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IN THE JOURNAL

NEW ISSUE:
RURAL HEALTH

Much attention is focused these days on the relatively poor health outcomes and heightened rate of socioeconomic disadvantage of rural America. The December issue of Health Affairs explores many dimensions of health and health care for the one out of five Americans who live in what the US Census Bureau defines as a rural area.

The December issue of Health Affairs was supported by the Robert Wood Johnson Foundation, The Colorado Health Foundation, the Episcopal Health Foundation, the Kate B. Reynolds Charitable Trust, Con Alma Health Foundation, Empire Health Foundation, The John A. Hartford Foundation, the California Health Care Foundation, and St. David’s Foundation.

Read the December 2019 table of contents and listen to a two-minute introduction of the issue from Editor-in-Chief Alan Weil.

Structural Urbanism Contributes To Poorer Health Outcomes For Rural America

By Janice Probst, Jan Marie Eberth, and Elizabeth Crouch

In this overview paper, Janice Probst and colleagues point out that rural mortality rates only started falling behind urban rates in the mid-1980s. The authors introduce the concept of "structural urbanism"—a bias in financing health care services tied to individuals that favors densely populated areas and fails to account for the fixed costs associated with delivering services to those living more remotely. Read More >>

What Is Rural? Challenges And Implications Of Definitions That Inadequately Encompass Rural People And Places
By Kevin J. Bennett, Tyrone F. Borders, George M. Holmes, Katy Backes Kozhimannil, and Erika Ziller

Kevin Bennett and coauthors review how various government agencies define rural and point out the consequences of using definitions that may be inappropriate for a particular purpose. Read More >>

Recovery Residences Combat Addiction In Rural Communities
By Brian Rinker

Many communities far from treatment centers and large health systems are expanding access to local sober-living homes. Read More >>

AHEAD OF PRINT

National Health Care Spending In 2018: Growth Driven By Accelerations In Medicare And Private Insurance Spending
By Micah Hartman, Anne B. Martin, Joseph Benson, Aaron Catlin, and
The National Health Expenditure Accounts Team

This new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services estimates that in 2018 health care spending in the United States grew at a rate of 4.6 percent to $3.6 trillion, or $11,172 per person. The 4.6 percent growth rate in 2018 was faster than that of 4.2 percent in 2017 but was equal to the rate in 2016. The 0.4-percentage-point acceleration in overall growth in 2018 was driven by faster growth in private health insurance spending and Medicare. For the second year in a row, the number of uninsured people increased by 1.0 million, reaching 30.7 million in 2018. Read More >>

THIS WEEK ON THE BLOG

FOLLOWING THE ACA

ACA Round-Up: Enrollment Lags, IRS Reporting Requirements, And QHP Compliance Report
By Katie Keith (12/5/19)

With less than two weeks left until the December 15 deadline, enrollment through HealthCare.gov is lagging by about 10 percent relative to last year. This update also covers the release of new issuer-level enrollment data for prior years, nonenforcement of penalties connected with certain IRS reporting requirements, and a report on improved insurer compliance with 2019 notices. Read More >>

CONSIDERING HEALTH SPENDING

There’s Nothing Wrong With US Health Care That Less Money Couldn’t Fix
By Bruce Pyenson, and Marjorie Schulman (12/6/19)

Changes along these lines, which involve more than simple defunding approaches, would help to stabilize current health care spending while giving politicians time to work out more emotionally and politically charged issues. Read More >>

MEDICARE

Moving To A Market-Driven Medicare Program
By Brian J. Miller and Gail R. Wilensky (12/5/19)

With more than half a century of price setting in Medicare fee-for-service, we have failed to control health care expenditure growth. Now is the time to try something different.
Read More >>

PATIENTS AND CONSUMERS

The Lurking Danger In The “Business Case” For Patient Safety
By Michael L. Millenson (12/2/19)

Hospital boards and leaders have a duty to their community to make replicating the “zero preventable harm” exemplars’ achievements a measurable, accountable, and urgent goal. Read More >>

ACCESS TO CARE

Beyond The Firewall: Pathways To Affordable Health Coverage For Low-Income Workers
By Tara Straw (12/3/19)

Compared to middle- and upper-income employees, low-income workers are often offered less robust coverage, get less employer help with their premiums, and must pay a greater share of their income toward health care costs. Read More >>

VIOLENCE AND HEALTH

The Critical Role Of Philanthropy In Researching Solutions To Gun Violence
By Nina E. Vinik (12/5/19)

The Joyce Foundation looks back at 25 years of funding gun violence research. Grantees have included universities, hospitals, and think tanks. Early research supported by Joyce helped define gun violence as a public health discipline. And, because lack of data was a barrier to understanding gun violence, this foundation and others funded development of a comprehensive data set on all violent deaths in the US. There is more we need to learn, though, says this author. Read More >>

PRIMARY CARE

Leveraging Virtual Networks To Improve Dermatologic Access And Care
By Karen E. Edison (12/4/19)

Initiatives such as Project ECHO help us maximize the physician expertise we do have—making expert care available to more patients, and improving cost-effectiveness in the health care system—and they make a difference.
Read More >>

ELSEWHERE@HEALTH AFFAIRS

Fitzhugh Mullan: A Health Affairs Reading List
(12/4/19)

The Health Affairs community was deeply saddened to learn that Fitzhugh Mullan— pediatrician, activist, researcher, educator, editor—passed away on November 29, 2019, at the age of 77. He will be so dearly missed. Over more than 30 years, Mullan authored dozens of articles that were published by Health Affairs, including research, commentaries, and interviews. Read More >>

MEDICAID

Inside Tennessee’s Final 1115 Medicaid Block Grant Proposal
By Sara Rosenbaum, Alexander Somodevilla, Morgan Handley, and Rebecca Morris (12/6/19)

The state’s proposal, if approved, would become “Amendment 42” to TennCare since its establishment nearly 30 years ago, although the term “amendment” would hardly seem to describe such a total and sweeping departure from the normal Medicaid coverage and payment principles that govern all state Medicaid programs, including TennCare.
Read More >>

HEALTH AFFAIRS EVENTS–2019 Commonwealth Fund International Health Policy Survey

This Week! December 11 at 9:00 am – 12:00 pm Eastern
Conrad Hotel – 950 New York Ave NW, Washington DC
Register To Attend

Join us for a special event to be convened by Health Affairs and The Commonwealth Fund marking the publication of the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians in 11 Countries. Senior government officials, delivery system experts, and leading policy thinkers from around the world will gather for a high level discussion of strategies to promote high-quality primary care, with special attention to the integration of health and social care.

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About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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