Highlights
News about Publications from the
Milbank Memorial Fund
October 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
Evidence-Based Maternity Care: What It Is and What It Can Achieve
by Carol Sakala and Maureen P. Corry
Co-published with Childbirth Connection and the Reforming States Group- Recent Milbank Memorial Fund Reports
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 BoardsImproving Population Health: The Uses of Systematic Reviews
by Melissa Sweet and Ray Moynihan
Produced in Collaboration with the Centers for Disease Control and Prevention- New Book
Public Health Law: Power, Duty, Restraint
Revised and Expanded Second Edition
by Lawrence O. Gostin
October 2008- 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 2007- Electronic Access to The Milbank Quarterly
1. WELCOME
Welcome to the October 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 3 (September 2008)
TABLE OF CONTENTS AND ABSTRACTS
"Hospital-Physician Collaboration: Landscape of Economic Integration and Impact on Clinical Integration"
by Lawton Robert Burns and Ralph W. Muller
ABSTRACT
FULL TEXT"Getting Real Performance Out of Pay-for-Performance"
by Sean Nicholson, Mark V. Pauly, Anita Ya Jung Wu, James F. Murray, Steven M. Teutsch, and Marc L. Berger
ABSTRACT"Local Access to Care Programs (LACPs): New Developments in the Access to Care for the Uninsured"
by Lynn A. Blewett, Jeanette Ziegenfuss, and Michael E. Davern
ABSTRACT"Message Design Strategies to Raise Public Awareness of Social Determinants of Health and Population Health Disparities"
by Jeff Niederdeppe, Q. Lisa Bu, Porismita Borah, David A. Kindig, and Stephanie A. Robert
ABSTRACT
IN THIS ISSUE
Relationships between physicians and hospitals are at the heart of many challenges facing health care managers, payers, and policymakers. As medical care is paid for in the United States, hospital executives and physicians live in somewhat different worlds, drawing (with some exceptions) on deliberately separated income streams, as Jeff Goldsmith has put it (personal communication). Nonetheless, many of the current ideas for improving health services, like bundled payments for physicians and hospitals, pay-for-performance, and clinical integration, require cooperation between physicians and hospital administrators. Such cooperation, however, does not come easily or naturally. It is the topic of the first article in this issue of The Milbank Quarterly.
In “Hospital-Physician Collaboration: Landscape of Economic Integration and Impact on Clinical Integration,” Lawton Burns and Ralph Muller survey a large and rapidly evolving array of activities that are changing relationships between hospitals and physicians, including recruitment, risk sharing, and employment. They also analyze the goals that hospitals and physicians bring to their relationship, concluding that any overlap is, at best, partial and does not relate to broader societal goals of reduced cost or improved quality.
Burns and Muller also provide a concise review of the research literature on the impact of the various models of integration on cost efficiency, clinical integration, and quality outcomes. Because so many different models and possible effects are involved, the results defy brief summarization here, but Burns and Muller’s overall conclusion is that the effects generally appear to be weak and inconsistent. After discussing the possible reasons for this, they conclude by analyzing several factors that facilitate or hinder the economic and clinical integration of hospitals and physicians.
The next article in this issue, “Getting Real Performance Out of Pay-for-Performance,” by Sean Nicholson, Mark Pauly, Anita Ya Jung Wu, James Murray, Steven Teutsch, and Marc Berger, is a theoretical analysis of a payment strategy that has gained popularity in recent years. They argue that pay-for-performance based on process-of-care measures can affect outcomes (the ultimate goal) only insofar as the rewarded processes reliably lead to better outcomes and that the processes now being rewarded are only weakly linked to better outcomes. This limits the value of pay-for-performance as a health improvement strategy.
Basing pay-for-performance programs on outcomes would seem to avoid this limitation, so Nicholson and his colleagues analyze the conditions under which basing rewards on outcomes-based measures would be a sound strategy. They conclude that such an approach would work best when purchasers know less than providers do about which processes produce health improvements and when purchasers are able to risk-adjust measures of patients’ health status. Conversely, they argue, outcomes-based pay-for-performance approaches would be unnecessary if definitive information were available about what they call the health production function or if provider-specific, severity-adjusted outcome data were available and actually used by patients to select service providers. Under the former condition, well-designed fee-for-service payments would work, and under the latter conditions, patients’ choice of providers would serve the same purpose as pay-for-performance does.
The next article in this issue is concerned with the health care of uninsured people who do not have access to employer-sponsored insurance and who are not eligible for public programs such as Medicaid. In “Local Access to Care Programs (LACPs): New Developments in the Access to Care for the Uninsured,” Lynn Blewett, Jeanette Ziegenfuss, and Michael Davern examine programs that have been developed—largely independently by cities and counties across the country—to facilitate access to medical care for uninsured people. These programs do not involve insurance and so are not subject to the service entitlements and regulatory oversight that accompanies insurance. But they provide more structure than is offered by establishing facilities at which uninsured people can seek care.
