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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.

Hospital-Physician Rift Endangers Health Care Goals

Deteriorating relations between hospitals and physicians are imperiling a wide range of health care objectives, Robert Berenson and colleagues from the Center for Studying Health System Change (HSC) report in a Health Affairs Web Exclusive published December 5. The HSC paper, one of the lead articles in a six-article Health Affairs package on the interaction between physicians and hospitals, was cited by Time in a new article on "Hospital-Physician Wars."

Accountability. Two other articles offer different approaches to aligning incentives for physicians and hospitals more closely. Dartmouth Medical School professor Elliott Fisher and coauthors propose making "extended hospital medical staffs" accountable for quality and cost.

Gain sharing. Gail Wilensky, senior fellow at Project HOPE, and coauthors advocate the use of comprehensive gain-sharing arrangements, where hospitals and physicians share savings generated by more efficient care delivery, as a way to transition to a future of integrated delivery systems.

Perspectives. In addition to the three articles, the package includes shorter Perspectives:

Researchers Document Erosion Of Private-Sector Retiree Health Coverage

In 2003, only about one-quarter of private-sector employees worked at establishments that offered retiree health insurance, down from 33 percent in 1997, University of Michigan researcher Thomas Buchmueller and coauthors report in the Nov/Dec issue of Health Affairs. Using data from the Medical Expenditure Panel Survey Insurance Component, which provides a much larger sampling of private firms than used in previous surveys, the researchers also report that private firms have been passing greater shares of their health insurance costs to retirees: Between 2000 and 2003, employers offering coverage raised the premium contributions required of retirees younger than 65 by 78 percent.

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

On The Health Affairs Blog: Global Health, Epogen, and More

All readers are welcome to comment on Health Affairs' new blog. New posts this past week include:

Global health. Former Blue Cross and Blue Shield senior executive Steven Sieverts suggests that a solution to health care financing problems in today's developing world might be found in the "prepayment plans" that were common in the United States in the 1930s and 1940s.

Medicare payment for Epogen. Rep. Bill Thomas (R-CA) devoted his last hearing as chairman of the Ways and Means Committee to "the vexatious problem of Medicare payment for end stage renal disease. Thomas has been on the warpath about ESRD payment in recent months, as a series of studies have detailed overuse and overpayment for Epogen, used to treat anemia in renal patients," writes deputy editor Rob Cunningham after attending the hearing.

WellPoint, Inc. CEO. John Iglehart, founding editor of Health Affairs, shares highlights of his interview with WellPoint, Inc. CEO Larry Glasscock on competition among insurers.


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 Nov/Dec 2006 issue was supported by the California HealthCare Foundation. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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