Highlights
News about Publications from the
Milbank Memorial Fund
March 2008
- Welcome
- New from The Milbank Quarterly
Table of Contents and Abstracts
"In This Issue"
by Bradford H. Gray, Editor- Recent Milbank Memorial Fund Reports
Improving Population Health: The Uses of Systematic Reviews
by Melissa Sweet and Ray Moynihan
Produced in Collaboration with the Centers for Disease Control and Prevention (CDC)Regulating Medical Services in China
by Hong Wang, Yanfeng Ge, and Sen Gong
Co-published with the Department of Social Development, Development Research Center (DRC), the State Council of P.R. China- New and Recent Books
The Health Care Revolution: From Medical Monopoly to Market Competition
by Carl F. Ameringer
March 2008Searching Eyes: Privacy, the State, and Disease Surveillance in America
by Amy L. Fairchild, Ronald Bayer, and James Colgrove
October 2007Low Income, Social Growth, and Good Health: A History of Twelve Countries
by James C. Riley
October 2007- Electronic Access to The Milbank Quarterly
1. WELCOME
Welcome to the March 2008 edition of Highlights, the Milbank Memorial Fund's update service. The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan analysis, study, research, and communication on significant issues in health policy since its inception in 1905. Its staff organizes and participates in meetings with decision makers and publishes reports, books, and The Milbank Quarterly, a peer-reviewed journal of population health and health policy.
Periodically, we will send you information about publications of the Fund. These messages will include links to the Milbank Memorial Fund web pages so that you can access, with no charge, electronic editions of selected Fund publications and request copies of available print editions of Fund reports. For a complete list of Fund reports or to request copies of print editions (available on a limited basis without charge for individual or educational use), please visit our home page, http://www.milbank.org, or contact us by telephone at (212) 355-8400.
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2. NEW FROM THE MILBANK QUARTERLYVOLUME 86, NUMBER 1 (March 2008)
TABLE OF CONTENTS AND ABSTRACTS
"Upstream Solutions: Does the Supplemental Security Income Program Reduce Disability in the Elderly?"
by Pamela Herd, Robert F. Schoeni, and James S. House
ABSTRACT
FULL TEXT"Why Is Late-Life Disability Declining?"
by Robert F. Schoeni, Vicki A. Freedman, and Linda G. Martin
ABSTRACT"Effects of Changes in Incomes and Practice Circumstances on Physicians’ Decisions to Treat Charity and Medicaid Patients"
by Peter J. Cunningham and Jack Hadley
ABSTRACT"Health Research Funding Agencies’ Support and Promotion of Knowledge Translation: An International Study"
by Jacqueline M. Tetroe, Ian D. Graham, Robbie Foy, Nicole Robinson, Martin P. Eccles, Michel Wensing, Pierre Durieux, France Légaré, Camilla Palmhøj Nielson, Armita Adily, Jeanette E. Ward, Cassandra Porter, Beverley Shea, and Jeremy M. Grimshaw
ABSTRACT
IN THIS ISSUE
A great deal of evidence from many countries links higher income to better health status. Even so, the nature of that association still remains controversial. Although higher incomes could be leading to better health, it also could enable people in better health to earn higher incomes; that is, income and health could have shared causes. Whether increases in income make a difference in people’s future health status is uncertain as well, and this is a particularly important policy question regarding people with low incomes. The first article in this issue of The Milbank Quarterly addresses this question. In “Upstream Solutions: Does the Supplemental Security Income Program Reduce Disability in the Elderly?” Pamela Herd, Robert Schoeni, and James House review the published evidence regarding whether socioeconomic status is a “fundamental cause” of differences in health status (Link and Phelan 1995), and they present new data on this question.