These local access to care programs (LACPs), as the authors term them, include an enrollment mechanism, nominal enrollment fees (though not actuarially based, as insurance charges are), and networks of providers that commit to offering a specified amount of services, either at no charge or for highly discounted fees. Using a variety of methods, Blewett, Ziegenfuss, and Davern identified forty-seven LACPs in twenty-seven states, serving an estimated 640,000 enrollees. They describe four different types of arrangements for financing and organization, arguing that greater awareness of these programs among researchers is the first step to understanding their operation and impact. The stability of these programs and the difference they make for their enrollees and for local service providers are not yet understood.
Epidemiologists have taught us that many of the most important determinants of population health—matters pertaining to poverty, education, working conditions, and neighborhoods—lie beyond the reach of the health care system. However, the public and the media tend to think of personal health behavior and access to medical care as the primary factors affecting health. The next article in this issue is concerned with what can be done to change this view. In “Message Design Strategies to Raise Public Awareness of Social Determinants of Health and Population Health Disparities,” Jeff Niederdeppe, Q. Lisa Bu, Porismita Borah, David Kindig, and Stephanie Robert link the field of communications science with the topic of population health.
The authors summarize the available evidence regarding three communication strategies—message framing, narratives, and visual imagery—and consider how they could be used to increase public awareness of the social determinants of health and social disparities in health status. The authors identify those factors that must be overcome in order to stimulate action by raising public awareness. Unfortunately, the most easily reached audience (the best educated) is not the population that could be most readily mobilized by appeals to self-interest.
Niederdeppe and his colleagues also discuss pitfalls that may arise when various message strategies are used, including the danger that the strategy itself may distract audiences from the central message or stimulate counterproductive emotional reactions such as anger and guilt. After acknowledging the limits of the evidence they have summarized regarding how to communicate messages pertaining to population health, the authors conclude by identifying promising areas for future research.
--Bradford H. Gray
Editor, The Milbank Quarterly
3. NEW MILBANK MEMORIAL FUND REPORTEvidence-Based Maternity Care: What It Is and What It Can Achieve
Co-published with Childbirth Connection and the Reforming States Group
October 2008Published by Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund and written by Carol Sakala and Maureen P. Corry of Childbirth Connection, Evidence-Based Maternity Care: What It Is and What It Can Achieve discusses current maternity care in the U.S. health care system and identifies key indicators that show the need for improvement. The report further summarizes results of the many systematic reviews that could be used to improve maternity care quality, identifies barriers to the use of evidence-based maternity care, and offers policy recommendations and other strategies that could lead to wider implementation of evidenced-based maternity care in the United States and facilitate optimal outcomes in mothers and newborns.
4. RECENT MILBANK MEMORIAL FUND REPORTSMedical 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.
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
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.
5. NEW BOOKPublic Health Law: Power, Duty, Restraint
Revised and Expanded Second Edition
by Lawrence O. Gostin
October 2008
800 pages
co-published with and distributed by the University of California Press
paper: $45.00 ISBN 978-0-520-25376-6Description from the Press:
"Public Health Law, first published in 2000, has been widely acclaimed as the definitive statement on public health law at the start of the twenty-first century. Lawrence O. Gostin's definition was based on the notion that government bears a responsibility for advancing the health and well-being of the general population, and the book developed a rich understanding of the government's powers and duties while showing law to be an effective tool in the realization of a healthier and safer population. In this second edition, Gostin analyzes the major health threats of our times, from emerging infectious diseases and bioterrorism to chronic diseases caused by obesity."
From the Foreword by Carmen Hooker Odom, President, Daniel M. Fox, President Emeritus, and Samuel L. Milbank, Chairman:
"Public Health Law: Power, Duty, Restraint was the third of what are now nineteen 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, which could contribute to more effective health policy.
Larry Gostin offers fresh information and analysis in every chapter of this second edition. Perhaps most important, he describes increased attention to the strengths and weaknesses of public health law as a result of events since its initial publication.
The first edition appeared a year before the first of a series of challenges to public health, each of which has stimulated changes in law and regulation as well as the allocation of new resources by government at every level. These challenges include the events of September 11, the twenty-two cases of anthrax in the next several months, the SARS epidemic, the increased risk of a pandemic of avian flu, hurricanes Katrina and Rita, and, as this edition went to press, news that public health regulations could not prevent a willful Atlanta lawyer from placing at risk of tuberculosis people on several airplanes and two continents.
During the past seven years, moreover, the field of public health law has expanded in size and scope. For the first time in over a century, public health law is increasingly recognized as one of the professions of public health, as essential as medicine, the laboratory sciences, and epidemiology. This book has contributed to the growth of the field as a text in many schools of law and public health and as the source of numerous citations in articles and books.
Gostin has been a leader in studying, interpreting, and teaching public health law—as well as in drafting it—for three decades. In writing and then revising this book, he says, ‘I aspire to create a record of the field of public health law at the turn of the millennium.’ He has achieved that aspiration.”
For further information and to order, visit http://www.ucpress.edu/books/pages/11023.php.
6. RECENT BOOKS
The 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.
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 C. Riley’s Low Income, Social Growth, and Good Health: A History of Twelve Countries (2007); 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); and James A. Wooten’s The Employee Retirement Income Security Act of 1974: A Political History (2005).
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.
7. 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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