Contrary to popular belief, communities with high levels of uninsured or immigrant residents generally have much lower rates of per person hospital emergency department (ED) use than other communities, according to a Center for Studying Health System Change study published July 18 on the Health Affairs Web site. In 2003, author Peter Cunningham reports, noncitizens had about 17 fewer ED visits per 100 people than citizens, while uninsured people had 16 fewer visits than Medicaid patients, about 20 fewer visits than Medicare beneficiaries, and roughly the same number of visits as privately insured people. Cunningham suggests that high ED use in part reflects provider practice patterns and patient preferences independent of income and insurance status.

Combining high-deductible health plans with tax-favored Health Savings Accounts is often touted as a way of giving consumers more of a financial stake in their health care decisions. But a new study in the July/August Health Affairs finds that such "consumer-driven" coverage arrangements would actually result in reduced or unchanged cost-sharing, both on average and at the margin, for consumers responsible for over half of the health care expenditures. HSA/high-deductible plans leave untouched the high spenders who are responsible for the bulk of health care expenditures, say coauthors Dahlia Remler and Sherry Glied, who add that today's comprehensive plans already require significant cost-sharing.

A two-decade trend of increasing numbers of public health workers could reverse if the federal government decreases support for anti-bioterrorism activities, Christine Gebbie and Bernard Turnock warn in the July/August Health Affairs. Concerns over terrorism, emergency preparedness, and such threats as pandemic influenza have helped expand and strengthen the public health workforce in recent years, according to Gebbie and Turnock. But now policymakers are grappling with decreasing numbers of workers at the state and local levels; impending shortages of experienced workers to replace retiring ones; insufficient education and training; and inadequate incentives to recognize and reward skills and performance.