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New postings and analysis from Health Affairs, the leading journal of health policy. Health Affairs publishes new research each week online at For more information, contact Chris Fleming at 301-347-3944.

Those With Multiple Conditions Cause Bulk Of Medicare Spending Growth

Virtually all of the growth in Medicare spending over the past 15 years can be traced to patients who were treated for five or more medical conditions during the year, according to a new study by economists Kenneth Thorpe and David Howard released today as a Web Exclusive on the Web site of the journal Health Affairs. These beneficiaries alone accounted for 76 percent of total Medicare spending in 2002, up from 52.2 percent in 1987. While obesity contributed significantly to higher Medicare spending, "increases in the share of non-obese beneficiaries treated for five or more medical conditions show that there are other factors at work," say Thorpe and Howard of Emory University's Rollins School of Public Health.

Natrecor Saga Points Way To Improvements In FDA Handling Of Drugs

The history of the heart failure drug nesiritide shows that surrogate endpoints should be linked to real clinical improvements before they are used as the sole bases for approving new drugs, Aaron Kesselheim and coauthors say in the July/August Health Affairs. Serious safety questions have arisen concerning nesiritide, sold as Natrecor, since the FDA approved it in 2001. Among other recommendations, Kesselheim and coauthors suggest giving the FDA the power to require post-marketing studies as a condition of approval, to suspend sales if these studies are not completed, and to require a re-approval process based on new data that emerge from post-marketing studies.

Print editions of Health Affairs may be ordered for $35 each from Health Affairs' Customer Service at 301-347-3900 or online at

Give Family The Benefit Of The HIPAA Doubt, Says Health Affairs Author

Family members should be presumed under HIPAA's privacy provisions to be acting in "good faith" - as employers, funeral directors, and drug company representatives already are - when they seek access to protected health information without the patient's written authorization, Irene Wielawski writes in a Narrative Matters essay in the July/August Health Affairs. Wielawski also argues for eliminating jail time from the possible punishments for violating HIPAA. She says that when various college health officials refused to provide information about her daughter's chances of catching tuberculosis from her roommate, they quickly "leaped from a generally muddled understanding of [HIPAA] to the tag line: 'And I could go to jail'."


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print, with additional online-only papers published weekly as Health Affairs Web Exclusives at The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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