Innovative Maternal Health Program in Tanzania Expected to Impact At Least 50,000 Mothers and Children by 2016

October 2, 2012

Provided by Bloomberg Philanthropies through PR Newswire

NEW YORK, Oct. 2, 2012 /PRNewswire-USNewswire/ — An innovative maternal health program in Tanzania funded by Bloomberg Philanthropies is projected to impact at least 50,000 mothers and their children over the next three years, Mayor and philanthropist Michael R. Bloomberg announced today.

More than 100 local non-physician clinicians including assistant medical officers and nurse midwives in Tanzania’s most isolated areas have been trained to perform life-saving procedures including caesarean sections since the program began. The number of maternal deaths from bleeding and other complications in Tanzania have been reduced; in one district alone, maternal deaths declined by 32% in less than 2 years due to the project.

To date, more than one thousand babies have been delivered by c-section in villages where women previously had to travel several hours to receive care – often when it was too late. Women in Tanzania deliver an average of 5.5 children in their lifetime, meaning every mother’s life saved not only impacts her and her newborn but also the well-being of her other children.

Tanzania has the eighth highest number of maternal deaths in the world; a woman dies from complications of pregnancy and childbirth almost every hour in Tanzania.

“No one should have to die giving birth,” said Michael R. Bloomberg. “Sadly, in some parts of the world, too many women die due to complications in childbirth because of inaccessible and inadequate care. We are implementing a pilot in Tanzania, a country with one of the world’s highest rates of maternal deaths, where we have built a unique program that we know is already saving lives by providing emergency obstetric care in rural communities.”

“Reducing maternal deaths requires innovative approaches to delivering care in the hardest to reach places,” said Ban Ki-moon, Secretary-General of the United Nations. “I am encouraged by this type of partnership which, as we see in Tanzania, promises to improve the lives of women, their families and communities.”

“Through the efforts of Bloomberg Philanthropies and their partners, we are making progress in reducing maternal deaths in Tanzania which has been a high priority for my government,” H.E. Jakaya Mrisho Kikwete, President of Tanzania, said. “The results-oriented approach of this program has provided life-saving procedures to thousands of women, and we look forward to expanding this effort with the additional support of the H&B Agerup Foundation to save lives and improve the health of Tanzanians.”

“After traveling to Tanzania to see firsthand the work, progress and results of this maternal health program, we saw an opportunity to contribute to the continued development and implementation of this program,” said Helen Agerup, chair of H&B Agerup Foundation. “As an entrepreneur and medical professional, I was impressed by how this program challenged conventional medical approaches to improve mothers’ and children’s health and to save lives in some of the most remote parts of Tanzania.”

“With the contribution of H&B Agerup Foundation and the cooperation of the Tanzanian government, we can deepen this program’s impact in some of the most remote regions of the country,” Bloomberg said. “Early results show a two-fold increase in the number of health center-based deliveries, an important step towards reducing maternal death. As we monitor the progress of this ground-breaking work, we think it has the potential to become a model for other countries in Africa where maternal deaths are unacceptably high.”

Facts About Bloomberg Philanthropies Maternal Health Initiative

According to the United Nations, almost 300,000 women die globally from pregnancy and childbirth every year. For every woman that dies, another 20 suffer an injury, illness or disability, often with life-long consequences.

99% of maternal deaths occur in developing countries with over half of these in Sub-Saharan Africa. Tanzania has the fifth highest number of maternal deaths in Sub-Saharan Africa.

Access to comprehensive emergency obstetric services can prevent most maternal deaths, yet women continue to die because there are few facilities with skilled personnel and the distances are long. The crux of the Bloomberg Philanthropies Maternal Health Program is the decentralization of life-saving health care services to the level of the village, where it is needed the most. The approach has two components:

1) Upgrading Infrastructure
Almost every community in Tanzania has access to a health care center that can provide basic health care services. The Bloomberg Maternal Health Program has upgraded these health centers by constructing operating rooms and other critical infrastructure needed for comprehensive emergency obstetric care.

2) Training healthcare workers
Most remote communities of Tanzania do not have a medical doctor, and obstetricians are almost non-existent in rural areas. Tanzania was an early adopter of a practical solution known as “task-shifting” which allows non-physician clinicians to provide health care services. Non-physician clinicians are much more likely to work in isolated communities than doctors. Recognizing this, our program trains non-physician clinicians – called Assistant Medical Officers (AMO) – to manage complicated deliveries, including caesarian sections, and nurse midwives to administer anesthesia.

