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The 1% of Americans who spend the most on medical care experienced a 4% drop in their share of the nation's overall healthcare spending from 1996 to 2003-the first such decline in three decades, according to a study by researchers at the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD. In addition to providing some terrific cost and utilization data, the findings suggest that prescription drug spending is rising across a large segment of healthcare users, whereas the proportion of healthcare costs related to hospital inpatient care in a more concentrated population is growing more slowly. A significant shift in healthcare spending patterns could alter the effectiveness of policies and care management programs aimed at containing healthcare costs.