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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.

July-August Health Affairs Focuses On "The State of Public Health"

Public health resources are insufficient to keep pace with the changing demands of the public health system, especially given new concerns about bioterrorism, pandemic disease, and hurricane response, according to a study in the July/August 2006 issue of Health Affairs by Leslie Beitsch and colleagues. Their study is only one of the many articles on public health in the new Health Affairs issue, which is titled "The State Of Public Health" and funded by the Robert Wood Johnson Foundation.

Beitsch and his coauthors point out that public health spending accounts for less than 2.5 percent of total health care spending. Mean per capita spending for public health in 2004-2005 was $149, the study says, compared with $6,423 for overall health care spending and $254 for protective services from police.

Print editions of Health Affairs may be ordered for $35 each from Health Affairs' Customer Service at 301-347-3900 or online at

Cost Savings From Electronic Health Records? It Ain't Necessarily So.

Some observers have claimed that electronic health records (EHRs) could bring substantial cost decreases and quality improvements. But in the July/August Health Affairs, Jaan Sidorov writes: "A considerable body of research suggests that widespread adoption of the EHR increases health costs." Sidorov points out that EHRs often lead to higher billings and declines in providers' productivity with no change in provider-to-patient ratios. He suggests that "the EHR's greatest value arguably lies in support of" potentially transformative initiatives, such as disease management and patient-centeredness, "versus the prospect of less efficiency, greater cost, inconsistent quality, and unchanged malpractice burdens resulting from a simple engraftment [of EHR] onto the current health care system."

Personal Assistance Workforce Might Not Meet Expected Demand

A large and steady fifteen-year gain in the number of personal assistance workers, who provide critical services that let millions of disabled and elderly Americans remain at home and out of institutions, could be coming to an end, Stephen Kaye and coauthors write in the July/August Health Affairs. The ranks of these workers could begin to decline due to cuts in Medicaid, persistently low wages, scarce health benefits, and high job turnover. If conditions do not improve, the researchers warn, attracting and retaining skilled workers who provide personal assistance could become increasingly difficult, even though the number of people needing these services will more than double by 2050.


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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