Highlights
News about Publications from the
Milbank Memorial Fund
June 2008
- Welcome
- New from The Milbank Quarterly
Table of Contents and Abstracts
"In This Issue"
by Bradford H. Gray, Editor- New Milbank Memorial Fund Report
Medical Regulatory Authorities and the Quality of Medical Services in Canada and the United States
Co-published with the Federation of Medical Regulatory Authorities of Canada and the Federation of State Medical Boards- 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- Recent Books
The Health Care Revolution: From Medical Monopoly to Market Competition
by Carl F. Ameringer
April 2008Searching Eyes: Privacy, the State, and Disease Surveillance in America
by Amy L. Fairchild, Ronald Bayer, and James Colgrove
November 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 June 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 2 (June 2008)
TABLE OF CONTENTS AND ABSTRACTS
"'Developing Good Taste in Evidence':
Facilitators of and Hindrances to Evidence-Informed Health Policymaking in State Government"
by Christopher J. Jewell and Lisa A. Bero
ABSTRACT
FULL TEXT"State Responses to New Flexibility in Medicaid"
by Teresa A. Coughlin and Stephen Zuckerman
ABSTRACT"A Plan for Action: Key Perspectives from the Racial/Ethnic Disparities Strategy Forum"
by Roderick K. King, Alexander R. Green, Aswita Tan-McGrory, Elizabeth J. Donahue, Jessie Kimbrough-Sugick, and Joseph R. Betancourt
ABSTRACT"Population Causes and Consequences of Leading Chronic Diseases: A Comparative Analysis of Prevailing Explanations"
by David Stuckler
ABSTRACT"Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations"
by David Mechanic
ABSTRACT
IN THIS ISSUE
“Evidence based” has become a prominent goal in recent years in many aspects of health care, such as clinical decision making, health care management, health benefit design, and in both health policy and population health, the Quarterly’s central concerns. (A Google search for “evidence based” and “health” yields more than nine million hits!) Many aspects of the challenge of incorporating scientific evidence into the policymaking process have been explored in these pages in recent years (see Jacobson, Butterill, and Goering 2005; Lavis et al. 2002, 2003; Lomas et al. 2003; Mitton et al. 2007; Tetroe et al. 2008). But only limited attention has been given to the perspective of policymakers themselves. That is the topic of the first article in this issue of The Milbank Quarterly.
In “‘Developing Good Taste in Evidence’: Facilitators of and Hindrances to Evidence-Informed Health Policymaking in State Government,” Christopher Jewell and Lisa Bero share lessons learned from interviews with twenty-eight state-level policymakers who were sufficiently interested in the use of research-based evidence to attend the five-day Rocky Mountain Evidence-Based Workshop between 2000 and 2005. Considering several types of policy decisions faced by state legislators or bureaucrats, Jewell and Bero identify factors that hinder the use of research evidence in policymaking. These include common institutional arrangements and competing sources of information, as well as the quantity, quality, accessibility, and usability of research evidence. Jewell and Bero also identify several facilitators of evidence-informed health policymaking, including linking results to costs and benefits, reframing policy issues to resonate with research evidence, educating policymakers about the nature of evidence, creating “research-focused venues” connected with policymaking, and developing collaborations involving researchers and policymakers.
The next article in this issue, “State Responses to New Flexibility in Medicaid” by Teresa Coughlin and Stephen Zuckerman, focuses on a largely overlooked form of policymaking: the Medicaid waiver. The Medicaid program is administered and partially funded at the state level, but many requirements regarding who and what services must be covered are attached to the federal government’s significant share of the program’s costs. The federal government also must bear the same share of the costs of certain optional services and beneficiary categories that the states can choose to cover. This structure has provided enough flexibility to turn Medicaid into fifty-six different programs (not only all states but also the District of Columbia and several territories). Even so, states have found that federal requirements limit their ability to make certain desired changes in order to expand programs or contain costs. Waivers of federal Medicaid requirements have become an instrument by which the federal government gives states additional flexibility to modify their Medicaid programs.
Coughlin and Zuckerman describe the ways that Medicaid waivers have been used in recent years: to provide more benefit flexibility, to allow the imposition of more cost sharing by beneficiaries, to expand coverage, to put caps on enrollment, to incorporate more market principles into Medicaid, and to promote public-private partnerships. The idea of states as laboratories of reform (or laboratories of democracy, as Justice Louis Brandeis famously put it) is commonly invoked in policy discussions about the United States’ federal structure. The number of current policy experiments in the Medicaid program presents both an opportunity and a challenge for the policy research community.
Racial/ethnic disparities in health status and differences in services received have been well documented in the United States and elsewhere (Exworthy et al. 2006; Institute of Medicine 2002). But what can providers of health care do to reduce patterns of disparities in care? That is the topic of the next article in this issue, “A Plan for Action: Key Perspectives from the Racial/Ethnic Disparities Strategy Forum,” by Roderick King, Alexander Green, Aswita Tan-McGrory, Elizabeth Donahue, Jessie Kimbrough-Sugick, and Joseph Betancourt.
