• 2009 Alaska Health Workforce Vacancy Study

      Landon, Beth; Doucette, Sanna; Frazier, Rosyland; Wilson, Meghan; Silver, Darla; Hill, Alexandra; Sanders, Kate; Sharp, Suzanne; Johnson, Kristin; DeRoche, Patricia; et al. (Institute of Social and Economic Research, University of Alaska Anchorage, 2009-12)
      Alaska continues to experience health professional shortages. The state has long had a deficient “supply side” characterized by insufficient numbers of key health workers whose recruitment, retention, and training have been impeded by Alaska’s remoteness, harsh climate, rural isolation, low population density, and scarce training resources. Alaska is the only state without a pharmacy school and lacks its own dental and physical therapy schools as well. Health professional shortages can be decreased through the start of new training programs, the expansion of existing programs, and the improvement of the effectiveness of recruitment and retention efforts. However, strategic planning and the execution of such programs require valid and accurate data. To this end, stakeholders such as the Alaska Mental Health Trust Authority (AMHTA) and Alaskan's For Access to Health Care (ACCESS), along with schools and departments within the University of Alaska Anchorage (UAA), funded the Alaska Center for Rural Health-Alaska’s AHEC (ACRH) and the Institute of Social and Economic Research (ISER) to conduct a comprehensive health workforce study during winter and spring of 2009. This report highlights employers’ needs for employees to fill budgeted positions. This is different from a needs assessment that would take into account population demographics and disease incidence and prevalence. This health workforce study is an assessment of health manpower shortage based on budgeted staff positions and their vacancies in organizations throughout the state. Respondents included part-time positions, which resulted in our counting full-time equivalent (FTE) rather than individuals (“bodies”). In situations where a position was divided among more than one occupation (e.g., Dental Assistant and Billing Clerk), we asked the respondent to count the position under which they considered the position’s “primary occupation.” This was a point-in-time cross-sectional study. Recently filled vacancies or imminent vacancies were not counted. Positions filled by relief/temporary/locum/contract health workers were counted as vacancies only if these workers were temporarily filling a currently vacant, budgeted position. Due to budget and time constraints, we were not able to conduct a trend analysis that is a comparison of this study’s findings and the prior 2007 study. The key questions this study sought to answer were (1) How many budgeted positions, either full- or part-time, existed in organizations providing health services in Alaska? (2) How many of these budgeted positions were currently vacant? (3) What was the vacancy rate? (4) How many of the organizations that employ these occupations hired new graduates of training programs? (5) How many of the currently vacant budgeted positions (#2) could be filled by new graduates of training programs? (6) What were the mean and maximum length of time, expressed in months, that the vacancies have existed? (7) What were the principal, underlying causes of vacancies? The study was designed in consultation with an advisory group that included AMHTA, ACCESS, and UAA. The study targeted 93 health occupations. The unit of analysis was the employment site by organization type, which allowed for the allocation of positions and vacancies by geographic region. For each employer, we identified the staff person most knowledgeable about hiring and vacancies. In large organizations this meant that one employer might provide information about multiple sites and organization types; smaller employers were responsible for only a single site.
    • Alaska Employer Health-Care Benefits: A Survey of Alaska Employers

      Guettabi, Mouhcine; Frazier, Rosyland; Knapp, Gunnar (Institute of Social and Economic Research, University of Alaska Anchorage, 2014-10)
      The majority of Alaskans and Americans who have health insurance coverage get it through an employer—either their own employer or the employer of a family member. The U.S. Census Bureau estimates that 55.4% of all Alaskans got health insurance through an employer in 2012—and 68.4% of those with health insurance got it through an employer. But those census estimates also suggest that the share of Alaskans and other Americans who get health insurance from their employers has been gradually declining (Figures I-1a and I-1b). Figure I-1a. Figure I-1b. Source: U.S. Census Bureau, Health Insurance Historical Tables-HIB Series, Table HIB-4: Health Insurance Coverage Status and Type of Coverage by State--All Persons: 1999 to 2012, http://www.census.gov/hhes/www/hlthins/data/historical/HIB_tables.html. Because employer-sponsored insurance is so important to Alaskans, the Alaska Health Care Commission sponsored a survey of businesses, local governments, and school districts statewide, asking whether they offer employees insurance or other health benefits, which employees are eligible, and what types of plans and rates they offer.
    • Alaska Veterans Needs Assessment

