State and local budget pressures and a surge in efforts to contain Medicaid spending have led to a "noticeable erosion" in community-based services for low-income people with serious mental illnesses, particularly those who lack health insurance, researchers from the Centers for Studying Health System Change report in the in the May/June Health Affairs. http://content.healthaffairs.org/cgi/content/abstract/25/3/694 The new issue of the journal, released May 9, is a thematic volume focusing on mental health.

Heart patients who pick a top-performing hospital or surgeon are half as likely to die as those who pick a poor-scoring provider, Ashish Jha and Arnold Epstein write in the May/June Health Affairs assessing the merits of New York's 15-year-old public report card system for deaths from coronary artery bypass graft (CABG) surgery. Despite this disparity, patients and their cardiologists are not giving top performers more business. However, one in five surgeons who were graded poorly relocated or discontinued practice within two years.

Despite claims by the American Medical Association and others that rising malpractice premiums are driving physicians out of business, self-employed physicians paid lower premiums in 2000 than they did in 1986, according to data from surveys conducted by the AMA itself from 1970 to 2000. In constant 2000 dollars, mean malpractice premiums rose from $5,934 in 1970 to $20,106 in 1986, then declined to $15,478 in 1996, Mark Rodwin and coauthors state in a May/June Health Affairs article that analyzes the AMA data. Premiums rose from 1996 until the AMA discontinued the surveys after 2000; however, in 2000 mean premiums were $18,400, still below the 1986 level and representing only 7 percent of total practice expenses.