King and his colleagues report on the efforts of a working group assembled to bring several streams of research to bear on the problem of reducing disparities in care. Their effort to map out a plan of action to reduce disparities quickly confronted limitations in our knowledge. Although many kinds of disparities in care have been documented by researchers, the causes are not well understood. One of the reasons for this is that few health care organizations develop the information needed to show whether there are racial/ethnic differences in the services received by their patients. Many do not routinely collect information about patients’ race and ethnicity, and even fewer analyze utilization data to locate differences in treatment that could be subject to a further search for root causes. King and associates urge the routine collection and analysis of such data by health care organizations, and they suggest that established quality improvement techniques be applied when disparities in care are identified.
The next article in this issue is also concerned with disparities, but at a global level. In “Population Causes and Consequences of Leading Chronic Diseases: A Comparative Analysis of Prevailing Explanations,” David Stuckler analyzes trends in patterns of mortality in poor and rich countries. His specific concern is the rapid growth in poor countries of chronic conditions such as cardiovascular disease, cancers, respiratory disease, and diabetes.
Stuckler presents evidence that factors associated with globalization—direct foreign investment, urbanization, market integration, and improving economic status—are more important than the aging of populations as determinants of the rising mortality rate of chronic disease in poor countries. The more proximate causes are familiar ones: tobacco use, alcohol consumption, unhealthy diets, and lack of physical activity. His findings regarding disease trends add to a growing body of knowledge suggesting that chronic disease deserves much greater attention than it has received to date from the agencies and organizations concerned with population health in poor countries.
The final article in this issue analyzes a problem that has been addressed many times in these pages over the past twenty years: the state of professionalism in medicine (Light and Levine 1988; Mechanic 1996; Stevens 2001; Wolinsky 1988). In “Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations,” David Mechanic lays out what he sees as the essential elements of medical professionalism, including competence, respect for patients, and not allowing self-interest to influence treatment decisions. After touching on the now-familiar threats to the traditional expectations of physicians as professionals, he argues that three elements can lend new strength and plausibility to claims of following professional ideals.
Mechanic suggests that the rise of the information technologies associated with evidence-based medicine can address certain challenges to professionalism, including the proliferation of evidence and competing demands on physicians’ time. Changes in payment methods could alter incentives that push in directions inconsistent with professional ideals. Developments in disease management also hold promise of improving the situation. Mechanic does not claim that the developments on which he focuses are the entire solution (problems resulting from physicians’ involving themselves in unnecessary economic conflicts of interest remain), but he does believe that the situation regarding medical professionalism is more hopeful than is sometimes depicted.
--Bradford H. Gray
Editor, The Milbank Quarterly
Exworthy, M., A. Bindman, H. Davies, and A.E. Washington. 2006. Evidence into Policy and Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle Disparities and Inequalities in U.S. and U.K. Health and Health Care. The Milbank Quarterly 84(1):75–109.
Institute of Medicine. 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academies Press.
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.
Light, D., and S. Levine. 1988. The Changing Character of the Medical Profession: A Theoretical Overview. The Milbank Quarterly 66(suppl. 2):10–32.
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.
Mechanic, D. 1996. Changing Medical Organization and the Erosion of Trust. The Milbank Quarterly 74(2):171–89.
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.
Stevens, R. 2001. Public Roles for the Medical Profession in the United States: Beyond Theories of Decline and Fall. The Milbank Quarterly 79(3):327–53.
Tetroe, J., I.D. Graham, R. Foy, N. Robinson, M.P. Eccles, M. Wensing, P. Durieux, et al. 2008. Health Research Funding Agencies’ Support and Promotion of Knowledge Translation: An International Study. The Milbank Quarterly 86(1):125–55.
Wolinsky, F.D. 1988. The Professional Dominance Perspective, Revisited. The Milbank Quarterly 66(suppl. 2):33–47.
3. NEW MILBANK MEMORIAL FUND REPORTMedical Regulatory Authorities and the Quality of Medical Services in Canada and the United States
Co-published with the Federation of Medical Regulatory Authorities of Canada and the Federation of State Medical Boards
June 2008Published by the Federation of State Medical Boards (FSMB) in the United States, the Federation of Medical Regulatory Authorities of Canada (FMRAC), and the Milbank Memorial Fund, Medical Regulatory Authorities and the Quality of Medical Services in Canada and the United States explores innovative ways for medical regulatory bodies to increase their capacity to protect the public and improve health care quality and safety. Its collective authors report the results of a survey of quality improvement practices and interests of regulatory bodies in both countries. They also propose a “value proposition” for physician-led medical regulation, describe the implications for policy, and close with questions for their colleagues in medical regulation to ponder and discuss with their professional colleagues and policymakers in their jurisdictions. Print copies are freely available upon request.
4. 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 freely available upon request.
5. RECENT BOOKSThe Health Care Revolution: From Medical Monopoly to Market Competition
by Carl F. Ameringer
April 2008
272 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
November 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
248 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.
6. 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.
If you would like to be added to this mailing list, simply send an email to smq@waynetcom.com with "subscribe Milbank Highlights" in the subject field. If you would like to remove yourself from the list, please send an email to smq@waynetcom.com with "unsubscribe Milbank Highlights" in the subject field.
     
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