      Guettabi, Mouhcine; Frazier, Rosyland (Institute of Social and Economic Research, University of Alaska Anchorage, 2015-10-01)
      The Institute of Social of Economic Research conducted a needs assessment of Alaska Veterans starting in the spring of 2014. Our goal was to identify and measure areas for improvement in providing services and determining the methods to achieve improvement. Our approach consisted of three methods: ‐ Survey of Alaska veterans using a list of 2,950 veterans who have requested veteran designation on their driver’s license. ‐ Focus groups: one consisting of women and one of disabled veterans. ‐ Key informant interviews with individuals responsible for helping veterans navigate the benefits available to them. Our findings are far ranging and details can be found in the report below. One of the most important lessons was the difference in needs across age groups. Younger veterans were concerned about education and employment while their older counterparts valued health care and navigating the application process. Consistent with these differences, the focus groups made it clear that targeted reminders that take into account the veteran’s life stage may be more effective. As things stand, the amount of information one is exposed to at separation can be overwhelming and intimidating. Awareness and use of federal benefits was high for health care, housing, and education benefits. Employment services were less utilized but most of our respondents were aware of their existence (Table 19). Across the board, lack of knowledge/awareness of specific benefits does not seem to be systemic. The three most claimed benefits were Health Care, Disability Compensation, Home Loans, and Education and Training. At the state level, the most commonly claimed benefits by the survey respondents are the veteran driver’s license, veterans license plates, hunting and fishing licenses, property exemption, education benefits, and veterans housing and residential loans. Of note is that only 9% claimed Veteran employment services and awareness about state benefits seems to be more of an issue than in the federal case. A third of our respondents had a disability rating of 50% or higher. Disability payments are very important across the board but seem to be essential for veterans with higher disability ratings. These payments were also more important to younger veterans who potentially have had less time to accumulate savings over their lifetime. Health care use is very much associated with age as older respondents were more likely to have applied for Health Care Services. Additionally, disability rating is also associated with frequency of health care use and utilization of VA services. Thirty percent of our respondents think they will use VA as their primary source of healthcare.Younger veterans are considerably more likely to use education benefits. The majority of our respondents used education benefits after active duty. However, more than ten percent have used education benefits both before and after and another seven percent used them only during active service. When asked about living arrangements in case a veteran could not care for themselves, it was clear that proximity to friends and family was paramount. Anchorage was chosen as the location most of them would prefer.
    • Cancer Control Continuum Gap Analysis: Inventory of Current Policy and Environmental Strategies

      Frazier, Rosyland; Guettabi, Mouhcine; Cueva, Katie (Institute of Social and Economic Research, University of Alaska Anchorage, 2013)
      "Comprehensive cancer control (CCC) is a process through which communities and partner organizations pool resources to reduce the burden of cancer. These combined efforts help to reduce cancer risk, find cancers earlier, improve treatments, and increase the number of people who survive cancer. ”This analysis has explored both current policies that have been enacted in Alaska at the state and federal level, and those that are acknowledged at a national level. The gap analysis is designed to inform the State DHSS as it takes steps to develop a policy agenda for comprehensive cancer control that aims to; reduce the risk of developing cancer, identify cancer earlier, improve cancer treatment, and increase the number of cancer survivors."
    • The Cost of SBIRT Implementation in Mat-Su Primary Care Practices

      Tran, Trang C.; Guettabi, Mouhcine; Frazier, Rosyland; King, Diane; Zold, Amanda (Institute of Social and Economic Research, University of Alaska, 2018)
      The purpose of this report is to calculate the cost of alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in three primary care practices located in the Matanuska-Susitna area. Using Fleming et al. (2000)’s benefit-cost ratio of screening and brief physician advice in managed care settings, we estimated the dollar benefits potentially generated by SBIRT services.
    • Food System Assessment