Fundamental cause theory posits that socioeconomic status is not just a proxy for other factors that may influence health, such as access to health care, sedentary behavior, smoking, and obesity. One body of evidence supporting this claim shows that neither changes in these factors during the twentieth century nor shifts in the major causes of mortality from infectious to chronic diseases altered the link between low socioeconomic status and poor health. If low income is in fact a fundamental cause of health problems, then population health policy should place more emphasis on factors like social and economic status. Herd, Schoeni, and House examine whether the Supplementary Security Income (SSI) program, whose purpose is to raise the income of the poorest elderly Americans, affects that population’s level of disability. The authors use within-state changes in SSI benefit levels between 1990 and 2000 to examine the effects of these changes on the states’ rates of disability. Their results support the hypothesis that more generous SSI benefit levels lead to reductions in disability in the poor elderly. For example, an increase of $100 per month in the state’s maximum SSI benefit for single elderly individuals led to a decrease of almost a half percent in their rate of mobility limitations. Since only about 10 percent of single elderly individuals receive SSI benefits, the effect for that population could be up to ten times larger.
The United States spends much more on health care than do other industrialized countries yet lags behind them on major health indicators. Although more research is needed, the important point is that income support policies may provide another way to resolve this dilemma.
The second article in this issue also is concerned with disability among the elderly in the United States. Like the first article, it provides both an extensive literature review and new empirical evidence. Survey data show that the rate of disability for the elderly has been declining since 1980. In “Why Is Late-Life Disability Declining?” Robert Schoeni, Vicki Freedman, and Linda Martin provide the most comprehensive examination, to date, of the reasons for this phenomenon, including new analyses of data collected from the National Health Interview Survey between 1982 and 2005. Many factors seem to be involved, including a greater use of assistive technology and the declining rates of heart and circulatory conditions and other physical causes of disability. But like Herd and her colleagues in the first article, Schoeni, Freedman, and Martin also implicate several more fundamental causes, including greater educational attainment and less poverty among the elderly.
The third article in this issue analyzes the provision of health care for people in the United States who lack health insurance. It is well known that the number of uninsured has been rising in recent years, with almost 47 million people having no health insurance at any time in 2006, according to estimates from the Current Population Survey (DeNavas-Walt, Proctor, and Smith 2007). But it is less well known that some of the ways in which the poor and uninsured can obtain physicians’ services have been changing. In “Effects of Changes in Incomes and Practice Circumstances on Physicians’ Decisions to Treat Charity and Medicaid Patients,” Peter Cunningham and Jack Hadley analyze some of the reasons why the number of physicians who treat poor patients has been decreasing.
Using data from four rounds of physician surveys in the Community Tracking Study (CTS), the authors found that two factors—physicians’ income and ownership of their practice—were associated with physicians’ decisions to stop accepting new Medicaid patients or to provide charity care. These factors did not, however, operate in the same way for these two categories of patients. That is, a decline in physicians’ income was associated with their decisions to stop accepting Medicaid patients but did not affect their acceptance of charity care patients. Conversely, physicians who owned their practice but then moved to employed positions tended to accept fewer charity care patients but to accept more Medicaid patients. The effect on charity care is important because, as Cunningham and Hadley show, the percentage of physicians who own their own practice has been falling (from 68.9 percent in the 1996/1997 CTS survey to 57.6 percent in the 2004/2005 survey). Unless the number of uninsured persons drops, the declining availability of charity care from private physicians will increase the importance of safety-net organizations that provide medical care.
The final article in this issue returns to a topic that the Quarterly has addressed several times in recent years: ways to increase policymakers’ use of research evidence (Jacobson, Butterill, and Goering 2005; Lavis et al. 2002, 2003; Lomas et al. 2003; Mitton et al. 2007). In “Health Research Funding Agencies’ Support and Promotion of Knowledge Translation: An International Study,” Jacqueline Tetroe, Ian Graham, and colleagues describe the efforts of thirty-three research funding organizations in nine countries to promote the translation into policy of research that they had supported. The authors studied these organizations, which were mostly government agencies, by interviewing key internal informants about their organizations’ efforts to promote the use of research, including requirements placed on investigators. The researchers did not collect data about the policymakers’ perspective on the question.
