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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.

Health Affairs Study: With Cesareans, More Is Not Better

In counties where a greater percentage of babies are delivered through cesarean section, physicians extend the procedure to patients who benefit less from the procedure, according to a study published August 8 on the Web site of the journal Health Affairs. The study by Amitabh Chandra and coauthors found great geographic variation in the use of cesareans, mostly unrelated to patients' medical conditions. Rather, the study found that nonmedical factors such as the density of providers and local medical malpractice pressures drove variation in the cesarean rate. The study also determined that counties performing cesareans more often could reduce the rate of this expensive and hazardous intervention by three to five percentage points without increasing maternal or newborn mortality.

Two-Stage Strategy Proves Key To Arkansas Obesity Fight

In the July/August Health Affairs, Kevin Ryan and coauthors say Arkansas was able to adopt measures to fight childhood obesity in schools by using a two-stage strategy. State anti-obesity legislation contained noncontroversial requirements such as removing vending machines from elementary schools. More contentious matters, such as vending machine restrictions in high schools, were left to a Child Health Advisory Committee, which reported directly to the state's independent Board of Education without further legislative or gubernatorial intervention. Arkansas defused schools' resistance to unfunded anti-obesity mandates by providing implementation assistance, and the state adopted privacy protections for children's body mass index measurements.

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

Study: Population Surveys Can Produce Good Adult Uninsured Estimates

Also in the July/August Health Affairs, Jenifer Kincheloe and coauthors find that carefully designed population surveys such as the California Health Interview Survey (CHIS) can produce reasonably accurate measurements of adult Medicaid enrollment. Thus, the authors say, "estimates of the uninsured population derived from these surveys can be trusted. In the CHIS, underreporting of Medicaid coverage is most common among enrollees [in Medi-Cal, the California Medicaid program] with limited beneifits, who might pay out of pocket for many - perhaps most - health services," say Kincheloe and coauthors, but, overall, "CHIS estimates of adult Medi-Cal enrollment match administrative counts."


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 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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Health Affairs gratefully acknowledges the support of Health Care Update News Service in the dissemination of this e-alert.