HIGHLIGHTS OF STUDIES APPEARING IN THE JULY/AUGUST
ISSUE OF HEALTH AFFAIRS

• The Most Expensive Medical Conditions in America, by Benjamin G. Druss, Steven C. Marcus, Mark Olfson, and Harold Alan Pincus. In an attempt to identify the most expensive medical conditions in the U.S. and examine the association between the amount of money spent on a disease and the disability it causes, researchers found no significant correlation between treatment cost and the burden of disease. In fact, they found that the most expensive diseases are not necessarily the most disabling. Study authors conclude that the ethical issues surrounding health care priority setting outweigh cost effectiveness or disease burden but the data should be used to improve and inform the priority setting process.

• Health Care Spending In 1991-1998: A Fifty-State Review, by Anne Martin, Lekha Whittle, Katharine Levit, Greg Won, and Lindy Hinman. A federal study of health care spending in 50 states shows that spending varies considerably across states. For example, spending in Massachusetts was 76% higher than spending in Utah, where spending per person ranged from $2,731 in Utah to $4,810 in Massachusetts. In general spending was higher in the Northeast than in the West. The analysis examines overall spending levels, growth rates, Medicare and Medicaid spending as well as the factors that influence spending.

• Patient in Conflict with Managed Care: A Profile of Appeals in Two HMOs, by Carole Roan Gresenz, David M. Studdert, Nancy Campbell, and Deborah R. Hensler. A survey of 11,000 appeals lodged between 1998-2000 at two major California HMOs shows that as many as half of all appeals involved requests for reimbursement of costs for services that had already been rendered. And half of those appeals involved emergency room care treatment. Contrary to popular belief, appeals for denial of access to services were not as prevalent. Appeals that made it through the initial stage, where 90% are eliminated, were the most likely to be granted. Appeals for reimbursement of emergency room care had a 95% success rate. The findings suggest a need to develop creative approaches to help enrollees better understand their health plan policies and rules.

Health Affairs, published by Project HOPE, is a bimonthly, multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the journal are free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs, 301-656-7401, ext. 230, or via e-mail, press@healthaffairs.org. Selected articles from the July/August issue are available free on the journal's Web site, www.healthaffairs.org

©2002 Project HOPE–The People-to-People Health Foundation, Inc.