• A few remarks about Health Affairs

    Perhaps you’ve heard that Susan Dentzer is leaving her position as Vice President and Editor-in-Chief of Health Affairs. John Iglehart, who had led the journal from its inception until 2007, is returning and will lead the search for a new Vice President and Editor-in-Chief. Some have asked me if I know more I can share about the background on the leadership change. I do not.

    However, the change is an opportunity for me to comment on some ways in which I’d like to see Health Affairs grow. I preface my comments with what should be obvious: I am not, and have never been, a VP or chief editor of a major publication. I know far less than Iglehart or Dentzer about how to sustain such an enterprise. Consequently, I am not second guessing the decisions they have made or will make. I am merely offering my thoughts as a researcher who consumes the publication and as an author of a few papers that have appeared in it.

    Health Affairs occupies a special and important position in the space of vehicles for dissemination and translation. At the intersection of scholarship and policy, it is one of the few journals about health care read by academics, industry leaders, policymakers, and program administrators. Satisfying all these disparate constituencies is exceedingly difficult. Yet a forum in which all are comfortable is vital to a constructive conversation about health system challenges and changes. Where else do they all mingle?*

    From my perspective, over the last several years, Health Affairs has shifted its emphasis away from some aspects of scholarship and toward policy. It may not be surprising to read that, for my tastes, it has shifted a little too far. I’m not alone. In part, that shift motivated the creation of the new journal Health Management, Policy and Innovation, for example. Keep in mind, though, that I am routinely frustrated by the pulled policy punches in academic work. One of the purposes of this blog is to highlight the policy relevance of scholarship in health economics and health services research. For justifiable reasons relating to the constraints and incentives of peer review and promotion, most scholarship in these domains is, in my view, too light on policy.

    Health Affairs, by and large, is not. But there is a difference between policy relevance and policy commentary. In recent years, the latter has been a little over-represented in Health Affairs. Sound, multivariate, and quite sophisticated analysis can be policy relevant. This has been under-represented in the journal as currently configured. Yes, it needs to be explained and translated, but it isn’t always academic minutiae (though, sometimes, yes it is). Policy commentary is often, well, just talk — not evidence-driven, but eminence-based or anecdotal. There’s a place for that. In fact, there are a lot of places for that. Do we need another?

    Health Affairs can be a different kind of place. I’d like to see it more frequently reach beyond commentary, as important and challenging as that is. I’d like to see it be a place that also confronts its entire constituency with commentary that is coupled with strong evidence brought to light by, sometimes, challenging techniques. I’d like to see Health Affairs demand more rigorous evidence — more than descriptive analysis or anecdotes — in its published papers while still maximizing accessibility to a wide audience. That is a tall order. But I think it’s what we need.

    To facilitate such a shift, the journal would need to be more investigator driven, as it once was. Instead of soliciting tens of articles for a theme issue, it would have to solicit fewer and leave space for idiosyncratic submissions from authors. Broadening the range of subjects addressed in each issue would also increase each one’s potential relevance. For one can’t know, for example, if the theme issue on, say, chronic disease planned for a year from now will publish when that topic is at the top of the agenda. Perhaps some other subject included in the issue will be.

    There are ways to bridge the demands of sound evidence (and the sometimes sophisticated techniques of academia) and the appeal of commentary. Editorials serve that role well in medical journals, for example. Health Affairs might also use its blog to translate some of the challenging papers it might publish for various audiences. I’m sure creative minds can think of other ideas.

    As is true of many things, Health Affairs is important but not perfect for all purposes. Nothing ever is. What it has going for it is a position of prominence and a legacy of facilitation of cross-pollination in health policy and scholarship. Perhaps in pursuit of new audiences, it has leaned harder into the space of policy commentary and away from scholarly analysis. I cast my vote for a return to its roots, a rebalancing of emphasis. But, I’m just one geeky wonk. What do you think?

    * Ahem. Well, perhaps here.

    @afrakt

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    • I agree wholeheartedly. I was on a paper submitted to Health Affairs a few years ago. After a lengthy review, it was denied. One of the reviewers provided thorough and helpful critique (it has since been much improved, and a better version accepted at a different journal). The second reviewer’s comments were limited to saying that this was a good paper, suitable for a research journal, but too complex for a policy journal like Health Affairs. We used multiple linear regression… I hope that more rigorous, policy-relevant analyses will have a home at Health Affairs in the future.

    • Agreed!

      Health Affairs has become far too soft and magazine-like. It’s a shame that much of the work published in the journal is extremely weak methodologically. What’s the point of having a journal so widely read if you can’t trust the conclusions?