The authors identified eight major types of activities as efforts to “push” information to policymakers, to create a “pull” for information, and to develop “linkage and exchange” relationships between researchers and policymakers. The authors then described the different approaches in detail, including the fact that the respondents used some twenty-nine different terms for what the authors conceptualized as “knowledge translation.” A notable aspect of the researchers’ strategy, consistent with the purpose of the project, was sponsoring a workshop for representatives of the Canadian and U.S. agencies in which they could present and obtain feedback about the project’s findings. (Funding limitations prevented the participation of agency representatives from the other countries.)
Despite the wide variety of approaches used to promote knowledge translation from researchers to policymakers, the authors concluded that none of the agencies they surveyed could be viewed as “exemplary” in terms of their knowledge translation efforts. No specific activities were required by all of the agencies, and furthermore, the agencies provided little evidence about the effectiveness of different methods. Nevertheless, the article provides an extensive catalog of approaches being used in hopes of enhancing the use of research evidence for policymaking purposes.
I conclude by noting that starting with this issue, The Milbank Quarterly will use a more structured format for abstracts to make them more consistent, informative, and accessible. Guidance for prospective authors about this and other matters continues to be available at Milbank.org.
--Bradford H. Gray
Editor, The Milbank Quarterly
DeNavas-Walt, C., B.D. Proctor, and J. Smith. 2007. Income, Poverty, and Health Insurance Coverage in the United States: 2006. U.S. Census Bureau, Current Population Reports, P60-233. Washington, D.C.: U.S. Government Printing Office.
Jacobson, N., D. Butterill, and P. Goering. 2005. Consulting as a Strategy for Knowledge Transfer. The Milbank Quarterly 83(2):299–321.
Lavis, J.N., D. Robertson, J.M. Woodside, C.B. McLeod, J. Abelson, and the Knowledge Transfer Study Group. 2003. How Can Research Organizations More Effectively Transfer Research Knowledge to Decision Makers? The Milbank Quarterly 81(2):221–48.
Lavis, J.N., S.E. Ross, J.E. Hurley, J.M. Hohenadel, G.L. Stoddart, C.A. Woodward, and J. Abelson. 2002. Examining the Role of Health Services Research in Public Policymaking. The Milbank Quarterly 80(1):125–54.
Link, B.G., and J. Phelan. 1995. Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior (extra issue):80–94.
Lomas, J., N. Fulop, D. Gagnon, and P. Allen. 2003. On Being a Good Listener: Setting Priorities for Applied Health Services Research. The Milbank Quarterly 81(3):363–88.
Mitton, C., C.E. Adair, E. McKenzie, S.B. Patten, and B.W. Perry. 2007. Knowledge Transfer and Exchange: Review and Synthesis of the Literature. The Milbank Quarterly 85(4):729–68.
3. RECENT MILBANK MEMORIAL FUND REPORTSImproving Population Health: The Uses of Systematic Reviews
by Melissa Sweet and Ray Moynihan
Produced in Collaboration with the Centers for Disease Control and Prevention (CDC)
December 2007Published by the Milbank Memorial Fund in collaboration with the Centers for Disease Control and Prevention, Improving Population Health: The Uses of Systematic Reviews describes the methods, applications, and value for policymakers of systematic reviews that evaluate interventions intended to improve population health. Systematic reviews are the best available scientific guidance for choosing among alternative policies and apply the methods of research synthesis—a rapidly developing area of inquiry that merges the biomedical and social sciences. Written by health journalists Melissa Sweet and Ray Moynihan, this report is informed by discussions with, and literature from, some of the key figures in the field, including researchers who conduct systematic reviews, policymakers who use them, and critical thinkers who are imagining ways of enhancing their utility. Print copies are freely available upon request.
