The proliferation of heart institutes, cancer centers, orthopedic hospitals, and other niche specialty centers signals an escalation in a new medical arms race as hospitals and physicians develop and market profitable specialty-service lines, according to a study by Center for Studying Health System Change (HSC) researchers published July 25 on the Health Affairs Web site. Hospitals and physicians often collaborate on specialty-service lines, but increasingly they are competing ferociously for patients as physicians add diagnostic and treatment capabilities to their practices that once were exclusively provided in hospitals, the study found.

In the July/August Health Affairs, Paul Simon and Jonathan Fielding advocate partnerships between business and public health agencies on issues such as tobacco control, workplace injuries, and infectious disease surveillance. Business has a larger stake than ever in supporting public health efforts, Simon and Fielding point out: Companies paid a quarter of the $1.7 trillion spent on health care in 2003, and they lose billions every year to diminished productivity stemming from chronic disease. On the flip side, the public health agenda is immeasurably strengthened if a supportive business community provides what Georges Benjamin refers to in his Perspective, http://content.healthaffairs.org/cgi/content/abstract/25/4/1040, as an "unanticipated messenger."

More than half of elderly Americans reported in 2003 that they had never been screened for colorectal cancer, despite the fact that in 2001, Medicare extended coverage for screening colonoscopies from high-risk to average-risk beneficiaries, Ya-Chen Tina Shih, Lirong Zhao, and Linda Elting report in the July/August Health Affairs. In addition, while a statistically significant gap in screening rates between non-Hispanic whites and non-Hispanic blacks disappeared between 2000 and 2003, the screening gap between non-Hispanic whites and Hispanics actually widened over the same period. The researchers suggest that the lower Hispanic screening rates could reflect financial barriers posed by Medicare cost-sharing requirements, as well as relatively lower colorectal cancer incidence and mortality rates among Hispanics.