Help for Authors


Submit a paper


The following are some of the main points that authors need to know when submitting a manuscript. Details on many of these topics are presented after this summary of highlights.

1. All papers must be submitted through our online manuscript processing system, which requires the establishment of a user account.

2. When you submit your paper, be prepared to supply information about the following:

a. Title of the paper

b. Authors' names, formal titles, affiliations, addresses, phone numbers, and e-mail addresses

c. Word count (including abstract, text, and endnotes but not including exhibits)

d. A list of funders that supported you or your coauthors in preparing the paper or the research on which it is based

e. Any affiliations of you or your coauthors that are relevant to the content/subject of your paper, financial or otherwise, that you have not already disclosed by virtue of listing employers/funders. At the editors' discretion, this information will be included with your paper if it is published.

3. Authors must not be identified anywhere in the submitted manuscript documents. Authors' names must not appear on the abstract page, on the first page of the text, or in headers or footers in the paper.

4. An abstract, not to exceed 150 words, should be included as part of the manuscript text.

5. Your paper should be prepared using a standard word-processing format (such as MS Word) in 12-point Courier New font or its equivalent, double-spaced, with a minimum of one-inch margins. These formatting rules apply to all text portions of the paper (including abstract and notes), but not exhibits or supplemental materials.

6. All pages should be numbered.

7. Cited references and explanatory notes should be presented in one section of consecutively numbered endnotes—no footnotes, please. Following Vancouver style for endnotes, each source gets its own endnote; each endnote is assigned a number; and that number may be repeated throughout the document as many times as the source is cited.

8. Exhibits must conform to the following requirements (more detail below). Tables must be included as editable components of the manuscript file and placed at the end of the manuscript. Figures (e.g., graphs, maps, diagrams) must be submitted as files that are separate from the manuscript text files and must be submitted in their native format (e.g., PowerPoint, Excel, rather than pasted-in images). Map files must be provided in .eps or .ai format. All exhibits are numbered consecutively in order of their appearance, not separately by type of exhibit (table or figure). Authors must provide numerical plotting data for all figures, and all exhibits must be provided in electronic form. All exhibits should be mentioned in the text (e.g., As shown in Exhibit 1) and there must be a complete list of exhibits at the end of the manuscript (see detail below).

9. Authors may include documents to supplement their manuscript. Supplemental documents may be used for extended methodological or technical discussion, extended bibliographies, or exhibits that are too long or complex to appear in print. Such documents should be referred to in the main text and should clearly labeled as supplements.

If you have any questions about the manuscript submission process, please contact Executive Editor Donald E. Metz at 301-347-3907, or via e-mail,


Health Affairs
authors should direct their papers to a diverse national audience interested in present and future health policy issues. New data, reports of major new trends, and serious proposals for reform are encouraged. The focus of Health Affairs articles is on policy implications, not elaborate discussions of methodology and data sources. Thus, we ask authors to keep discussion of data and methods brief. However, the data and methods must be adequately assessed in the peer review process. For this purpose, if a study's data and methods cannot be explained adequately in a brief discussion, we encourage authors to provide more methodological detail in the form of an appendix or other explanatory section for review purposes only.


Beginning in 2001, Health Affairs began publishing a significant number of peer-reviewed papers that first appeared online. These papers meet the same standards of review and revision as papers appearing in the print edition; they are an integral part of the Health Affairs body of work. Web First papers appear on average once a week; subscribers and others who have requested notification of new materials receive weekly e-mail alerts, and Web Firsts are available free to all site visitors for one week, after which they become available on a pay-per-view basis or to paying subscribers. Although authors may indicate their interest in Web First publication, the editors reserve the right to pursue Web First publication with submitted papers, particularly those addressing an issue of high topicality or policy interest. Web First papers appear in "print" in the issue of the journal that follows online publication.


Please include an abstract (unstructured) not to exceed 150 words. Additional guidance on abstracts is available elsewhere.

Length: Please submit your paper in twelve-point Courier New font or its equivalent, double-spaced, with a minimum of one-inch margins; please number all pages. See our FAQs for word limits.