Regulating Medical Services in China
English version
Chinese version
by Hong Wang, Yanfeng Ge, and Sen Gong
Co-published with the Department of Social Development, Development Research Center (DRC), the State Council of P.R. China
June 2007Regulating Medical Services in China describes problems in access, quality, and cost of health care during the transformation of China to a market-oriented economic system. The report emphasizes the causes and effects of the absence of effective regulation of medical services in China. It also describes how experience in other countries could inform senior officials of the Central Government of the People's Republic of China as they reform regulatory policy. Two authors of the report are officials of the DRC; the third is a member of the faculty of public health at Yale University and a program officer of the Milbank Memorial Fund. The report is the result of conversations involving officials of Chinese ministries responsible for aspects of health policy with counterparts from Australia, Canada, Scotland, and the United States. Print copies are available without charge from the Fund.
4. NEW AND RECENT BOOKSThe Health Care Revolution: From Medical Monopoly to Market Competition
by Carl F. Ameringer
March 2008
253 pages
co-published with and distributed by the University of California Press
cloth: $49.95 ISBN 978-0-520-25480-0Description from the Press:
"America's market-based health care system, unique among the nations of the world, is in large part the product of an obscure, yet profound, revolution that overthrew the medical monopoly in the late 1970s. In this lucid, balanced account, Carl F. Ameringer tells how this revolution came into being when the U.S. Supreme Court and Congress prompted the antitrust agencies of the federal government—the Federal Trade Commission and the Justice Department—to change the rules of the health care system. Ameringer lays out the key events that led up to this regime change; explores its broader social, political, and economic contexts; examines the views of both its proponents and opponents; and considers its current trajectory."
From the Foreword by Carmen Hooker Odom, President, Daniel M. Fox, President Emeritus, and Samuel L. Milbank, Chairman:
"The Health Care Revolution: From Medical Monopoly to Market Competition is the nineteenth of the California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press encourages the synthesis and communication of findings from research and experience that could contribute to more effective health policy.
Carl Ameringer describes as revolutionary a 'shift from a professional to a market regime' in health care as a result of the application of federal antitrust laws to the behavior of physicians since the 1970s. This revolution and what he calls the 'counteroffensive' against it by organizations of physicians have had a profound influence on policy making that affects not only access to health care, but also the quality and cost of that care.
Ameringer writes the history of the revolution and evaluates its significance for policy. His research draws on skills and experience he acquired as a lawyer and former assistant attorney general of Maryland and as a political scientist. An example of the unusual perspective he brings to this book is his observation that 'in addition to being the only Western industrialized nation that lacks a government-run or government-financed health care system, the United States is also unique in its enduring adherence to an antitrust tradition.' This tradition, according to Ameringer, has been a 'significant factor in the decision of policy makers to pursue markets rather than budgets to contain costs and to allocate resources.'
At the end of the book Ameringer assesses the effects of the incomplete revolution and its implications for policy in the future. The history Ameringer presents has shifted considerable power from the suppliers of health services, and especially from physicians, to the demand side of the market for care, and particularly to government and employer purchasers and the health plans and insurers who are their agents. Purchasers, Ameringer concludes, 'are just beginning to mine the fruits of this alignment.' The partial triumph of the market over professional monopoly could, for example, induce purchasers to act collectively to remedy market failure."
For further information and to order, visit http://www.ucpress.edu/books/pages/10188.php.
Searching Eyes: Privacy, the State, and Disease Surveillance in America
by Amy L. Fairchild, Ronald Bayer, and James Colgrove
October 2007
368 pages
co-published with and distributed by the University of California Press
paper: $19.95 ISBN 978-0-520-25325-4
cloth: $50.00 ISBN 978-0-520-25202-8Description from the Press:
"This is the first history of public health surveillance in the United States to span more than a century of conflict and controversy. The practice of reporting the names of those with disease to health authorities inevitably poses questions about the interplay between the imperative to control threats to the public's health and legal and ethical concerns about privacy. Authors Amy L. Fairchild, Ronald Bayer, and James Colgrove situate the tension inherent in public health surveillance in a broad social and political context and show how the changing meaning and significance of privacy have marked the politics and practice of surveillance since the end of the nineteenth century."
