The Agency for Healthcare Research and Quality (AHRQ) is committed to helping the Nation improve our health care system. To fulfill its mission, AHRQ conducts and supports a wide range of health services research. This report presents key findings from AHRQ's research portfolio during Fiscal Year 2010.
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Portfolios of Research
Medical Expenditure Panel Survey
Patient-Centered Outcomes Research/Comparative Effectiveness Portfolio
Patient Safety Portfolio
Health Information Technology Portfolio
Prevention/Care Management Portfolio
Value Portfolio and Related Activities
In fiscal year 2010 (FY10), the Agency for
Healthcare Research and Quality (AHRQ) was able
to increase key investments to help improve the
safety and quality of health care, ensure access to
care, increase the value of health care, reduce
disparities, and increase the use of health
In addition, the Patient Protection and Affordable
Care Act (Affordable Care Act), signed by the
President into law on March 23, 2010, brought
new and exciting opportunities to improve the
quality, safety, efficiency, and effectiveness of health
Patient Safety and Quality
In the largest Federal investment connecting
medical liability to quality, AHRQ awarded $25
million in funding to support efforts by States and
health systems to implement and evaluate patient
safety approaches and medical liability reform
models. In addition, AHRQ also invested $17
million to expand projects to help prevent
healthcare-associated infections (HAIs). The most
common complication of hospital care, HAIs cause
approximately 2 million infections and 99,000
deaths annually with a cost between $28 billion to
$33 billion. One FY10 project, the Comprehensive
Unit-based Safety Program (CUSP), shows
significant promise in reducing central line-associated
blood stream infections. A direct
outgrowth of earlier successful AHRQ-funded
efforts, CUSP reduced the rate of central line-associated
blood stream infections by two-thirds
within 3 months and over 18 months saved more
than 1,500 lives and nearly $200 million. AHRQ is
now supporting the implementation of CUSP to
all 50 States.
American Recovery and Reinvestment Act
Funding from the American Recovery and
Reinvestment Act (Recovery Act), signed into law
by President Obama in February 2009, allowed
AHRQ to expand its work in support of
comparative effectiveness research including
enhancing the Effective Health Care Program. The
overarching goal of comparative effectiveness
research is to improve health outcomes by
providing evidence to patients and their medical
providers to help them make the best decisions.
AHRQ's collaborative and transparent Effective
Health Care Program provides patients, clinicians,
and others with evidence-based information to
make informed decisions about health care.
Of the $1.1 billion contained within the Recovery
Act for comparative effectiveness research, $300
million was allocated to AHRQ, $400 million to
the National Institutes of Health (NIH), and $400
million to the Office of the Secretary of Health and
Human Services (HHS). Beginning in FY09,
AHRQ began issuing funding opportunity
announcements and working with NIH and the
Office of the Secretary to coordinate comparative
effectiveness research under the Recovery Act.
AHRQ agreed to manage the Office of the
Secretary's $400 million.
Recovery Act funds awarded from the Office of the
Secretary focus on four main areas:
- Data infrastructure awards to enhance existing
infrastructure and develop new databases,
networks, and registries to make both public
and private comparative effectiveness research
endeavors robust and sustainable over time.
- Dissemination, translation, and implementation
awards focused on ensuring the results of
comparative effectiveness research are disseminated, implemented, and used by
patients, families, and clinicians.
- Research awards to provide key information on
the relative benefits and harms of various
medical and health system interventions.
- Patient-Centered Outcomes Research (PCOR)
inventory and evaluation awards to catalog
PCOR comparative effectiveness research
activities and infrastructure to track investments
in comparative effectiveness research going
To execute Recovery Act funding effectively,
AHRQ awards focus on the following areas of
PCOR/comparative effectiveness research:
- Horizon scanning awards will identify new and
emerging issues for comparative effectiveness
review investments. Some of the richest topics
for comparative effectiveness research will likely
be found at the frontier of new health care and
systems interventions, where there may be great
promise but uncertain population benefits and
risks. Horizon scanning is vital to
understanding the relevant health care context
and landscape, as a basis for identifying and
beginning to prioritize among research needs.
