As it can be seen, the top 5% of spenders account for almost half of spending, and the top 1% account for more than 20%. While some concentration in expenditure is to be expected when looking at the distribution across the entire population – because it is in the nature of healthcare that some individuals, particularly those older and with complicated health conditions, will require large expenditure –, these figures seem remarkably large. They suggest important inequality in access, over and above inequality in need. Indeed, the publisher of the graph notes that a report from the Medicare Payment Assessment Commission shows that personal spending for individuals covered by Medicaid is somewhat less concentrated than for the population as a whole.