends in Cost and Access AHRQ 04-0085

16 Programs and Tools to Improve the Quality of Mental

Health Services AHRQ 04-0061

15 Women and Domestic Violence: Programs and Tools That Improve 

Care for Victims AHRQ 04-0055

14 Hospital Nurse Staffing and Quality of Care AHRQ 04-0029

13 Dental Care: Improving Access and Quality AHRQ 03-0040

12 Advance Care Planning: Preferences for Care at the End of Life AHRQ 03-0018

11 AHRQ Tools for Managed Care AHRQ 03-0016

10 AHRQ Tools and Resources for Better Health Care AHRQ 03-0008

9 Reducing Costs in the Health Care System: Learning From 

What Has Been Done AHRQ 02-0046

8 Prescription Drug Therapies: Reducing Costs and Improving AHRQ 02-0045

Outcomes

7 Improving Treatment Decisions for Patients with Community- AHRQ 02-0033

Acquired Pneumonia

6 Medical Informatics for Better and Safer Health Care AHRQ 02-0031

5 Expanding Patient-Centered Care to Empower Patients and AHRQ 02-0024

Assist Providers

4 Managing Osteoarthritis: Helping the Elderly Maintain Function AHRQ 02-0023

and Mobility

3 Preventing Disability in the Elderly With Chronic Disease AHRQ 02-0018

2 Improving Care for Diabetes Patients Through Intensive AHRQ 02-0005

Therapy and a Team Approach

1 Reducing and Preventing Adverse Drug Events To Decrease AHRQ 01-0020

Hospital Costs
U.S. Department of

Health and Human Services

Public Health Service

Agency for Healthcare Research and Quality

540 Gaither Road

Rockville, Maryland 20850

www.ahrq.gov

AHRQ Pub. No. 06-0060

June 2006