      Hanna, Virgene; Frazier, Rosyland; Parker, Khristy L.; Ikatova, Irena (Institute of Social and Economic Research, University of Alaska Anchorage, 2012)
      Food assessments are conducted for different reasons such as creating a more sustainable commercial food production system or to target particular policies. The main focus of this effort was to locate indicators that could be updated regularly so current information would be readily available and so that changes or trends could be monitored. Without knowing the current state of food-related indicators it’s difficult to make informed decisions about which issues and goals are priorities. We start with an overview of the food system model we used. Chapter 2 is a demographic overview of Alaska’s residents. The next five chapters present the indicators for each of the components of the food system. Chapter 8 contains the data we think would be need to develop a better picture of Alaska’s food system. The final section of this report is an index of the indicators: the name of the indicator, where the indicator appears in this report, the years of data included, the source (the agency or organization thatproduced the data), the source title for the data, and the location of the data, usually a Web address.
    • Health Effects of Indoor-Air Benzene in Anchorage Residences: A Study of Indoor-Air Quality in Houses with Attached Garages

      Gordian, Mary Ellen; Frazier, Rosyland; Hill, Alexandra; Schreiner, Irma; Siver, Darla; Stewart, Alistair; Morris, Steve (Institute of Social and Economic Research, University of Alaska Anchorage, 2009-06)
      Benzene is a known carcinogen. It affects white blood cells; it causes leukemia and aplastic anemia. It may also affect the immune system which is dependent on white blood cells.1 It has been removed from all household products, but it is still present in gasoline. Alaskan gasoline is particularly high in benzene (>5%). Gasoline refined in Alaska has high concentrations of benzene and other the aromatic compounds as much as 50% aromatics by volume. Leaving the aromatics in the gasoline helps cars start in the cold, but it also puts high concentrations of benzene in both the ambient and indoor air. We already knew from previous work done in Alaska by Bernard Goldstein in Valdez2 and the Anchorage Department of Health and Human Services in Anchorage3 that people were exposed to high ambient levels of benzene in the winter, and that there were high indoor benzene concentrations in homes with attached garages if the garage was used to store gasoline or gasoline powered engines. Benzene does not bioaccumulate in the body as dioxin or some pesticides do. But are its effects cumulative? Does a little dose of benzene everyday have the same effect as a large dose over less time? Benzene reduces CD4 cells in a dose-response manner at workplace concentrations less than 1 ppm (OSHA 8-hour exposure limit) in workers.4 People who live in homes with high benzene concentrations may be exposed 24 hours a day, seven days a week. There have been no studies of health effects of such environmental exposure to benzene. This study was done to determine three things: 1. What percentage of Anchorage homes with attached garages had high levels of indoor benzene? 2. Were the high levels of indoor benzene affecting the health of the residents? 3. Were residents more likely to develop asthma in homes with high levels of indoor benzene?
    • How Do Alaskans Cover Their Medical Bills?

      Leask, Linda; Frazier, Rosyland; Passini, Jessica (Institute of Social and Economic Research, University of Alaska Anchorage, 2017-04-01)
      The Affordable Care Act (ACA) has been at the top of the news lately, with Congress considering but then dropping proposed changes. Congress will try again to change the ACA—but it’s uncertain how or when. This summary looks broadly at all the kinds of health-care coverage Alaskans have now, and how ACA provisions have changed that coverage.
    • How Hard Is It for Alaska’s Medicare Patients to Find Family Doctors?

      Frazier, Rosyland; Foster, Mark A. (Institute of Social and Economic Research, University of Alaska Anchorage, 2009-03)
      In the past few years, Alaskans have been hearing reports that some primary-care doctors won’t see new Medicare patients. Medicare pays these doctors only about two-thirds of what private insurance pays—and that’s after a sizable increase in 2009. But most Americans 65 or older have to use Medicare as their main insurance, even if they also have private insurance. Just how widespread is the problem of Alaska’s primary-care doctors turning away Medicare patients? ISER surveyed hundreds of doctors to find out—and learned that so far there’s a major problem in Anchorage, a noticeable problem in the Mat-Su Borough and Fairbanks, and almost no problem in other areas.
    • The Impact of Anchorage's 2000 and 2007 Smoke-Free Policies on Select Restaurants and Bars

      Guettabi, Mouhcine; Frazier, Rosyland; Cueva, Katie; Wheeler, John; Nye, Peggy (Institute of Social and Economic Research, University of Alaska Anchorage, 2014-01)
      The American Lung Association in Alaska (ALAA) asked the Institute of Social and Economic Research (ISER) to investigate the impact of the Anchorage 2000 and 2007 Clean Indoor Air (CIA) municipal ordinances on selected restaurants and bars. As previous U.S. studies have been conducted that speak to the economic and health impacts of CIA laws, ALAA also requested that ISER synthesize results of these existing studies and conduct a survey on restaurant and bar representatives’ perceptions of the impact of the ordinances.
    • Implementing SBIRT in Primary Care: A Study of Three Mat-Su Borough Health Care Practices

