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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.

New Scorecard Says U.S. Health Care System Needs Improvement

Despite spending 16 percent of its gross domestic product on health care -- double the median for industrialized nations -- the U.S. remains the only industrialized country in the world that does not guarantee universal coverage and is not a leader in health information technology, outcomes, or quality of care. So report Cathy Schoen and her colleagues at the Commonwealth Fund in an article, published September 20 on the Health Affairs Web site, describing the scores earned by the nation's health care system on a new comprehensive scorecard developed by Commonwealth. The scorecard, "which was designed to assess and monitor all key dimensions of performance in relationship to benchmarks and over time," gives the U.S. an overall score of 66 out of a possible 100. The article by Schoen and coauthors is available free on the Health Affairs Web site until October 1.

On Biotech Drugs, It's Not "The Prices, Stupid," Say Authors

The United States spends much more per capita on biopharmaceuticals than other industrialized countries and Mexico, but U.S. prices for specific formulations are comparable with prices in other countries, say Patricia Danzon of the University of Pennsylvania and Michael Furukawa of Arizona State University. The authors say that greater use of high-priced formulations is one factor behind higher U.S. spending; other possible contributors are greater use of high-priced molecules and/or higher total use. "Thus, for this high-technology sector," Danzon and Furukawa conclude, "our data suggest that 'it's the availability and utilization mix, not the prices'."

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

Higher Cost Sharing Doesn't Deter Use Of Pricey Specialty Drugs

Increasing patient copayments for expensive specialty prescription drugs won't reduce overall health care expenditures because patients will continue taking the drugs even when their costs rise, according to Dana Goldman and his colleagues at the RAND Corporation. The RAND Health study found that the best way to hold down costs for expensive specialty drugs, as opposed to just transferring more of those costs to patients, is to make sure that the medications are prescribed only to the patients who can truly benefit from them. "Management of these drugs may rightly focus on making sure that only patients who will most benefit receive them, but once such patients are identified, it makes little sense to limit coverage," the authors say.

Mass. Health Reform: Great Potential, But Significant Challenges Remain

Massachusetts' plan to move toward universal coverage represents an impressive political achievement, and the plan's policy innovations offer important lessons to other states. However, the true significance of the Massachusetts experiment will become clear only after the state addresses daunting implementation challenges over the next several years. That's the verdict delivered by the two lead papers of a six-paper package on the Massachusetts experience published September 14 on the Health Affairs Web site. John McDonough, executive director of the Boston-based Health Care For All, teams with three colleagues from that organization to provide a comprehensive look at the important events and key players involved in the plan's package. John Holahan and Linda Blumberg of the Urban Institute survey the issues Massachusetts will have to address as it seeks to turn its path-breaking plan into reality. The papers are available free until September 28.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The nonpartisan, 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. The Sept./Oct. 2006 issue was supported principally by the Blue Shield of California Foundation with additional support from Amgen and Genentech. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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