Today, Bloomberg Philanthropies announced a new investment in the program through a partnership with Geneva-based H&B Agerup Foundation over the next 3 years — bringing the total commitment to $15.5 million since late 2006. The program operates in close consultation with the Tanzanian Ministry of Health and Social Welfare. It is implemented by the World Lung Foundation and is evaluated by the Centers for Disease Control and Prevention (CDC), in partnership with the CDC Foundation.

Tanzania: By The Numbers
The United Nations’ Millennium Development Goal (MDG) 5 calls for a 75% reduction in maternal mortality rates by 2015. At the current rate of progress, Tanzania is not on track to reach MDG 5. Our program strives to accelerate progress and early results suggest we are headed in the right direction. We are showing that women will use life-saving medical treatments and facilities when they are easily accessible and provide high-quality care.

So far:

  1. Nine extremely remote heath centers have been upgraded. Prior to the program, patients had to travel 3-4 hours to the nearest hospital. Now, emergency obstetric care is available in the community.
  2. More than 100 non-physician clinicians have been trained in comprehensive emergency obstetric care or anesthesia.
  3. Health center utilization for delivery care has increased substantially, from about 3,500 deliveries per year in all 9 health centers prior to the program to about 9,000 in 2011 after the intervention.
  4. More than 1,000 c-sections have been performed
  5. The Ulanga district, one of 7 districts where the program is operating, saw a 32% decline in maternal deaths after the program was implemented.
  6. Conservative projections show that at least 50,000 women and children will be impacted by our work.

About Bloomberg Philanthropies 
Bloomberg Philanthropies works primarily to advance five areas globally: the Arts, Education, the Environment, Government Innovation, and Public Health. In 2011, $330 million was distributed. For more information please go to Follow us on Twitter @BloombergDotOrg.

SOURCE Bloomberg Philanthropies

Source: PR Newswire


The Health Law And The Supreme Court: A Primer For The Upcoming Oral Arguments

Later this month, the high court will consider the fate of the health law. Here are key points to keep in mind while watching the action.

Topics: Supreme Court, Politics, Health Reform

By Stuart Taylor, Jr.

Mar 15, 2012

How big is the constitutional challenge to the Obama health care law, which the Supreme Court will hear on March 26-28?

For starters, it’s big enough for the justices to schedule six hours of arguments — more time than given to any case since 1966. After all, the Affordable Care Act is arguably the most consequential domestic legislation since the creation of Medicare in 1965.

It’s also big enough to attract more briefs than any other case in history. At least 170, including more than 120 “friend-of-the-court” or amicus briefs, have been filed, many of which are joined by 10, 20 or more groups of every imaginable description.

And, finally, it’s big enough to cause the justices to postpone until October half of the 12 cases that they would ordinarily hear in April in order to clear time to get started on the health care opinions that they are expected to issue by the late June, or possibly, early July.


What’s it all about?
The immediate issues, in the order the court will hear them, begin with the question of whether the so-called “individual mandate” — which requires that almost all Americans without coverage buy individual health insurance policies or pay fines — is ripe for adjudication now. Or must the case be deferred until 2015 because of the 1867 Anti-Injunction Act, which bars federal courts from ruling on the constitutionality of tax laws before payments are due?

After that come the arguments about what many consider the central issue: whether the mandate, which is unprecedented, should be voided because it represents an unconstitutional exercise of Congress’ powers to regulate commerce and to levy taxes.

Next is what becomes of the law’s hundreds of other provisions, covering 2,700 pages, if the mandate is unconstitutional? Are some or all of them “severable,” meaning that Congress would have wanted them to stand even if the mandate falls? For example, what about the provisions establishing tax credits to help small businesses and individuals buy health insurance and taxing large employers that do not provide full-time employees government-approved coverage?

Apart from those issues, does the law’s expansion of Medicaid violate the sovereignty of the states by effectively requiring them to spend more of their own money or forfeit all of the federal Medicaid money they now receive?

What’s the likely outcome?
Nobody knows. It’s clear that the court’s four more liberal members, like almost all other liberal legal experts, will find the law constitutional in all respects. It’s also clear that conservative Justice Clarence Thomas will vote to strike down much or all of the law. It’s less clear what swing-voting Justice Anthony Kennedy and conservative Chief Justice John Roberts as well as Justices Antonin Scalia and Samuel Alito will do.