      Passini, Jessica; Elkins, Amanda; King, Diane; Frazier, Rosyland (Center for Behavioral Health Research and Services, 2018)
      Despite decades of research evidence that SBIRT is effective for addressing unhealthy patterns of drinking and reducing binge drinking, its adoption within healthcare practices continues to be slow. Providers have identified numerous reasons for not routinely screening and intervening on alcohol, including limited time, training, and resources for patients requiring treatment; lack of confidence in their ability to help patients reduce their drinking; inadequate reimbursement for SBIRT services, and worry about stigmatizing patients.
    • Improving Health Care Access for Older Alaskans: What Are the Options?

      Frazier, Rosyland; Foster, Mark A. (Institute of Social and Economic Research, University of Alaska Anchorage, 2010-06)
      This report focuses on the problem older Alaskans who rely on Medicare face getting access to primary care, and discusses some of the options policymakers are considering to resolve the problem. But older Americans across the country also report difficulty getting the primary care they need. The discussion here sheds light on the problem and potential solutions nationwide. Most Americans 65 and older use Medicare as their primary health insurance. Medicare is federal health insurance for people 65 and older, people under 65 with certain disabilities, and people of any age with end-stage renal disease—but this report looks only at access issues for Medicare beneficiaries 65 and older. Doctors don’t have to participate in the Medicare program. But those who do participate have to accept, as full payment, what Medicare pays for specific services. Many primary-care doctors say Medicare doesn’t pay them enough to cover their costs—so growing numbers are declining to see new Medicare patients. Among primary-care doctors nationwide, 61% accept new Medicare patients.1 National surveys sponsored by the Medicare Payment Advisory Commission have found that 17% of Medicare patients in the U.S. had “a big problem” finding family doctors in 2007—up from 13% in 2005.2 In Alaska, a 2008 survey by the Institute of Social and Economic Research (ISER) found that just over half of Alaska’s primary-care doctors were willing to treat new Medicare patients.3 The situation was worse in Anchorage, where 40% of all older Alaskans live. Only 17% of primary-care doctors in Anchorage were willing to treat new Medicare patients as of 2008 (Figure 1).4
    • Kids Count Alaska 2013-2014

      Frazier, Rosyland; Wheeler, John; Spiers, Kent; Kirby, Daniel; Mielke, Meg (Institute of Social and Economic Research, University of Alaska Anchorage, 2015-03-26)
      Kids Count Alaska is part of a nationwide program, sponsored by the Annie E. Casey Foundation, to collect and publicize information about children’s health, safety, education, and economic status. We gather information from many sources and present it in one place, to give Alaskans and others a broad picture of how well the state’s children are doing—and provide parents, policymakers, and others with information they need to improve life for children and families. Our goals are: • Distributing information about the status of Alaska’s children • Creating an informed public, motivated to help children • Comparing the status of children in Alaska with that of children nationwide, but also presenting additional indicators relevant for Alaska
    • Pathways to College Preparatory Advanced Academic Offerings in the Anchorage School District