From the Foreword by Daniel M. Fox, President, and Samuel L. Milbank, Chairman:
"Searching Eyes: Privacy, the State, and Disease Surveillance in America is the eighteenth of the California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press seeks to encourage the synthesis and communication of findings from research that could contribute to more effective health policy.
The authors of Searching Eyes offer a new approach to surveillance policy. They analyze surveillance as an issue in the politics of policymaking for public health, which it has been for more than a century.
Fairchild, Bayer, and Colgrove, with a significant contribution from Daniel Wolfe, describe the practical tension between privacy and the welfare of society since the nineteenth century. Their extensive research in primary sources reveals how difficult it has been to make and implement surveillance policy. The book begins in the late nineteenth century when, as a result of advances in scientific knowledge, 'public health officials moved,' the authors write, 'to pull chronic infectious disease into the ambit of public health surveillance.' Next the authors describe significant occasions during the twentieth century when 'many people with illness [for example, occupational, disease, cancer and birth defects] would demand the right to be counted so that the extent of their afflictions could serve as a prod for…ameliorative legislation.' This aspect of the history of surveillance, the authors find, 'democratized' privacy as 'different constituencies balanced privacy against what they perceived to be their own greater interests.'
The era of 'democratic privacy' is likely to continue indefinitely as new issues of surveillance policy arise. One such issue is the tension between policy to create immunization registries and the privacy of parents and children. Another is likely to be whether and how to use information about routine laboratory testing of the blood of persons with diabetes to improve the quality of care for individual patients."
For further information and to order, visit http://www.ucpress.edu/books/pages/10532.html.
Low Income, Social Growth, and Good Health: A History of Twelve Countries
by James C. Riley
October 2007
246 pages
co-published with and distributed by the University of California Press
cloth: $45.00 ISBN 978-0-520-25286-8Description from the Press:
"This book studies the experience of twelve countries that have broken through the limits that low incomes so often impose on human survival: China, Costa Rica, Cuba, Jamaica, Japan, Korea, Mexico, Oman, Panama, the former Soviet Union, Sri Lanka, and Venezuela. Most made impressive gains in life expectancy in the decades after 1920, and by 1960 nearly matched the rich countries in survival. James C. Riley finds that all of these countries enjoyed significant social growth, all invested in public health, and all gained the people's participation in the effort to improve their own lives and health. This innovative analysis suggests an alternative model of growth in which the measure of a nation's success is not its per capita income but the life expectancy of its population."
From the Foreword by Daniel M. Fox, President, and Samuel L. Milbank, Chairman:
"Low Income, Social Growth, and Good Health: A History of Twelve Countries is the seventeenth of the California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press seeks to encourage the synthesis and communication of findings from research that could contribute to more effective health policy.
James C. Riley's research makes him a critic of the high priority accorded to economic growth by most national and multilateral development agencies. In the twelve countries he studied in order to write this book, increased life expectancy and healthier populations were the basis rather than the result of economic growth. People had longer and healthier lives in these countries because of 'social growth' that enabled even poor communities to organize programs of schooling, public health, and health care.
Unlike most analysts and critics of policy for aid to low-income countries, Riley uses the methods of social history and historical epidemiology. He draws his generalizations from case studies of the attainment of increased life expectancy during the twentieth century in twelve countries in very different regions of the world.
Unlike wealthy countries, whose history in the nineteenth century has been the model for most development policy, each of the countries Riley studied 'managed to initiate and sustain social growth from a position of near poverty.' Wealthy countries, he writes, 'used rising levels of income in the hands of consumers and government to pay for social growth.' The countries Riley presents and assesses 'found ways to build their own forms of social capital,' especially primary schools, health care, and public health services, including educating their citizens about the 'health risks they faced and how to temper them.'