Authors may submit exhibits to present data, graphs, maps, diagrams and other types of illustrative materials. There is no strict limit on the number of exhibits an author may include with a paper, but we typically do not exceed four exhibits per published paper, and we encourage authors to use exhibits sparingly and to avoid overly complex presentations. Exhibits should be submitted in the software in which they were composed (such as Word, MS Excel, or PowerPoint) so that they are editable and so that any data points are recoverable; exhibits should not be submitted as embedded images or objects that cannot be edited. There are different requirements for tables and figures; these are alluded to above and specified in more detail elsewhere. See below ("Style") for additional information on exhibit presentation.

Supplemental Materials:
Health Affairs is aimed at a diverse audience of readers, many of whom are primarily interested in the policy implications of research findings and not the technical details of research methodologies. We therefore encourage authors to be concise in describing details of methods and data (authors should aim for 750 words or less of methods/data discussion in their papers). This does not relieve authors of supplying information that is necessary to evaluate the credibility of their work. If 750 words is not sufficient for these purposes, authors are encouraged to include with their submission more detailed description of data, methods, and analysis in the form of a technical appendix for review purposes only.

You may use as much space as you need for such an appendix, but please bear in mind that clarity and brevity are still expected, as reviewers are often under considerable time pressure to complete their work. The word count of supplemental materials does not count against the word count of the paper for publication purposes.

PLEASE NOTE: If your analysis is based on regressions, please include with your manuscript a technical appendix showing the full specification of each regression--number of observations, dependent and independent variables (including any transformations from the variables discussed in the text), coefficients, either standard errors or t-statistics, R-squared and F statistics. This information will not be published with your paper but will be made available to reviewers to facilitate their judgment of whether the analysis supports the conclusions in the text; and if the paper is published, it will be available online to readers. You may decide how much if any of the regression results to display in exhibits in the paper, but the presentation should be concise, and presented in a form that would be suitable for nonexperts.

If you have any questions about what types of information should be included in the paper and which should be relegated to an appendix, please contact the editors.

Manuscript type:
Although we appreciate authors' familiarity with the various sections of the journal, the editors retain the right to assign articles to sections.

Only people who participated in the writing of the manuscript should be listed as authors (other contributors may be mentioned in an acknowledgment). More than five authors may require justification, in accordance with the authorship criteria of the International Committee of Medical Journal Editors (please note that Health Affairs has its own submission guidelines and does not adhere to the general guidelines for manuscript submission found on the ICMJE Web site). Authors' names must not appear anywhere in the files submitted with the manuscript.

Manuscript Submission:
All manuscripts must be submitted via Health Affairs' online manuscript processing system. You must have a user account before you can submit a paper. If you have a user account, log in using your user ID and password at the login screen. If you have an account but have forgotten your user ID or password, go to the login screen, enter your e-mail address in the "Password Help" field, then click on "Go." You will receive e-mail with instructions on how to obtain a user ID and password. If you do not have a user account, you can establish one by going to the login screen and clicking on "Create Account" in the upper right-hand corner of the page. To create an account, you will need to supply your first and last name, e-mail address, job title and institution, mailing address, phone number, a password, and a list of your areas of expertise.

Specific instructions on how to submit papers are available via the "submit" links on the Help for Authors main page.

Revision process:
Once a manuscript has gone through peer review and the editors have decided that a request for revisions is warranted, we request a similar submission process; details are available through the appropriate link on the Help for Authors main page. You will be given more specific instructions for the final submission at that time; please read the revision letter carefully and comply with all editors' requests.

Outside editorial assistance:
The Health Affairs copyeditors work with every accepted paper to apply consistent style, correct grammar, and appropriate length. Also, Health Affairs editors routinely give detailed suggestions for improving a manuscript during the peer-review process. However, they cannot offer direct assistance to authors before a paper is accepted, other than answering routine questions and providing access to the style guide on request. If authors require more assistance with their writing, especially before the submission process begins, editorial services are available to provide this assistance for a fee. One such service is ScienceDocs (details are available at

Health Affairs
is not affiliated with ScienceDocs or any other company offering editorial services. Authors may use these services at their own discretion and risk; use of such services does not directly affect a paper's chances of acceptance, and all accepted papers are still subject to copyediting as described above.


