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The BiDil Debate

ED Use

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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.

Puckrein: BiDil Will Help Fight Heart Failure Among African Americans

The Food and Drug Administration acted correctly when it approved BiDil to treat congestive heart failure in self-described African Americans, the first time the agency had ever approved any medication for a race-specific indication, Gary Puckrein writes in a Web-Exclusive article published August 15 on the Health Affairs Web site. "BiDil provides African Americans with an effective new weapon against heart failure," said Puckrein, executive director of the National Minority Health Month Foundation. "Existing heart failure medications don't work as well for African Americans as they do for members of other racial and ethnic groups, and heart failure hits the African American community disproportionately hard."

"Prudent Layperson" Mandates Don't Increase ED Use, Says Study

State "prudent layperson" mandates, which require health plans to cover hospital emergency care that a prudent layperson would seek, do not result in statistically significant increases in hospital emergency department use, Renee Hsia and coauthors report in the July/August Health Affairs. The researchers hypothesized that the effects of these mandates might be strongest among private HMO enrollees, since HMOs are said to be more likely than other types of plans to restrict ED use, and all prudent layperson mandates apply to HMOs while other types of plans are covered by some state mandates but not others. However, using data gathered by the Center for Health System Change, Hsia's team found no significant increase in ED use even when they restricted their analysis to HMO enrollees.

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Ryan White Funding Disparities Stem From Double Counting Urban AIDS Cases

States whose AIDS cases are concentrated within metropolitan areas receive markedly higher funding per AIDS case under the Ryan White Care Act, Erika Martin and coauthors report in the July/August Health Affairs. This urban/rural disparity, which was reduced but not eliminated by changes to the RWCA in 2000, stems from the fact that AIDS cases in metropolitan areas are counted for funding allocations under both Title I and Title II of the Act. Factors such as state poverty levels, geographic region, and racial and ethnic make-up, as well as the RWCA's use of AIDS cases rather than HIV cases, played only small roles in state funding differences under the RWCA, the authors say.


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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