- Evidence synthesis awards will increase the
number of comparative effectiveness reviews
conducted through AHRQ's Evidence-based
Practice Center (EPC). The ultimate goal of
comparative effectiveness research reviews is to
present the "state of the science" on a given
topic in a manner that can be directly applied
to decisions made by users of health care
information. These users include clinicians,
patients and caregivers, policymakers, and
payers, and may be individuals or their related
organizations. This program allows for input
from all perspectives into the development of
the research and implementation of the
- Evidence gap identification awards will develop
a formal process that will involve stakeholders,
including clinicians, funding agencies, and
researchers, to consider the gaps identified in
systematic comparative effectiveness reviews.
This will help shape future research agendas
and set priorities for a national investment in
new comparative effectiveness research based on
the findings. Some projects have already been
completed and identify future research topics in
the important areas of hip fracture, prostate
cancer, breast cancer, and diabetes.
- Translation and dissemination awards will
expand AHRQ's translation and dissemination
activities and strengthen the infrastructure
supporting these activities by supporting
grantees in developing and implementing
innovative approaches to integrating
comparative effectiveness research findings into
clinical practice and health care decisionmaking.
For example, one research team is adapting a
summary of evidence about antidepressants
produced by AHRQ for use as a decision aid—a tool that helps patients, including those with
low health literacy, understand the pros and
cons of these medicines. Other researchers will
adapt, evaluate, and disseminate AHRQ
summary guides on hypertension and type 2
diabetes for hard-to-reach and underserved
black men, including men who are homeless or
living in public housing, men in the
correctional system, and men who participate in
- Evidence generation awards will establish a
coordinated national investment in
practical/pragmatic comparative effectiveness
research. These studies will measure
effectiveness—the benefit the treatment
produces in routine clinical practice—and will
include novel study designs focusing on real-world populations. One of the many projects
will compare the effectiveness of surgery and
radiation for localized prostate cancer, the most
common male cancer. It will focus on modern
technologies and control for differences in
patients and treatments that may affect
outcomes. Another study will compare
treatments of bipolar disorder in real-world
settings. Figuring out which treatments work
best for which patients helps individuals assess
options when making decisions regarding health
- Training and career development awards
support the career development of clinicians
and doctoral researchers focusing their research
on the synthesis, generation, and translation of
new scientific evidence and analytic tools for
comparative effectiveness research. These awards
will train leaders in comparative effectiveness
research who will contribute substantially to
transforming our health system to one centered
on improved health outcomes for all patients.
- The Community Forum initiative will expand
AHRQ's existing efforts to obtain professional
and consumer input to inform its Effective
Health Care Program activities, build methods
and capacity for obtaining public input, and
allow the program to obtain guidance and
insights from a broader public involvement.
For more information on AHRQ's Recovery Act
investments, go to http://www.ahrq.gov/fund/cefarra.htm.
AHRQ 2010 Annual Conference
More than 1,800 people attended AHRQ's 2010 Annual Conference, held September 26-29, 2010. This
year's annual conference featured 70 sessions that covered such topics as transforming health care
delivery, developing new patient care models, strengthening preventive care and reducing health
disparities, improving quality and patient safety, and measuring and reporting on provider and system
performance. Interactive tabletop exhibits and 60 research posters filled the mAHRQet Place Café. For
the first time, AHRQ also provided continuing education credits for a number of sessions. Sessions
- New and Improved: Registries for Evaluating Patient Outcomes and Health IT.
- Reducing HAIs: Effective Change Strategies From a National Collaborative of Regional HAI
- Understanding Trends in Medical Care Costs: Analyzing the Impact of Changes in the Health Care
- Quality Improvement Initiatives: National Implementation of CUSP and TeamSTEPPS®
- Medical Homes: Refining the AHRQ Blueprint.
- Identifying, Preventing, and Reducing Diagnostic Error in Health Care.
- Do Patient-Centered Medical Homes Lower Costs and Improve Quality?
- The Value of Information: An Innovative Approach to Prioritizing Comparative Effectiveness
- The Use of Trigger Tools to Identify Risks and Hazards to Patient Safety.
- Improving Preventive Health Care for Older Americans.
AHRQ's 2011 Annual Conference is scheduled for September 18-21, 2011.
As 1 of 12 agencies within HHS, the mission of
AHRQ is to improve the quality, safety, efficiency,
and effectiveness of health care for all Americans.
The Agency fulfills this mission by working with
- Reduces the risk of harm from health care
services by using evidence-based research and
technology to promote the delivery of the best
- Transforms the practice of health care to achieve
wider access to effective services and reduce
unnecessary health care costs.