Kennedy, Roberts, Alito, and (especially) Scalia — whom the government’s brief quotes five times — have all joined past decisions construing federal regulatory power very broadly. Two respected conservative federal appeals court judges, Laurence Silberman and Geoffrey Sutton, who is one of Scalia’s favorite law clerks, have upheld the law.

What are the major arguments for and against the individual mandate?
Defenders say that the broad constitutional power of Congress to regulate interstate commerce, and the even broader power to “lay and collect taxes,” both provide ample authority for requiring that people buy insurance as part of a comprehensive scheme to end “discriminatory insurance practices that have excluded millions of people from coverage based on medical history,” in the words of a brief by Solicitor General Donald Verrilli.

The same brief also asserts that uninsured people consume $43 billion a year worth of emergency-room and other health care for which they do not pay, costs that are shifted to insurers and that raise insured families’ average premiums by more than $1,000 a year. Critics of the law dispute these numbers.

The 26 states challenging the law (along with a business group and four individuals) say, in the words of a brief by Paul Clement, who was solicitor general under President George W. Bush: “The individual mandate rests on a claim of federal power that is both unprecedented and unbounded: the power to compel individuals to engage in commerce in order more effectively to regulate commerce. This asserted power does not exist. … It is a revolution in the relationship between the central government and the governed.”

Clement also stresses that President Barack Obama and his allies in Congress insisted during the debate before the measure became law that the financial penalty for failing to comply with the individual mandate is not a tax. They should not be allowed, he argues, to “enact legislation that would not have passed had it been labeled a tax and then turn around and defend it as a valid exercise of the tax power.”

The Anti-Injunction Act?
This reconstruction-era statute bars courts from considering the constitutionality of tax laws until payments are due. It will apply here if the court deems the individual mandate’s penalty provision a “tax.”

Because the mandate is not scheduled to take effect until 2014 and the first penalties would not be due until 2015, the federal courts would not yet have jurisdiction to consider the constitutionality of the penalties or the mandate. In other words, consideration of the case would be postponed until 2015, and, therefore, such a decision would convert the biggest case in decades into the biggest anticlimax in Supreme Court history.

Both sides say that the Anti-Injunction Act does not apply. But the court appointed a lawyer as “friend of the court” to argue that it does, as one federal appeals court held. This appointment signaled the court’s care to observe arguable limits on its jurisdiction even when the parties agree that it has jurisdiction.

What are the major arguments on severability?
The government says that if the court strikes down the mandate, it should defer until future cases any ruling on the severability of most other provisions. But, if it does rule on severability, the government maintains that only two other provisions should go down with the mandate. Those are the “guaranteed-issue” and “community-rating” provisions, which bar insurers from denying coverage or charging higher premiums because of medical history. Without the individual mandate, the government says, those provisions would send premiums soaring by creating incentives for healthy people to defer buying insurance until they need health care.

The 26 states argue that the mandate was deemed by Congress to be “necessary to make the other provisions work as intended,” and that the court should strike down the whole law.

The court appointed another friend-of-the-court lawyer to write a brief arguing that a decision striking down the mandate should leave the rest of the law — including guaranteed issue and community rating — intact.

What are the major arguments on Medicaid?
The government asserts that “it is well settled that Congress’s spending power includes the power to fix the terms on which it will disburse funds to the states,” that Congress has repeatedly expanded the state-federal Medicaid program, and that this new expansion will not “impose significantly onerous burdens on the states.”

The 26 states counter that the Medicaid expansion unconstitutionally coerces them because it “threatens States with the loss of every penny of federal funding under the single largest grant-in-aid program in existence — literally billions of dollars each year — if they do not capitulate to Congress’ steep new demands.”

Stuart Taylor, Jr. is an author and contributor to the National Journal and other publications.


Physician praises Passport

By Special to The Sun
Tuesday, February 14, 2012 at 2:31 pm

When I started practicing medicine in Bardstown almost 35 years ago, I was optimistic about my opportunity to make sick children well and to watch healthy children grow into strong adults.

Even though I started out with a slightly naïve view, I’m very proud to say I’ve had a hand in caring for thousands of Kentucky’s children. I made a commitment to serve Medicaid patients at the very beginning of my career, but I was not enthusiastic when managed care arrived in 1997.

Both my staff and the staff at Passport Health Plan will attest to my reservations during the start up. On one hand, I was right to be cautious; there were administrative and technology issues that created burdens on my practice.