Riley's research also suggests that there is no template for policy that can be applied in every low-income country. In an earlier book, Rising Life Expectancy: A Global History, he assessed the influence of six variables on reduced mortality: public health; medicine; wealth, income and economic development; famine, malnutrition and diet; household and individual behavior; and literacy and education. The evidence in this book strengthens the finding of his earlier research that 'different countries and different populations have used different combinations' of programs to achieve lower mortality.
Riley's central message is that, rather than seek a 'leading or dominant explanation of social or economic growth' as the 'marker for countries that lag,' scholars and policymakers should be more attentive to programs that are 'most easily adopted in the circumstances that prevail' in each low-income country. He urges leaders of donor organizations to shift their emphasis from development policy that encourages substantial innovation in public policy and individual behavior to 'finding the adaptations that can most readily be made [in a country] given existing patterns of behavior, habits of mind, institutions, [and] resources.'"
For further information and to order, visit http://www.ucpress.edu/books/pages/10755.html.
The California/Milbank Books on Health and the Public series addresses the politics and policy of maintaining and improving the health of Americans. Other books in the series include James Colgrove's State of Immunity: The Politics of Vaccination in Twentieth-Century America (2006); David Rosner and Gerald Markowitz's Are We Ready? Public Health since 9/11 (2006); Christine K. Cassel’s Medicare Matters: What Geriatric Medicine Can Teach American Health Care (2005); Peter Baldwin's Disease and Democracy: The Industrialized World Faces AIDS (2005); Jeanne Daly's Evidence-Based Medicine and the Search for a Science of Clinical Care (2005); James A. Wooten’s The Employee Retirement Income Security Act of 1974: A Political History (2005); and Joanne Lynn’s Sick to Death and Not Going to Take It Anymore! Reforming Health Care for the Last Years of Life (2004).
To learn about all the books in this series and to order, visit http://www.ucpress.edu/books/CMHP.ser.php or call the University of California Press at 1-800-777-4726.
5. ELECTRONIC ACCESS TO THE MILBANK QUARTERLY
SEARCHABLE ELECTRONIC SUBSCRIBER ACCESS
Beginning with the 1997 volume (number 75), The Milbank Quarterly is available in fully searchable html format, as well as pdf, via Blackwell Synergy (http://www.blackwellpublishing.com/journal.asp?ref=0887-378X&site=1). Subscribing institutions and individuals can now search across all available full-text articles for words or phrases to find information; in addition, they can link directly from references, authors, and keywords to databases such as MEDLINE, ISI, and CrossRef and to cited articles in other journals. Those registered on Blackwell Synergy can also sign up for electronic tables of contents to the Quarterly and other related journals and access online sample issues for all Blackwell journals (http://www.blackwell-synergy.com/servlet/useragent?func=showHome). Access instructions are now being distributed. Subscribers to the Quarterly will receive an access token and instructions on how to register on Synergy and activate their online subscription from Blackwell Publishing; AcademyHealth members will receive information from the Academy about how to access the journal directly from the Academy website (http://www.academyhealth.org/publications/journals.htm). The journal is also available to libraries via http://www.ovid.com on Journals@Ovid, a fully searchable, cross-referenced database. (Call 1-800-950-2035 for full details, including rates.) Individual subscribers also have free access via The Milbank Quarterly page on the Blackwell website (http://www.blackwellpublishing.com/journal.asp?ref=0887-378X&site=1). All articles from The Milbank Quarterly published between 1923 and the most recent three-year period are now available for no charge through libraries and institutions that subscribe to JSTOR’s Arts & Sciences IV Collection (http://www.jstor.org). In case of difficulty, or if you have any questions about The Milbank Quarterly online, contact the Blackwell help desk (onlinehelp@oxon.blackwellpublishing.com).
An increasing number of recipients of Highlights are not affiliated with academic institutions, nor are they individual subscribers. If you would like to have access to the electronic version of the Quarterly, note that many university libraries are happy to offer privileges to persons in their communities, especially those in government positions.
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