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February 12, 2006
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New postings and analysis from Health Affairs, the leading journal of health policy. Health Affairs publishes new research each week online at For more information, contact Chris Fleming at 301-347-3944.

Spending Increases Not Responsible for Improved Heart Attack Outcomes

In an article published Feb. 7 on the Health Affairs Web site, Dartmouth researchers Jonathan Skinner, Douglas Staiger, and Elliott Fisher challenge the conventional wisdom that growing health care costs are paying for new treatments and reduced mortality. The Dartmouth trio found that the factors fueling improvement in outcomes for heart attack patients from 1986 through 2002 were not the factors that fueled increases in costs, and much of the improvement occurred in U.S. regions exhibiting below-average growth in spending.

You can also read perspectives on the Dartmouth study by David Cutler and Alan Garber.

For Surgeries, Physician-Owned Cardiac Hospitals Affect Where, Not Who

Physician-owned cardiac specialty hospitals take market share from community hospitals, but they donít appreciably increase the overall number of, or severity mix among, people receiving cardiac surgery, say Jeffrey Stensland and Ariel Winter in the January/February Health Affairs. This could be because surgery is less discretionary than services such as imaging studies and laboratory tests, where physician ownership does increase usage. Or, the researchers warn, it could be because the arms race between cardiac and community hospitals has only just begun.

Changing Physician Payment Incentives Entails Complex Trade-Offs

In a report from the field in the January/February Health Affairs, Nora Super reminds us how pervasively financial incentives can affect physician behavior and how hard it is to say what the "right" incentives are. As Cincinnati Group Health Associates has moved from capitation to fee-for-service payment, GHA physicians have grown more willing to schedule unnecessary office visits and order unnecessary tests. On the other hand, the group now favors sicker patients over soccer moms. GHA physicians say they now have more incentive to get preventive care to those with chronic diseases, although that may be because capitation never put GHA at risk for hospital costs.

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


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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