- Improves health care outcomes by encouraging
providers, consumers, and patients to use
evidence-based information to make informed
Ultimately, the Agency achieves its goals by
translating research into improved health care
practice and policy. Health care providers, patients,
policymakers, payers, administrators, and others
use AHRQ research findings to improve health care
quality, accessibility, and outcomes of care.
Disseminating AHRQ's research findings helps
support a Nation of healthier, more productive
people and results in an enhanced return on the
Nation's substantial investment in health care. This
report presents key accomplishments, initiatives,
and research findings from AHRQ's research
Portfolios during FY10.
The Agency's mission helps HHS achieve its
strategic goals to transform health care, implement
the Recovery Act, promote early childhood health
and development, help Americans achieve and
maintain healthy weight, prevent and reduce
tobacco use, protect the health and safety of
Americans in public health emergencies, accelerate
the process of scientific discovery to improve
patient care, and ensure program integrity and
responsible stewardship. The Agency has a broad
research portfolio that touches on nearly every
aspect of health care including:
- Clinical practice.
- Outcomes and effectiveness of care.
- Evidence-based practice.
- Primary care and care for priority populations.
- Health care quality.
- Patient safety/medical errors.
- Organization and delivery of care and use of health care resources.
- Health care costs and financing.
- Health information technology.
- Knowledge transfer.
Clinicians use AHRQ's evidence-based tools and
research to deliver high-quality health care and to
work with their patients as partners. AHRQ also
provides clinicians with clinical decision-support
tools as well as access to evidence-based guidelines,
preventive care recommendations, and quality
Policymakers, purchasers, health plans, and health
systems use AHRQ research to make more
informed decisions on health care services,
insurance, costs, access, and quality. Public
policymakers use the information produced by
AHRQ to expand their capability to monitor and
evaluate changes in the health care system and to
devise policies designed to improve its
performance. AHRQ works with State
policymakers to strengthen their Medicaid
programs through a learning network of all
Medicaid Medical Directors. In addition, AHRQ
has worked closely with States on new efforts to
assess and improve quality of care for children
enrolled in CHIP and Medicaid.
Purchasers use the products of AHRQ-sponsored
research to obtain high-quality health care services.
Health plan and delivery system administrators use
the findings and tools developed through AHRQ
sponsored research to make choices on how to
improve the health care system's ability to provide
access to and deliver high-quality, high-value care.
AHRQ research helps consumers get and use
objective, evidence-based information on how to
choose health plans, doctors, or hospitals. In
addition, AHRQ helps consumers play an active
role in their health care and reduce the likelihood
that they will be subject to a medical error. Personal
health guides developed by AHRQ help people keep track of their preventive care and other health
services they receive.
Return to Contents
Portfolios of Research
Research at AHRQ is performed under Portfolios
that encompass nearly every aspect of health care.
These research Portfolios include: Patient-Centered
Outcomes Research, often referred to as
Comparative Effectiveness, Patient Safety, Health
Information Technology, Prevention/Care
Management, and Value. AHRQ also has a number
of Crosscutting Activities related to quality,
effectiveness, and efficiency. AHRQ's Knowledge
Transfer and Implementation Program supports
these Portfolios by disseminating products, tools,
and research to specific audiences taking full
advantage of all new media and electronic
Patient-Centered Outcomes Research/Comparative Effectiveness
The mission of the Comparative Effectiveness
Portfolio is to provide health care decisionmakers—including patients, clinicians, purchasers, and
policymakers—with up-to-date, evidence-based
information about their treatment options to make
informed health care decisions. The evidence is
generated from research studies that compare
drugs, medical devices, test, surgeries, or ways to
deliver health care.
This Portfolio aims to identify risks and hazards
that lead to medical errors and find ways to prevent
patient injury associated with delivery of health
care. Important goals include: providing
information on the scope and impact of medical
errors, identifying the root causes of threats to
patient safety, and examining effective ways to
make system-level changes to help prevent errors.
Disseminating and translating research findings and methods to reduce errors are also important.
Additionally, the portfolio aims to develop an
environment or culture within health care settings
that encourages health professionals to share and
report information about medical errors and ways
to prevent them.