      Hirshberg, Diane; Frazier, Rosyland (Center for Alaska Education Policy Research, University of Alaska Anchorage, 2016-10-14)
      There are many ways a child in the Anchorage School District (ASD) can access advanced course offerings. To a parent these pathways may seem complex. ASD offers options for gifted and highly gifted students at the elementary and middle school level, and accelerated, and enriched learning opportunities such as honors and advanced placement courses at the secondary level. These opportunities, though linked, are not the same, nor do they necessarily follow from one to another in a straight path. Moreover, pathways to and through these opportunities can be quite different. Offerings are different at the elementary, middle and high school levels, with differing qualifications and eligibility. And, some of the programs are only offered in a few particular schools. This variety provides lots of flexibility. It also creates a complex path of choices and decisions. In all of these pathways and choices, active advocacy by a parent is necessary to ensure that their child receive the best and most appropriate opportunities. In this report we describe the many advanced and accelerated learning opportunities available in Anchorage elementary, middle and high schools, and the ways students can access these opportunities. We provide visuals including figures, tables and text to highlight the pathways to and through advanced offerings from Kindergarten to 12th grade. This document is based upon publicly available information. We have combined information from the ASD gifted program website the ASD High School Handbook, the ASD High School Program of Studies guide, and minutes of the ASD Board meetings. We also spoke with staff in the gifted program at ASD. Individual school-level issues that are outside of ASD policy and procedures have not been included. This report focused on the services, programs and schools within the Anchorage School District that service as pathways to college preparation and advance academic course offerings. As we describe in more detail in this report, there are very different offerings and paths at the elementary, middle and high school. In general, there are gifted and highly gifted programs at the elementary and middle school level, and a highly gifted program at the high school level. At all school levels, the highly gifted programs are offered at a limited number of schools. In high school, all students (including those in the highly gifted program) have the opportunity to take honors and advanced placement classes. Math is not included in the middle and high school gifted program. Math instead is a curriculum progression. Advanced math opportunities usually start in 6th grade, when students can choose placement into math courses that are a higher than the usual level. Opting for advanced math in 6th grade puts a student on track to reach Algebra I in 8th grade and calculus in 12th. At the elementary school level ASD operates gifted programs in all schools and a highly gifted program in one. There are also alternative and optional schools, which offer accelerated and enriched learning environments. If a student is in the highly gifted or gifted program in elementary school, he or she usually transitions to gifted and highly gifted middle school programs. In middle school these programs 3 include gifted language arts and science classes. Students who were not a part of the gifted program in elementary school can access the middle school gifted program, by testing in. Many optional and alternative programs provide enriched and accelerated classes to all students in them. For high school students there is a greater variety of advanced offerings. Starting in 9th grade there are honors and Advanced Placement (AP) courses, Credit-by-Choice options, and optional programs within the high schools and alternative schools. Students in the middle school gifted and highly gifted program have the opportunity to transition into the high school Highly Gifted Program.
    • Pathways to College Preparatory Advanced Academic Offerings in the Anchorage School District

      Frazier, Rosyland (Center for Alaska Education Policy Research, University of Alaska Anchorage, 2016-10-01)
      There are many ways a child in the Anchorage School District (ASD) can access advanced course offerings. To a parent these pathways may seem complex. ASD offers options for gifted and highly gifted students at the elementary and middle school level, and accelerated, and enriched learning opportunities such as honors and advanced placement courses at the secondary level. These opportunities, though linked, are not the same, nor do they necessarily follow from one to another in a straight path. Moreover, pathways to and through these opportunities can be quite different. Offerings are different at the elementary, middle and high school levels, with differing qualifications and eligibility. And, some of the programs are only offered in a few particular schools. This variety provides lots of flexibility. It also creates a complex path of choices and decisions. In all of these pathways and choices, active advocacy by a parent is necessary to ensure that their child receive the best and most appropriate opportunities. In this report we describe the many advanced and accelerated learning opportunities available in Anchorage elementary, middle and high schools, and the ways students can access these opportunities. We provide visuals including figures, tables and text to highlight the pathways to and through advanced offerings from Kindergarten to 12th grade. This document is based upon publicly available information. We have combined information from the ASD gifted program website the ASD High School Handbook, the ASD High School Program of Studies guide, and minutes of the ASD Board meetings. We also spoke with staff in the gifted program at ASD. Individual school-level issues that are outside of ASD policy and procedures have not been included. This report focused on the services, programs and schools within the Anchorage School District that service as pathways to college preparation and advance academic course offerings. As we describe in more detail in this report, there are very different offerings and paths at the elementary, middle and high school. In general, there are gifted and highly gifted programs at the elementary and middle school level, and a highly gifted program at the high school level. At all school levels, the highly gifted programs are offered at a limited number of schools. In high school, all students (including those in the highly gifted program) have the opportunity to take honors and advanced placement classes. Math is not included in the middle and high school gifted program. Math instead is a curriculum progression. Advanced math opportunities usually start in 6th grade, when students can choose placement into math courses that are a higher than the usual level. Opting for advanced math in 6th grade puts a student on track to reach Algebra I in 8th grade and calculus in 12th. At the elementary school level ASD operates gifted programs in all schools and a highly gifted program in one. There are also alternative and optional schools, which offer accelerated and enriched learning environments. If a student is in the highly gifted or gifted program in elementary school, he or she usually transitions to gifted and highly gifted middle school programs. In middle school these programs 3 include gifted language arts and science classes. Students who were not a part of the gifted program in elementary school can access the middle school gifted program, by testing in. Many optional and alternative programs provide enriched and accelerated classes to all students in them. For high school students there is a greater variety of advanced offerings. Starting in 9th grade there are honors and Advanced Placement (AP) courses, Credit-by-Choice options, and optional programs within the high schools and alternative schools. Students in the middle school gifted and highly gifted program have the opportunity to transition into the high school Highly Gifted Program. The following table provides a look at advanced offerings at different school levels. Each of these offerings is discussed in the report.
    • Policy Implications of Freestanding Emergency Departments

