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Health Affairs Tackles Low Life Expectancy in the U.S. and Questions Popular Remedies


Women and Younger Americans Skewing Mortality Rates


Bethesda, MD -- Health Affairs' March issue includes a variety of articles centered around health and wellness, including featured pieces on mortality rates under age 50 and among women in many counties in the United States. The issue also addresses whether physicians will see a return on investment from adoption of electronic health records (EHRs), and raises questions about cost savings from workplace wellness programs and the impact on less healthy workers.


Another featured article probes dramatic variations in cesarean section rates at US hospitals and explores the health and cost implications for a range of stakeholders.


Female mortality rates increased in 42.8 percent of counties in the United States during 1992-2006. A featured study by David Kindig and Erika Cheng of the University of Wisconsin-Madison found that although mortality rates are falling in most counties in the United States, female mortality rates increased in 1,224 counties compared to an increase in 108 counties for men. The study is the first to examine the relationship between socioeconomic and behavioral factors and mortality at the county level. The authors found that for both men and women, factors associated with lower mortality included having a college degree, higher median household income, Hispanic ethnicity, and living in a higher population density area. For women, living in counties in the South and West was associated with a 6 percent higher mortality rate than living in the Northeast. Smoking rates were also a key factor in higher mortality rates. The researchers recommend targeted approaches that are suited to the unique needs of a county, and observe that investments in health care, public health, behavioral change, and social and physical environment will be needed to improve worsening mortality rates in the United States.

In a related article, Jessica Ho of the University of Pennsylvania reports on her analysis that mortality under age 50 accounts for much of the fact that US life expectancy lags that of other high-income countries. She recommends focusing on prevention of the major causes of death in these younger populations, such as unintentional injuries, including drug overdose; noncommunicable diseases; perinatal conditions; and homicide.


The average physician will lose $43,743 over five years after adopting EHRs; federal meaningful-use incentives alone may only help a small proportion of practices achieve a positive return on investment. Julia Adler-Milstein of the University of Michigan School of Information and School of Public Health and coauthors used survey data from forty-nine community practices in a large EHR pilot in Massachusetts and projected that only 27 percent of practices would achieve a positive return on investment in five years; an additional 14 percent would be in the black assuming they received the $44,000 federal meaningful-use incentive. The biggest difference in which practices achieved a positive versus negative return stemmed from whether they used EHRs to increase revenue by seeing more patients or through improved billing. The incentives had a larger impact on practices with more than six physicians and those that provided primary care compared to smaller and specialty practices. The most common financial change was a reduction in the cost of paper medical records (seen by 55 percent of respondents), yet almost half of practices did not realize these savings because they continued to keep records on paper. The authors conclude that adoption of EHRs can have a positive financial effect on practices, yet the current incentives tend to favor larger practices. Meaningful-use incentives may therefore not be sufficient to entice practices of varying sizes and types to use EHRs without further guidance on how they can benefit from adoption.


Workplace wellness articles include:


  • Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy Workers, Jill Horwitz of the University of California, Los Angeles

  • A Hospital System's Wellness Plan Linked To Health Plan Enrollment Cut Hospitalizations But Not Overall Costs, Gautam Gowrisankaran of the University of Arizona

In another featured article, Katy B. Kozhimannil of the University of Minnesota and coauthors found that rates of cesarean deliveries varied tenfold across US hospitals, from 7.1 percent to 69.9 percent.

Because Medicaid pays for nearly half of births in the United States, the government has strong incentive to decrease variation and improve quality in the use of these costly procedures. The authors recommend steps including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.