Navigating the Health Care System
AHRQ Director Carolyn Clancy, M.D.,
presents a series of brief, easy-to-understand
advice columns for consumers to help them
navigate the health care system. The columns
address important issues such as how to
recognize high-quality health care, how to be an
informed health care consumer, and how to
choose a hospital, doctor, and health plan. In
addition, videos featuring Dr. Clancy on
Navigating the Health Care System encourage
patients to ask questions of their doctor, nurse,
or pharmacist and to speak up if they have
concerns about medications, tests, or
procedures. Other topics include tips for taking
medicines safely and how to avoid medical
errors. In FY10, column subjects included:
- Improving Your Health Literacy.
- Treating High Cholesterol.
- Why It's Wise to Use a Health Advocate.
- How to Avoid the Round-Trip Visit to the Hospital.
- Healthcare-Associated Infections: They Can Happen to You.
- Same-Day Surgery: What You Should Know.
- Comparing Blood Pressure Medicines.
- Comparing Diabetes Drugs.
- Comparing Medical Treatments for Antidepressants.
- Does Your Hospital Do A Good Job?
- Open Enrollment: What To Consider When Choosing a Health Plan.
To view the columns and videos, go to
Health Information Technology
This Portfolio aims to identify challenges to health
information technology (IT) adoption and use,
solutions and best practices for making health IT
work, and tools that will help hospitals and
clinicians successfully incorporate new health IT.
Research supported by the Portfolio aims to
develop evidence and inform policy and practice
on how health IT can improve the quality of
American health care. Further portfolio goals
include making the best evidence and consumer
health information available electronically when
and where it is needed, and developing secure and
private electronic health records.
The mission of the Prevention/Care Management
Portfolio is to improve the quality, safety, efficiency,
and effectiveness of the delivery of evidence-based
preventive services and chronic care management
in ambulatory care settings. Portfolio goals include:
- Supporting clinical decisionmaking for preventive services through the generation of new knowledge, synthesis of evidence, and dissemination and implementation of evidence-based recommendations.
- Developing the evidence base for and implementation of activities to improve primary care and clinical outcomes through health care redesign, clinical-community linkages, self management support, integration of health IT, and care coordination.
The goal of the Value Portfolio is to help assure
that consumers and patients are served by health
care organizations that reduce unnecessary costs
(waste) while maintaining or improving quality.
This is done by developing measures, data,
evidence, tools, and strategies that health care
organizations, systems, insurers, purchasers, and
policymakers use to reduce unnecessary costs while
maintaining or improving quality. Strategies
include process redesign, leadership and
management strategies, organizational and
community-wide quality improvement initiatives,
legal and regulatory changes, consumer choice,
public reporting, incentives, and payment changes.
Also, the portfolio conducts and supports
methodological work and modeling to improve
data and research, and to facilitate its use for policy
The activities in this area provide the core
infrastructure used by the AHRQ portfolios to do
their work. Activities in this Portfolio include data
collection and measurement, dissemination and
translation, and program evaluation. In addition,
support is provided for investigator-initiated and
targeted research grants and contracts that focus on
health services research in the areas of quality,
effectiveness, and efficiency.
Knowledge Transfer and Implementation Program
Translating research into practice as quickly as
possible is a high priority for AHRQ. As part of its
mission to develop programs for disseminating and
implementing the results of Agency activities, the
Office of Communications and Knowledge
Transfer directs a Knowledge Transfer and
Implementation Program to promote the use of
AHRQ tools, products, and initiatives by various
stakeholders. Knowledge Transfer activities consist
of a series of projects that disseminate and
implement AHRQ products, tools, and research to
a specific target audience. The goals are to:
- Enhance awareness about AHRQ's tools,
research, and products.
- Assist target audiences in the actual
implementation of AHRQ tools, research, and
- Gain feedback regarding the successes and
barriers that organizations are experiencing in
implementing AHRQ initiatives.
- Develop case studies showing how target
audiences have actually disseminated and
implemented specific AHRQ products.
Examples of dissemination projects and case studies
are provided throughout this report. For more
information about AHRQ's Knowledge Transfer
program, go to http://www.ahrq.gov/news/ktint.htm.
