About The Milbank Quarterly

Twelve states have not yet expanded Medicaid under the Affordable Care Act. In a new Perspective, Will Boles of Louisiana State University Health Sciences Center School of Medicine, along with Ruth Kennedy, Emma Siewert, Diane Rowland, Barbara Lyons, and Rebekah E. Gee, suggest that Louisiana can serve as a model for new Medicaid expansion states seeking to rapidly enroll people within a limited administrative budget. More

Low birth weight and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators. More

In the field of public health, the law and legal systems remain a poorly understood and substantially underutilized tool to address unfair or unjust societal conditions underpinning health inequities. The aim of our article is to demonstrate the value of expanding from a social model of health to a sociolegal model of health and empowering health actors to use the law more strategically in the pursuit of health equity. More

In 2018, the Declaration of Astana renewed goals set forth 40 years earlier by the World Health Organization and the United Nations’ Children Fund regarding the importance of primary health coverage in achieving universal health coverage. However, policymakers are often unclear how best to use primary care resources for maximum economic impact. In this overview of systemic reviews, Lorcan Clarke from the London School of Economics and Trinity College Dublin and colleagues finds that specific task shifting among different health care workers, telemedicine, longer primary care consultations, and pay for performance mechanisms are some of the strategies that can have positive economic effects. More

In this study, Kathryn E. Gunter of University of Chicago and colleagues explore the experiences of eight grantee organizations from the Bridging the Gap: Reducing Disparities in Diabetes Care initiative sponsored by the Merck Foundation, which aims improve diabetes outcomes by transforming primary care and addressing social needs within evolving payment methods. The authors find that current payment mechanisms for health care services do not adequately support critical up-front investments in infrastructure to address medical and social needs, nor provide sufficient incentives to make addressing social needs a priority More

In 2012, Colorado and Washington became the first states in the country to legalize marijuana and therefore “serve as quasi-natural experiments to examine how local jurisdictions have responded to state marijuana legalization.” In this study, Denise D. Payán, Paul Brown, and Anna V. Song of the University of California, Merced identified key county policymakers in those states and explored their arguments for or against marijuana facilities. The authors found that several counties in both Colorado and Washington have made substantial marijuana facility policy modifications since state legalization. More

Investments in early childhood education can have a long-lasting impact on health and well-being. This study by Jeff Niederdeppe of Cornell University and colleagues compared types of messages to garner public support, including simple advocacy messages, policy narratives (short stories with a setting, characters, and a plot that offers a policy solution to a social problem), and inoculation messages (messages designed to prepare audiences for building resistance to opposing messages). The authors found that narrative messages may be particularly effective in persuading individuals inclined to oppose such policies, while inoculation messages may protect favorable child care policy attitudes. More

Choosing Wisely aims to reduce the use of unnecessary, low-value medical services through development of service-utilization recommendations. In this review, Betsy Q. Cliff of the University of Illinois Chicago School of Public Health and colleagues synthesized the literature on interventions identified as low value by Choosing Wisely. The authors found that health system interventions based on Choosing Wisely guidelines can reduce the use of low-value services. They also found that multicomponent interventions targeting clinicians are currently the most effective types of interventions. More

Context: Rising prescription drug costs are consuming a growing proportion of state and private budgets. In response, lawmakers have experimented with… More

From Scurvy to Streptomycin to Social Policy Their cases were as similar as I could have them. —James Lind, 17531 With deep roots in clinical… More

The 2000 Surgeon General’s report identified the state of oral health in America as an issue of major concern, highlighting significant disparities… More

Context: The Affordable Care Act (ACA) individual health insurance marketplaces rely on purchasers to make informed choices to impose price and… More