On the other hand, Passport worked hard to fix what wasn’t working so doctors could focus on providing patient care. But, the gap between where we were with Medicaid managed care then and where we are now is enormous. Several recent articles point out that the state’s attempt to save money by introducing three other Medicaid managed care plans outside the Passport region isn’t going well. Maybe it was too much too soon.

My practice, Physicians to Children and Adolescents, serves over 4,700 patients on Medicaid.  Because of our locations in Bardstown and Springfield, some are covered by Passport, some by the other plans.

I’m not a managed care expert, but my staff and I see and experience the differences daily.
I suspect part of the difference is that Passport is a nonprofit and therefore never has to put the expectations of shareholders before the needs of members.

I’ve been impressed enough with Passport’s commitment to the Commonwealth to accept an offer to join their Board of directors.  From this vantage point, I’ve been able to confirm what I have long suspected: Passport Health Plan has a strong and engaged provider network, and an intense focus on delivering services at a cost that doesn’t diminish quality. In fact, engaging with providers is one of the hallmarks of Passport’s remarkable success.

I feel that Passport’s effectiveness, including their impressive clinical outcomes, are directly due to physicians and other health professionals (from throughout the service area) sitting  at the table making key decisions and sharing sacrifices for the good of the plan and the members.

The National Committee on Quality Assurance recently ranked Passport as the 13th best Medicaid plan in America, which could not have been accomplished without an invested provider network and a top-notch staff. As a member of the board of directors, I want to say Passport stands willing and ready to help the state get Medicaid back on track.

In addition to Jefferson, the plan has been successfully serving 15 rural counties for 14 years and respects and understands their unique needs.  Claims are paid on time, and members have access to the doctors, pharmacies, hospitals and specialists.

Passport is a strong and cost effective Medicaid plan that could be easily replicated throughout the Commonwealth.


Dr. James Hedrick, MD, practices pediatrics in Bardstown and received his medical degree from the University of Chicago, Pritzker School of Medicine in Chicago, Ill.


To view this article by Dr. James Hedrick, MD for The Springfield Sun please visit

Officials: Care disrupted Medicaid changes causing ‘nightmare’

Health officials who spoke said they have no such complaints about Passport Health Plan.

Deborah Yetter – Louisville Courier-Journal
FRANKFORT, KY.— Health care officials from throughout Kentucky described massive problems Wednesday with the state’s new Medicaid managed- care system — resulting in outcomes they say range from outrageous to absurd.

“This bureaucratic nightmare needs to change,” said Dr. Shawn Jones, a Paducah physician and president of the Kentucky Medical Association, speaking at a meeting of the Senate Health and Welfare Committee.

Jones was one of several officials who testified that it appears any cost savings from managed care will come at the expense of patients.

“It appears to me the only place the savings can come from is the delay and denying of care,” Jones said. “Patient care is being delayed and, in some cases, simply prevented.”

The problems date to Nov. 1 — the day the state hired three companies to handle most Medicaid services outside the Jefferson County region — and include chronically late payments, bungled claims processing and constant battles over new rules that require services once routinely covered by Medicaid to be “pre-authorized” to guarantee payment.

Patients spend hours in physicians’ waiting rooms — or get sent home and told to return after procedures are authorized, Jones said. Pharmacists spend hours on the telephone trying to get prescriptions authorized, said Robert McFalls, executive director of the Kentucky Pharmacists’ Association.

And in one recent case, a woman arrived in labor at the hospital, and the managed-care company insisted that her care be pre-authorized, said Joe Grossman, chief financial officer of Appalachian Regional HealthCare, which operates eight hospitals in Eastern Kentucky.

“Fourteen days later, mom and baby are home and we still have no pre-authorization,” Grossman said.

The managed-care plan, which covers about 560,000 Medicaid members outside the Jefferson County region, is the linchpin of Gov. Steve Beshear’s administration’s plan to achieve savings in the $6 billion-a-year federal-state health plan for the poor and disabled.

Several officials who spoke Wednesday said they believe the companies — CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky, all affiliated with out-of-state national chains — may be deliberately stalling payments.

“I feel like I’ve become a bank to these out-of-state insurance companies,” said Grossman, who added that his hospital chain is owed about $8 million. “I’ve lent them money.”

Nancy Galvani, with the Kentucky Hospital Association, said hospitals across the state are owed millions of dollars in unpaid claims since managed care took effect three months ago. Meanwhile, the managed- care companies are getting large payments up front to run Medicaid.