Authors should refer to the Chicago Manual of Style (University of Chicago Press) as a style guide for the text portion of their paper. Health Affairs uses the Vancouver style (following the Uniform Requirements for Manuscripts Submitted to Biomedical Journals) for references. Endnotes, including both sources and explanatory matter, should be kept to a minimum and numbered in the order in which they appear in the text, not alphabetically.

Journal-article citations must include the volume, issue number, and year of publication as well as the article page numbers. Book and report citations must include the pertinent details of publication (publisher, location, year). References to online documents must contain complete details (author's name if relevant, name of document, and citation information), not simply a URL. Improperly formatted notes may be returned to the author for revision, possibly delaying a paper's publication. All sources must be provided in English. Authors are responsible for the accurate translation of foreign-language sources' publication details into English during the revision process.

Here are some of the highlights of the Vancouver endnote style as used in Health Affairs:

  • Health Affairs does not use footnotes; all notations and references should be integrated into one section of consecutively numbered endnotes that are listed in the order in which they are called out in the text.
  • Use Arabic, not Roman, numbering.
  • References are individually assigned a unique "callout" number, and note numbers are repeated in the text whenever the source material applies.
  • Sentences may contain as many endnotes as are relevant, in whatever position they are most directly pertinent to the text where they apply
  • If a publication or article has up to six authors or editors, all should be listed; if a publication or article has more than six authors, the first six are listed, followed by "et al."

Many authors use software packages to prepare their lists of references. The three major packages (EndNote, ProCite, and Reference Manager) all contain an output style or bibliographic style for Vancouver. Authors maintain the responsibility of using the program(s) appropriately; Health Affairs cannot offer support for or assistance in their use. See,, or for more information. [Health Affairs does not endorse nor is financially connected to Thomson-Reuters, the company that produces this software; this mention does not constitute an endorsement.]
Endnotes should conform to the following examples.

1. Sparer MS, Brown LD. Uneasy alliances: managed care plans formed by safety-net providers. Health Aff (Millwood). 2000;19(4):23-35.

2. Cowan CA, Lazenby HC, Martin AB, McDonnell PA, Sensenig AL, Smith CE et al. National health expenditures, 1999. Health Care Financ Rev. 2001 Summer; 22(4):77-110.

3. Starr P. The social transformation of American medicine. New York: Basic Books; 1982.

4. Harris G. FDA orders recall of intravenous pumps. New York Times (Washington Final). 2005 Jun 22;Sect. A:12 (col. 1).

5. Corrigan JM, Kohn LT, Donaldson MS, editors. To err is human: building a safer health system. Washington: National Academies Press; 1999.

6. Anton B, Nelson R. Literacy, consumer informatics, and health care outcomes: interrelations and implications. In: Park HA, Murray P, Delaney C, editors. Consumer-centered computer-supported care for healthy people. Amsterdam: IOS Press; 2006. p. 49-53.

7. Patrias K. Computer-compatible writing and editing. Paper presented at: Interacting with the digital environment: modern scientific publishing. 46th Annual Meeting of the Council of Science Editors; 2003 May 3-6; Pittsburgh, PA.

8. Collins SR, Kriss JL, Davis K, Doty MM, Holmgren AL. Squeezed: why rising exposure to health care costs threatens the health and financial well-being of American families [Internet]. New York: Commonwealth Fund; 2006 Sep [cited 2006 Nov 2]. 34 p. Available from:

More extensive information on citing in Vancouver style is available online. We recommend the following sources:

National Library of Medicine, "International Committee of Medical Journal Editors Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Sample References,"

National Library of Medicine, "Citing Medicine,"

Monash University, "Vancouver style (uniform requirements for manuscripts submitted to biomedical journals),"

For specific questions on endnote style, e-mail

Exhibits: Exhibits should be mentioned ("called out") in the flow of the text, not simply as an added note suggesting their placement. There should be a comprehensive list of exhibits at the end of the text document, with each item in the list indicating whether the exhibit is a table or a figure, the title of the exhibit, and the source(s) for the data/information presented. Sources must be provided, even if the source is the authors’ analysis. If this is the case, please also specify what data the authors are analyzing (for example, “Authors’ analysis of data from the Medical Expenditure Panel Survey, 2014”).