Return to Contents
Medical Expenditure Panel Survey
In addition to research portfolios, AHRQ supports
the Medical Expenditure Panel Survey (MEPS). In
FY10, MEPS was instrumental in informing HHS
as well as the White House on health care spending
and the costs and availability of health insurance,
especially in the context of health reform
legislation. Data from MEPS were incorporated
into responses to a series of Congressional requests
for assistance on information regarding employer
costs for health insurance, health expenditures, and
Medicaid participation rates. MEPS data were also
used to update the Chronic Disease Cost
Calculator, a tool for estimating the burden and
cost of chronic disease among Medicaid
beneficiaries. During FY10, the MEPS program
produced 17 public use files and more than 35
statistical publications. This year, publications
focused on trends in employer-sponsored insurance
and trends in expenditures for specific services.
MEPS is the only national source of annual data
on the specific health services that Americans use,
how frequently they are used, their cost, and the
sources of paying for them. MEPS is designed to
help the managers and users of the nation's health
care system understand how changes in private
health insurance, and other dynamics of today's
market-driven health care delivery system, affect
health care in America. MEPS provides the
foundation for estimating the impact of health
policy changes on different economic groups and
special populations, such as the poor, elderly, the
uninsured, and racial/ethnic groups.
MEPS consists of a family of surveys that gather
information about families and individuals, their medical providers, and employers across the United
States. The MEPS Household Component
(MEPS-HC) collects information from families on
demographic characteristics, health conditions,
health status, use of medical care services, charges
and payments, access to care, satisfaction with care,
health insurance coverage, income, and
employment. MEPS-HC public use data files
released in FY10 cover the calendar year 2008, as
well as early look data for 2009. These data files
include full-year population characteristics; job
information, home health care use and expenses;
expenses for other medical equipment and services;
and dental, medical, emergency room, office-based provider, and outpatient hospital visits. MEPS also
surveys medical providers of persons in the MEPS-HC
to supplement information on health care
expenses and payments.
The MEPS Insurance Component (MEPS-IC)
collects data from a sample of private- and public-sector
employers on the health insurance plans they
offer their employees. The collected data include
the number and types of private insurance plans
offered (if any), premiums, contributions by
employers and employees, eligibility requirements,
benefits associated with these plans, and employer
characteristics. MEPS-IC data released in FY10
included 2009 MEPS-IC Health Insurance
Tables—National Estimates, as well as State and
Metro Area Estimates.
Report by the Maryland Health Care
Commission on Employer-Sponsored
The Maryland Health Care Commission has
released a new publication based on MEPS data
to summarize the characteristics of employer-sponsored
coverage in Maryland. This report,
Medical Expenditure Panel Survey—Insurance
Component, Maryland Sample through 2008,
provides information on employer-sponsored
health insurance in private-sector establishments
in Maryland in 2008. The report provides data
on the establishments in Maryland that offer
health insurance and the employees in these
establishments who are eligible and enrolled, by
employer category (e.g., firm size, industry
grouping) and worker characteristics (e.g., full-time).
The report also provides information on
premiums and employee contributions, and
details the numbers and types of employees who
lack access to health insurance through private-sector
employers in Maryland. Information
provided in this report is based on an analysis of
the Maryland Sample from the MEPS-IC
survey, an annual national survey of business
establishments (locations) conducted by the
United States Census Bureau for the Agency for
Healthcare Research and Quality. For a copy of
the report, go to http://mhcc.maryland.gov/health_insurance/insurance_coverage/mepsic2008.pdf [PDF File, Plugin Software Help].
MEPS and the Chronic
Disease Cost Calculator
To help the States estimate the burden and
financial impact of chronic diseases among their
Medicaid beneficiaries, the Centers for Disease
Control and Prevention and RTI International, in
partnership with AHRQ, the National Association
of Chronic Disease Directors, and the National
Pharmaceutical Council, developed the Chronic
Disease Cost Calculator.
The Chronic Disease Cost Calculator is a
downloadable tool that makes use of MEPS data to
support States in:
- Estimating State Medicaid expenditures for six
chronic diseases—congestive heart failure, heart
disease, stroke, hypertension, cancer, and
- Generating estimates of the costs to Medicaid of
selected chronic diseases using customized
inputs (e.g., prevalence rates and treatment
In FY10, these updates have been incorporated into
Version 2 of the Chronic Disease Cost Calculator,
- Estimates of the prevalence and costs of asthma,
arthritis, and depression.