      Frazier, Rosyland; Guettabi, Mouhcine (Institute of Social and Economic Research, University of Alaska Anchorage, 2015-05-01)
      Policymakers have a responsibility to look at both the short- and long-term implications of their decisions. The state’s current fiscal situation, coupled with rising health-care costs makes “budget neutrality” highly desirable in decision-making. In spite of efforts to bend the cost curve, health expenditures have grown inexorably in Alaska. As of 2009 our health expenditures per capita were the second highest in the nation. This means that the state spends a larger portion of its budget on health costs, employers allocate more of employees’ compensation to health premiums, and households spend more of their disposable income on out-of- pocket costs, premiums, and co-pays. The evidence we provide in this analysis consistently shows that freestanding emergency departments charge higher prices for services that are available for considerably less in traditional settings. Allowing freestanding emergency departments to enter the Alaska market goes against the many efforts being undertaken to contain health-care costs. Markets forces explain a significant portion of the high health-care prices charged in Alaska, but in this case the state has an opportunity to use its regulatory authority to help prevent even higher prices in the future. Putting costs aside, in considering emergency services one needs to rationalize the hospital and clinical capacity across a region and the needs of the population. In the Alaska health-care system there are problems with coordinating the delivery of care. Freestanding emergency departments pose the risk of exacerbating that lack of coordination, if people use them in lieu of seeing their primary physicians—which can disrupt the continuum of care and potentially hurt outcomes for patients.
    • Preventive Screenings Gap Analysis

      Frazier, Rosyland; Guettabi, Mouhcine; Wheeler, John; Cueva, Katie (Institute of Social and Economic Research, University of Alaska Anchorage, 2013-10-01)
    • Response to Questions: Potential Effects on Alaska of Proposed Health-Care Reform Legislation

      Foster, Mark A.; Frazier, Rosyland (Institute of Social and Economic Research, University of Alaska Anchorage, 2010-01)
      Mark Foster of Mark A. Foster and Associates (MAFA) is a consultant to ISER, and Rosyland Frazier is an ISER research associate. Both the authors have broad experience studying health-care issues in Alaska, and they have recently been looking at the problems Alaska’s Medicare patients face in getting primary-care doctors to see them. They prepared this note to respond quickly to questions from and discussions with the Office of the Governor in Washington, D.C. and Alaska’s Congressional delegation. Those questions and discussions were about the possible implications for Alaska’s Medicare patients of provisions in health-care reform legislation the U.S. Congress is considering, as well as about the broader potential effects on Alaska of the proposed legislation. This is by no means a full analysis of the many complex issues associated with health-care reform. A working paper by the same authors—examining the Medicare-access problem and related health-policy issues in more detail—will be available soon. The findings and conclusions of this note are those of the authors. If you have questions, get in touch will Rosyland Frazier at: anrrf@uaa.alaska.edu
    • Snapshot of Employer-Sponsored Health Insurance in Alaska

      Guettabi, Mouhcine; Frazier, Rosyland; Knapp, Gunnar (Institute of Social and Economic Research, University of Alaska Anchorage, 2014-09)
    • Trends in Alaska's Health-Care Spending

      Frazier, Rosyland; Guettabi, Mouhcine; Passini, Jessica (Institute of Social and Economic Research, University of Alaska, 2018)
      All Americans spend a lot to get health care—but Alaskans spend the most per resident, face the highest insurance premiums, and have seen overall spending grow much faster. Here we highlight some trends in Alaska’s health-care spending since the 1990s, based on existing publicly available data that allow us to compare changes in Alaska and nationwide. A chart book with much more detail is available on ISER’s website. We hope this broad information on trends in health-care spending will help Alaskans better understand what happened, consider possible reasons why, and think about potential ways to change the upward spiral.