The companies have been paid about $135 million since Nov. 1, according to state Auditor Adam Edelen, who last week opened an inquiry into their claims payments in response to complaints to his office.

No one from the managed-care companies spoke Wednesday. Sen. Julie Denton, a Louisville Republican and committee chairwoman, said she has invited their representatives to speak at next week’s meeting.

The companies issued a statement after Wednesday’s meeting.

“If there are complaints about WellCare, we want to address them and work with our providers to make the program a success,” said WellCare spokeswoman Denise Malecki.

Coventry spokesman Matthew Eyles said the company is willing to address the issues. “With any major new program, some problems will arise that need to be fixed, and we are committed to doing just that and won’t rest until those problems are resolved,” he said.

And Kentucky Spirit spokesman John Lee said the company continues to work “directly with our providers on specific, case-by-case issues.”

Health officials who spoke said they have no such complaints about Passport Health Plan, a nonprofit Medicaid managed care entity that provides service to about 170,000 Medicaid patients in Jefferson and 15 surrounding counties.

Neville Wise, the state’s acting Medicaid commissioner, spoke briefly, saying state officials are continuing to work with the health care providers and the managed-care companies to try to iron out problems. Many are being addressed, he said — such as the requirement that childbirth be pre-authorized. That has been corrected, he said.

Denton told Wise to keep trying to solve problems. “How many more ludicrous scenarios can there be?” she asked.

Health care officials who testified said that, while some problems have been corrected, others continue.

Janice Richardson, chief executive for Rivendell Behavioral Health Services, a children’s psychiatric hospital in Bowling Green, said the managed- care companies’ rules are disrupting care and in the long run are costing more.

For example, the companies limit the stay of children — even in cases where Rivendell doctors believe they need more care. So the children get discharged, get worse outside the hospital and are readmitted, Richardson said.

Managed-care officials have argued with Rivendell about the severity of children’s diagnoses and in one case accused hospital officials of “monkeying around” with a child’s treatment to prolong it, she said. “We are seeing kids over and over and over.”

Further, Richardson said, children who may be severely emotionally disturbed and suicidal are not getting the care they need.

“Somebody’s going to get hurt, and its going to be bad when it happens,” she said.

Steve Shannon, who represents the state’s 14 community mental health centers, said in an effort to head off such problems the centers began meeting with the managed-care companies before the Nov. 1 start-up date and have continued regular meetings and conference calls.

Still, claims processing and late payments are causing major hardships for the nonprofit community mental health centers. And the managed-care companies insist on prior authorization for many services and medications — yet don’t respond within the two days required by the state contracts and regulations.

Some authorizations take days or weeks, he said. Though the companies are supposed to fax the authorizations, one was mailing them, Shannon said.

“They were folding it, putting it in an envelope, licking it and putting a stamp on it,” Shannon said. “There is this thing called the Internet.”

Shannon said that all three of the new managed- care companies have extensive experience in other states and he is surprised they didn’t get off to a smoother start in Kentucky.

“They should know how to do this,” he said.

Shannon was among witnesses who said he wonders whether the delays and denials of care are deliberate on the part of the companies to keep money they get from the state to manage Medicaid.

“Is it really that hard to approve services and pay claims?” he asked.

Future of healthcare (From Fox News)

Here’s what your health care future holds


Published January 30, 2012


fox news

The first expert you ask for medical advice in 2025 may not be your doctor. Instead, perhaps you’ll consult your health avatar, a digital assistant that knows your entire health history and makes personalized recommendations.

It’s one of many possibilities for what primary care could look like in 13 years, according to “Primary Care 2025: A Scenario Exploration,” a new report by the Institute for Alternative Futures, a nonprofit think tank based in Alexandria, Va.

The institute worked with 50 health care experts to create four scenarios of the future, each one based on different assumptions. Funded by a grant from the Kresge Foundation, the project shows how a wide range of social, political and economic issues could affect health care and health insurance coverage. It also makes recommendations to achieve the best future.

“You don’t have the future air-dropped on you 10 years from now,” says Eric Meade, the institute’s vice president and senior futurist. “The future depends on actions you take along the way.”

The scenarios range from a grim prediction of desperation to hopeful outlooks for a well-functioning health care system.

“It’s when we’re able to acknowledge our fears and focus on aspirations that we’re able to create the future we would prefer,” Meade says.