- Expanded estimates, including costs to
Medicare, private payers, and the total
- Estimates of absenteeism costs; and
- Projections of future medical costs over the next
Requests for Assistance
on Health Initiatives
MEPS is an important data source to inform health
care policy decisionmaking at the State and
national levels. This was especially true as health
reform initiatives were considered at the Federal
level. In FY10, Congressional and Executive
Branch analysts requested MEPS data on health
care expenditures, including the costs of health
insurance to employers and employees, costs of
private health insurance, out-of-pocket spending,
the financial burden of health care, consumers' use
of assisted living, and the costs of emergency room
care compared with care provided in physicians'
offices. All analyses are posted at http://www.ahrq.gov.
Table 1 briefly summarizes some of the responses
AHRQ provided to specific requests in FY10.
Additional details on these requests can be found at
Table 1. MEPS responses to request for assistance on health initiatives for FY10
|Source of Request
|Senate Finance Committee
||Detailed estimates and data analyses of the concentration and persistence in the
level of health expenditures over time, controlling for age and health insurance
|Congressional Research Service
||Detailed tabulations of employer costs for health insurance as a percent of
establishment payroll, by firm size, based on MEPS-Insurance Component
(MEPS-IC) 2008 private coverage data.
National estimates from MEPS of the characteristics and numbers of individuals
with group and nongroup health insurance coverage.
Detailed estimates of COBRA enrollment for 2005-2008 for the private and
government sectors, based on MEPS-IC data.
Detailed estimates of trends in total premium costs and employers' and
employees' shares for private employers, as well as costs to State and local
governments, based on MEPS-IC data.
|House Ways and Means Committee
||Distributional estimates of employer-sponsored premiums, with a focus on
premiums above the 80th percentile in the cost distribution, further disaggregated
by industry type. Estimates derived from the MEPS-IC 2008 private coverage
|Office of Health Reform, HHS
||Detailed estimates of out-of-pocket spending for medical care according to certain
dollar thresholds, by specific household characteristics.
|Senate Joint Committee on Taxation
||Detailed estimates of the socio-demographic characteristics of individuals with
high cost premiums.
|Assistant Secretary for Planning and Evaluation, HHS
||Estimates of the population with extreme financial burdens for health care,
obtained from MEPS. A national estimate for the United States was produced
that is methodologically consistent with WHO and World Bank estimates.
Estimates of single and non-single health insurance premiums at the State level,
based on MEPS-IC data, for use in determining the small business tax credit
included in the health care reform legislation.
|Meena Seshamani, Office of Healthcare Reform, HHS
||Estimates of the 2-year health insurance status (transitions) of persons under age 65 who were insured through an employer in January 1996, by age, race/ethnicity, perceived health status, chronic conditions, gender, poverty status,
urban/rural status, and employment status.
|House Committee on Veterans' Affairs/General Accounting Office
||Detailed consultations and expert review of a Department of Veterans Affairs study of post traumatic stress disorder.
|Senate Committee on Aging
||Detailed briefing on AHRQ's assisted living collaborative, focusing on consumers
and their use of assisted living.
|Office of Congressman Lamar Smith
||National estimates of the cost of providing non-emergent care in the emergency room compared with physicians' offices, using MEPS household data.
|Office of Congressman Michael H. Michaud
||Estimates of health insurance offer rates for large employers in Maine, derived from the MEPS-IC 2008 private coverage data.
MEPS data are displayed in a full range of analytic
publications, including statistical briefs, research
findings, methodology reports, and chartbooks.
Examples follow of the findings in these
- The annual premium for an employer-sponsored
family health plan cost about 54
percent more in 2009 than it did in 2000:
$13,027 versus $8,437 respectively, adjusted for
inflation. During the same period, the average
cost of an annual premium for a single
individual rose by 41 percent, from an
inflation-adjusted $3,308 to $4,669. In
- Just under a third (30.5 percent) of the 59
million U.S. workers who were enrolled in
employer-sponsored health plans had family
coverage, while about half were enrolled in
single coverage plans, and nearly one-fifth
had employee-plus-one coverage; that is, a
plan that covered only the employee plus
one family member at a lower premium
than full family coverage.
- Among the 10 largest States, New York had
the highest average premiums, ranging from
$13,757 for family plans to $5,121 for
single coverage, while Ohio had the lowest,
ranging from $11,870 for family coverage to
$4,261 for single coverage plans.