Exhibits should have clear titles (“captions”), subheading labels, and (for figures) legends, and they should be understandable at a glance. Overly complicated exhibits or exhibits that are not formatted for nonexperts -- for example, raw regression output -- may be removed before publication and placed in an appendix for online viewing. Exhibits must be numbered consecutively as they appear, not separately based on whether they are a table or a figure. Tables should not be excessively horizontal in layout, because of the size of the Health Affairs page. If the work in the exhibit is not original and has been published elsewhere, the author is expected to obtain copyright permission from the publisher and is responsible for any fees that may be required.

Online Supplements and Appendices:
As described above, authors may submit supplemental materials to accompany their papers as online-only supplements. These materials should be submitted with the revision and clearly marked as supplements. They should be formatted as the authors wish them to appear online. The Health Affairs editors do not edit or format online supplemental materials; we take submitted files, produce PDFs, add a brief text passage identifying the materials with the published paper, and post them on the Web site along with the article. These PDFs are sent to authors for approval before the article is posted. The appearance and accuracy of all online supplemental materials are the responsibility of the authors. Additional detail is available elsewhere.


Online Comments: Health Affairs offers readers the opportunity to submit their reactions to specific articles for online posting. Online Comments are a moderated forum, which means that all responses are read, edited if necessary, and approved by the editorial staff before they are posted. Information about Online Comments is found in the content box (the box on the top right side of the first page) of every article on the Health Affairs Web site. There is no word limit to Online Comments, but you are encouraged to be brief and state your point(s) concisely and politely. All Online Comment writers must disclose their names and work affiliations; anonymous or partially identified comments will not be posted online.

Submissions to Online Comments are considered for eventual print publication at the discretion of the editors. If we do consider your letter for print publication, we will contact you first, and you will have the opportunity to approve galleys. Otherwise, Online Comments submissions will remain online only and will be archived with the contents of the site. Online Comments are linked with the articles to which they were submitted in response, and they can also be read on a summary page.

Authors whose papers are addressed in Online Comments are notified automatically and are given the opportunity to respond in a subsequent comment. The editors reserve the right to end exchanges between Online Comments authors that do not focus on matters of substance.

Letters To The Editor In Print: Letters in response to specific print articles can also be submitted for publication in a future print edition. Letters should be brief (not to exceed 300 words) and sharply focused. You may send your letter as an attachment to e-mail, along with your complete contact information (including work affiliation, mailing address, e-mail address, and phone and fax numbers) to Or you may use our online letters submission form. Health Affairs reserves the right to publish submitted letters either online or in the print edition; unsolicited letters to the editor will not be acknowledged.


We acknowledge all manuscripts upon receipt and submit them promptly for evaluation. All published papers are subjected to peer review; authors are encouraged to suggest names of appropriate reviewers for their papers during the online submission process, although the editors cannot guarantee that all requests will be honored.

Health Affairs
receives more than 1,000 manuscripts each year. All papers are reviewed by the editors for timeliness and relevance to the journal's objectives. About half of these submissions are selected for external review. For papers that are not selected for external review, the journal notifies authors of its decision within two to three weeks of submission. For papers that are selected for external review, authors can expect to wait about two to three months from the date of submission until notification of the journal's decision. For papers that are selected for revision, the length of time between the revision request and publication will vary widely (from six weeks to several months) depending on various factors, including the extent of revision required, the need for additional review and revision, whether the paper will be published in a bound volume or on our Web site, etc. Our acceptance rate for unsolicited papers is currently between 10 and 15 percent.

To check the status of a submitted paper, log in to our online manuscript processing system. Once you have logged in, you will be at your main menu. Click on "Author Center," then under "My Manuscripts," select the "Submitted Manuscripts" link. This page will display manuscripts of yours that are currently under consideration at Health Affairs, along with their status.


After Health Affairs accepts a manuscript for publication and schedules it either in a print issue or as a Web First, galleys are sent to the contact author for review. Corrections to the galleys should be returned to the editorial office within two days of receipt, following the instructions of the corresponding editor. Health Affairs sends all galleys electronically as PDF files except under prior arrangement with the editors. All authors must sign a copyright transfer agreement prior to publication. Upon a manuscript's publication in Health Affairs, each author receives two copies of the issue and reprint ordering information.