Health Affairs In 2019: Editor’s Picks

As we enter 2020, I am pleased to share my “top ten” articles from 2019.  As Health Affairs Editor-in-Chief, I enjoy reading hundreds of articles each year on an incredibly wide range of health policy topics.  My top ten goes beyond our “most-read” and “most-shared” articles, which tend to focus on costs and spending.  I like articles that ask particularly interesting questions, explore underreported issues, or analyze unique data sets.  I hope you find these articles compelling, enjoy reading them, and learn something from them, just as I have. They are listed below in the order in which they appeared in the journal. Happy reading!

February

Access To E-Prescriptions And Related Technologies Before And After Hurricanes Harvey, Irma, And Maria by Jaime Y. Smith and Max M. Sow

In this paper, Jaime Smith and Max Sow examine e-prescribing patterns immediately after major hurricanes made landfall in the US in 2017. E-prescribing plummeted in Texas and Florida when the hurricanes hit but returned to normal levels in less than a month, and often even faster; recovery was much slower in Puerto Rico, where it took months to restore power to much of the island. These findings highlight the potential, and limitations, of technology, and the need to attend to social disparities as we adopt those technologies.

March

Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care by J. Frank Wharam et al.

As more Americans are enrolled in health plans with high deductibles, concerns have grown regarding postponing or forgoing needed care. J. Frank Wharam and coauthors find delays in initiation of breast cancer care—imaging, biopsy, diagnosis, and treatment—among women in high-deductible plans. The effects were seen for low-income and high-income women.  Both income groups delayed care relative to women in low-deductible plans.

April

Knowledge Of Practicing Physicians About Their Legal Obligations When Caring For Patients With Disability by Nicole D. Agaronnik et al.

Federal civil rights laws not only prohibit discrimination against people with disabilities but also require reasonable accommodation to ensure equal access to services. Nicole Agaronnik and coauthors interviewed physicians in Massachusetts and find that interviewees report a limited or incorrect understanding of their obligations to patients with disability in three potentially problematic areas: “deciding which accommodations their practices should implement, refusing patients with disability, and holding patients accountable for costs of accommodations.” These findings indicate that legal protections alone are insufficient for effectuating equal access to care.

June

Spousal Caregivers Are Caregiving Alone In The Last Years Of Life by Katherine A. Ornstein et al.

Katherine Ornstein and colleagues analyze survey data and find that in the final years of their spouses’ lives, more than half of surviving spouses were the only person providing care in the home to their spouse. The surviving spouses had many health conditions of their own, with two-thirds in poor or fair health and 40 percent requiring assistance with activities of daily living. As the population ages, this paper highlights the urgency of considering the family unit when planning community-based care for people with serious illness.

July

Racial And Ethnic Disparities In Care Following The New York State Sepsis Initiative by Keith Corl et al.

In 2013 New York State undertook a major initiative that required hospitals to adopt an evidence-based protocol for sepsis care. Keith Corl and coauthors find overall improvements in care and no evidence of racial disparities in treatment within hospitals. However, because hospitals primarily serving black patients had smaller improvements, the initiative widened the sepsis care quality gap between blacks and whites. This article sheds important light on how improvement does not automatically yield progress toward health equity.

August

The Impact Of Military Parents’ Injuries On The Health And Well-Being Of Their Children by Elizabeth Hisle-Gorman et al.

Children of parents who are injured while serving in the military are at increased risk of various poor health outcomes. Elizabeth Hisle-Gorman and coauthors examine data for children two years before and two years after parental injuries and find that these children “received decreased preventive health care and had increased health care visits for injury, maltreatment, and mental health care and increased days on psychiatric medications.” Additionally, PTSD in a parent increases the effect of changes in children’s health care use. This paper provides a unique perspective on the multi-generational effects of military injuries.

September

Cooling The Hot Spots Where Child Hospitalization Rates Are High: A Neighborhood Approach To Population Health by Andrew F. Beck et al.

Hospitalization is a disturbing, disruptive, and expensive event for anyone, but especially for children. In 2015, Cincinnati Children’s hospital Medical Center began an initiative designed to reduce the number of children hospitalized in targeted neighborhoods with elevated rates of pediatric hospitalization. Andrew Beck and colleagues describe the comprehensive approach the initiative took to addressing children’s medical and social needs and report an almost 20 percent decline in the hospitalization rate in those neighborhoods. This paper demonstrates that a public health approach can reduce the need for clinical services.

October

Linking Public Safety And Public Health Data For Firearm Suicide Prevention In Utah by Catherine Barber et al.

In Utah, a state with high rates of gun ownership, suicide is the leading cause of death for residents ages 15–24 and the fourth-leading cause among those younger than 65. Catherine Barber and coauthors explore how the Utah legislature’s 2016 call to research firearms and suicide presents “a case study for how policy makers, researchers, firearm stakeholders, and others can reach across ideological lines to study their local firearm suicide problem and identify actionable prevention strategies.” This paper describes how communities can come together to address health challenges through the use of shared data and analysis.

November

Noncommunicable Diseases Attributable To Tobacco Use In China: Macroeconomic Burden And Tobacco Control Policies by Simiao Chen et al.

China is the world’s leading tobacco producer and consumer, yet no studies have examined the macroeconomic burden to China of noncommunicable diseases (NCDs) attributable to tobacco or secondhand smoke exposure. Simiao Chen and coauthors estimate the economic burden of tobacco consumption arising from eight tobacco-attributable diseases at US$2.3 trillion in the period 2015–30 and suggest that “if China raised the tobacco tax to 75 percent of the current retail price and implemented complementary policies…, the country’s economy could save 7.1 trillion yuan (US$1.0 trillion) from 2015 to 2030.” This analysis demonstrates the importance of economic simulations as a source of evidence when considering policy change.

December

The Decline In Rural Medical Students: A Growing Gap In Geographic Diversity Threatens The Rural Physician Workforce by Scott A. Shipman et al.

Medical students from rural backgrounds are more likely to practice in rural areas than those from urban backgrounds. Scott Shipman and coauthors find that in the years 2002–17 the number of medical school applicants from a rural background declined by 18 percent and the number of matriculants declined by 28 percent, while urban applicants increased by 59 percent and matriculants by 35 percent. The authors note “a growing mismatch between the qualifications of rural applicants and medical schools’ admissions priorities.” This work reminds us that overcoming the health disadvantages of rural America will require a multifaceted response.