Here’s a look at where things stand now and some of the best and worst possible outcomes for the future, according to the report.

Avatars provide more primary care

Now: Companies market a variety of online health and wellness programs and applications to help consumers track and improve their health.

Future best case: You still see doctors, but largely take care of yourself with the help of a digital avatar, which gives dependable advice based on your health data. You also learn by connecting with people who have similar conditions through social health networks.

Future worst case: Avatars vary widely in quality. Some companies market products to patients using free, low-quality avatars. This eventually leads to tragedy. In 2020, some 3,000 people die after taking their avatars’ advice and using an herbal product that causes a lethal interaction with their prescription medications. Regulators and industry associations promise safety of give-away avatars will improve, but many people continue to distrust virtual doctors. 

 Upscale practices charge yearly fees

Now: Concierge medicine includes upscale primary care practices that charge a yearly fee, or retainer, for enhanced care, such as cell phone access to your doctor, access to a suite of comprehensive tests and screening (including tests your insurance company wouldn’t cover), and personalized health coaching.

Future best case: Concierge medicine continues to provide cutting-edge care to the very rich. Innovations that are developed in these practices are adopted everywhere, so eventually all patients benefit.

Future worst case: The gap in the quality of care between rich and poor widens. The rich get great care. Most low-income Americans lucky enough to have coverage have high-deductible catastrophic health insurance plans and have to pay out of pocket for most of their care. Medicare and Medicaid patients face long lines.

Medical records go electronic

Now: Despite predictions in the 1980s that all medical records would be electronic by now, many health care providers are still converting from paper.

Future best case: Sophisticated electronic medical record systems reduce costs and improve care. Your record includes health data and information about your genetics, stress level, injury history, and social and economic circumstances to help doctors tailor treatment. Smartphone apps monitor your diet, physical activity and sleep patterns, which produces data you can enter into your record.

Future worst case: Poor people are stuck with an early version of electronic medical records, which includes limited billing and administrative information but doesn’t improve care.

Primary care doctor shortage impacts care

Now: Medical experts have been warning for years about a shortage of primary care doctors because too few medical students have been choosing the field and instead going into more lucrative specialties.

Future best case: Technology that helps patients care for themselves, along with a team approach to care — including nurses, social workers and community health workers — mitigates the shortage of primary care doctors.

Future worst case: Many doctors, nurses and pharmacists work into their 70s, and there are not enough of them to go around. A black market thrives with unlicensed caregivers diagnosing and doing minor surgeries on patients desperate for care.

Health insurance exchanges emerge

Now: States are developing health insurance exchanges — markets for individuals and small groups to buy health insurance. Exchanges will play a major role in health care starting in 2014, when virtually everyone is required to have health insurance under the Patient Protection and Affordable Care Act, the federal health care reform law.

The Kaiser Family Foundation keeps track of the status of health insurance exchanges.

Future best case: The health insurance exchanges expand the range of health insurance options, and almost everyone has health insurance.

Future worst case: The health insurance exchanges are unsuccessful in most states, prompting Congress to delay the mandate requiring everyone to have health insurance.

The original article can be found at
Here’s what your health care future holds

Biggest Bucks In Health Care Are Spent On A Very Few

by for NPR

So you know how on Monday the federal government reported that the $2.6 trillion the nation spent on health care in 2010 translated into just over $8,400 per person?

Well, a different study just released by a separate federal agency shows that second number doesn’t actually mean very much.

Researchers from the Agency for Healthcare Research and Quality looked at the way people actually spend money on health care. They found that half the population spends practically nothing on health care in any given year, while a very few unlucky people account for the lion’s share.

Specifically, in 2009, just 1 percent of the non-institutionalized population accounted for 21.8 percent of all U.S. health spending. And just 5 percent accounted for half the total spending.

Meanwhile, the bottom half of the population accounted for a mere 2.9 percent of total health spending in 2009.

So just who are those high spenders? Sick people, obviously.

But in looking at who remained in that top spending tier in both 2008 and 2009, researchers found that the high spenders were more likely to be:

  • Elderly,
  • Female,
  • White and
  • Covered by public health insurance.

Conversely, those who spent the least were more likely to report themselves as being in good or excellent health and to be younger. They were also more likely to be Hispanic or African-American.

The numbers could have political implications. At the least they help explain why so many people don’t understand the health care system. They either don’t have health insurance or don’t use it if they do.


To view this article by Julie Rovner for NPR, please visit