Most Americans favor the use of quarantine as a weapon against contagious diseases like SARS and avian flu. However, Americans are far less comfortable with strict enforcement and monitoring measures than are residents of Hong Kong, Singapore, and Taiwan. This message is contained in a new study, "Attitudes toward the Use of Quarantine in a Public Health Emergency in Four Countries," published Jan. 24 as a Health Affairs Web Exclusive. While 76 percent of Americans surveyed said that they favor quarantining those potentially exposed to serious contagious diseases, only 42 percent supported a compulsory quarantine under which those who refused to comply could be arrested.

In the January/February Health Affairs, Chip Kahn says that Medicare hospital performance data -- reported by hospitals on pain of losing a portion of their annual inpatient payment update -- show that urban hospitals are better at treating heart attack and heart failure but rural hospitals do better at treating pneumonia. Medicare's hospital "pay for reporting" is widely viewed as a way station to "pay for performance," but Kahn calls for more research comparing the quality effects of reporting requirements and P4P, and he warns that a poorly done P4P program risks promoting improvement efforts that focus narrowly on the areas being measured at the expense of overall quality. Print editions of the January/February issue on "U.S. Hospitals: Mission Vs. Market" may be ordered for $35 each from Health Affairs' Customer Service at 301-347-3900 or online at http://www.healthaffairs.org/1330_issue.php.

In the Narrative Matters section of the January/February Health Affairs, internist Audrey Young discusses the myriad complications she faces in getting her patients to exercise. Poverty is a major barrier that prevents many of the people she sees from exercising, since outside areas in their neighborhoods are dangerous. Yet her Chinese grandmother living in Indonesia won't exercise because, in her culture, only the poor perform physical activity. Young notes that, unlike pills, exercise often doesn't work quickly and doesn't come in easy-to-understand separate doses. To recommend and monitor exercise regimes, she says, physicians need to take the time to assess patients and their neighborhoods, and society needs to reimburse physicians for this time.