- The average annual employee contributions
to health insurance premiums were $3,474
for family coverage (26.7 percent of the
average family premium), $2,363 for
employee-plus-one coverage (26.1 percent of
the average premium) and $957 for single
coverage (20.5 percent of the average single
- About 21 percent of workers with single
coverage, 10 percent with employee-plus-one
coverage, and 11 percent with family
coverage made no contribution toward their
health insurance premium. However, these
proportions varied among the 10 largest
- In 2007, only a third of the 16.5 million
Americans who reported that they had diabetes
had all three examinations that are considered
critical for managing their disease and
preventing complications: checking the
patient's blood sugar levels, examining their eyes
for damage, and evaluating their feet for
indications of poor circulation.
- Just 58 percent reported having had one or
two of the exams, while 3 percent
didn't have any done, and 6 percent said they didn't know if they had had any of
- Privately insured adults ages 18 to 64
were twice as likely as adults who were
uninsured to have had all three tests (36
percent vs.18 percent).
- About 40 percent of adults ages 65
and older with diabetes who had Medicare
plus a secondary private insurance plan had
had all three tests, compared with 31.5
percent of those with Medicare only.
- For Americans ages 45 to 64 in 2006, total
health care expenses ($370 billion) were about
double the inflation-adjusted total for 1996
($187 billion). The proportion of people ages
45 to 64 who incurred medical expenses did
not change (about 89 percent), but average
annual health care expenses for those with
expenses increased from $3,849 (after adjusting
for inflation) to $5,455. Prescribed medicines
were a substantially higher proportion of total
expenses in 2006 than in 1996 (25 percent and
15 percent, respectively). The proportion of
total expenses for hospital inpatient care
decreased (from 36 percent to 26 percent). The
average expense per service rendered increased
significantly (in 2006 dollars):
- Physician office visit: $128 in 1996 to $207
- Inpatient hospital day: $3,005 to $3,491
- Emergency room visit: $563 to $947
- Dental visit: $195 to $265
- Prescription medicines: $103 to $199
- Purchases of cholesterol and diabetes
prescription drugs by elderly Medicare
beneficiaries reached nearly $19 billion in
2007—about one-fourth of the approximately
$82 billion spent for medications for the
elderly. Metabolic drugs, which are used to
reduce cholesterol levels, keep diabetes under
control, and combat weight and thyroid
problems, topped the list of the five leading
categories of drugs purchased by the elderly.
The other four drug classes in the top five
categories in 2007 were:
- Cardiovascular drugs, including blood
pressure medicines, diuretics, and drugs to
control abnormal heart rhythms such as
atrial fibrillation ($15 billion)
- Central nervous system drugs, such as
arthritis and other pain medications ($8
- Gastrointestinal drugs, which include anti-acid
medications ($7 billion)
- Hormones, to treat osteoporosis, cancer, and
other conditions ($5 billion)
Reports, data files, and additional information on
MEPS are available online at http://meps.ahrq.gov.
Japan's Institute for Health Economics and Policy medical care expenditure survey
modeled after MEPS
The Institute for Health Economics and Policy, an independent health care policy research organization
founded by Japan's Ministry of Health, Welfare, and Labour, has conducted a medical care expenditure
survey to improve the health care delivery and financing system in Japan. The survey is modeled after
According to Naohiro Mitsutake, Ph.D., Associate Director of the Institute's research department, the
information and advice the Japanese researchers received from AHRQ "were valuable in the design of
The Japanese researchers turned to MEPS to reach their ultimate goal. They felt the government should
have a panel design database, but needed a carefully designed survey methodology before beginning to
The initial Japanese pilot study, known as MEPS-J, was conducted by Institute researchers in 2008 and
2009 to test feasibility and capture new information on health care spending in the country. The study's
findings showed significant private health insurance spending in a country where all residents are covered
by public health insurance. While all residents of Japan are covered by one of the public health insurance
programs, most residents under age 75 incur a 30 percent copayment at the time of service. Private
insurance companies offer policies that cover some of those copayments. The MEPS-J survey found that
more than 70 percent of respondents had one of the private insurance policies, which cover part of the
out-of-pocket payments—a high rate of private insurance coverage that was not previously known.
In Japan, the government has several datasets which are regularly surveyed, such as the Patient Survey,
the Survey of Medical Institutions, and Medical Care Claims Survey; however, there were no panel
design surveys that included health care utilization as well as health status over time.
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