MILBANK QUARTERLY米尔班克季刊
MILBANK QUARTERLY(英文缩写 MILBANK Q),ISSN 0887-378X,eISSN 1468-0009,中文译名:米尔班克季刊 是一本学术期刊。本页汇总该期刊的最新影响因子、分区信息以及最新收录于 PubMed 的文献,帮助您快速了解期刊全貌。
发文量统计区间：2025-11-01 至 2026-10-31，按本站收录文献的发表日期统计。
期刊介绍
历年影响因子趋势
| JCR 数据年份 | 影响因子 | JCR 分区 |
|---|---|---|
| 2021 | 6.237 | Q1 |
| 2022 | 6.600 | Q1 |
| 2023 | 4.800 | Q1 |
| 2024 | 4.100 | Q1 |
| 2025 | 6.200 | Q1 |
MILBANK QUARTERLY 最新收录文献
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1. US Life Expectancy and Increasing Mortality Rates: An Analysis of the Crisis.
1. 美国预期寿命与死亡率上升：危机分析PMID:日期:2026-09-23Policy Points US life expectancy is shorter than in other high-income countries and the gap has widened dramatically over time, driven in particular by rising mortality rates that threaten the probability that youth can survive to middle age, or even adulthood. Policy priorities to address this crisis include efforts to address the proximal causes of rising mortality, such as poor diet, drug overdoses, problem drinking, homicide, suicide, and chronic diseases such as cardiometabolic, neurologic and genitourinary diseases, among others. Meaningful progress in closing the gap with other high-income countries must go beyond proximal causes to address structural factors that systematically compromise the health of Americans, such as deficiencies in the health care system, adverse socioeconomic conditions, threats from the physical and social environment, and public policies that do not prioritize the health and safety of the population or that perpetuate health inequities. At a time when political support for such policies is sharply divided in the United States, states are exerting greater power over policies that could improve-or worsen-population health. The challenge in the United States in solving the mortality crisis is not a lack of policy solutions but of political will to prioritize population health over competing interests. US life expectancy is shorter than in other high-income countries, and the gap has widened over time. This article examines the mortality patterns that help explain the widening gap, considers the root causes that might be to blame, and discusses potential policy solutions. Sources of mortality data included the United Nations Department of Economic and Social Affairs, US Mortality Database, Centers for Disease Control and Prevention, and Organisation for Economic Cooperation and Development. The analysis examined life expectancy and age-specific mortality rates by country, cause-specific US mortality rates from 1999 through 2023, and cause-specific mortality rates in 16 high-income countries for comparison. A literature review examined potential explanations for the US health disadvantage, including the growing role of states and partisan polarization. This was supplemented by an analysis of state-level life expectancy and gubernatorial party affiliation for 1941-2022 and a comparison of state life expectancy in 2017-2021 with countries reporting similar life expectancy. As of 2023, US life expectancy ranked 38th among countries with a population greater than 1 million, and the populations of 60 countries faced a lower risk of dying before age 40 than did Americans. Causes of death responsible for changes in all-cause mortality varied by age group. Leading contributors among infants and children included sudden unexplained infant deaths and external causes (e.g., transport, homicide, suicide). Young adults (ages 25-44) experienced the largest relative increases in all-cause mortality of any age group, including a 71.2% increase between 2010 and 2021, driven by deaths from external causes, notably drug overdoses, and early-onset diseases (e.g., hypertensive disease, endocrine and metabolic disorders, alcoholic liver disease). Middle-aged adults experienced increased mortality from similar causes (hypertensive diseases, endocrine and metabolic disorders, external causes), as well as higher death rates from nervous and genitourinary system diseases. Mortality from COVID-19, which emerged in 2020 as the third leading causes of death among middle-aged adults, almost doubled in 2021, despite the availability of vaccines. Older adults experienced increased mortality from neurologic diseases and endocrine and metabolic disorders and the highest mortality rates from COVID-19. Since 2010, the gap in all-cause mortality between the United States and 16 high-income countries has been driven by higher death rates from circulatory diseases, external causes, nervous system diseases, respiratory diseases, and endocrine and metabolic disorders. Explanations for the US health disadvantage include proximal causes (e.g., opioid epidemic, access to firearms, the obesogenic food environment, affective disorders), as well as systemic factors such as deficiencies in the health care system, socioneconomic precarity, a lax regulatory environment, and structural racism. State-level life expectancy and mortality rates have increased over time and appear associated with policy and increasingly partisan orientations. The United States faces a mortality crisis that requires attention not only to specific causes of death but also systemic issues that compromise health. That better health outcomes are achievable is demonstrated by the growing list of high-income and middle-income countries that have achieved higher life expectancy than the United States. Policies that would close the gap, which have historically attracted weak political support in the United States and are now being actively opposed at the federal level, can be pursued by states and communities with greater commitments to improving population health.
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2. Certified Nurse-Midwife Practice Authority as a Structural Determinant of Maternal Health.
2. 认证护士-助产士执业权限作为孕产妇健康的结构性决定因素PMID:日期:2026-09-17Policy Points State scope-of-practice restrictions on certified nurse-midwives are associated with lower workforce density and higher maternal vulnerability. In fact, 25 states currently impose collaborative or restricted practice environments that coincide with the nation's worst maternal health indicators. Mediation analysis revealed that 27% of the regulatory effect operates through workforce supply, whereas 73% reflects a direct policy effect, indicating that both regulatory reform and workforce investment are needed. Federal incentives through the Centers for Medicare and Medicaid Services's Rural Health Transformation Program now award scoring points based on state practice authority classifications, directly linking the state regulatory environment to federal funding and providing states with both an evidence-based rationale and a financial incentive for reform. Certified nurse-midwives (CNMs) provide evidence-based maternity care associated with improved birth outcomes, yet half of US states do not grant them independent practice authority. State scope-of-practice regulations may function as structural determinants of maternal health by constraining both the midwifery workforce and the conditions under which care is delivered. Prior studies have documented associations between midwifery regulation and workforce availability but have not formally tested the mechanisms linking regulation to population-level maternal health outcomes. We conducted a cross-sectional ecological analysis of all 50 US states, classifying each by CNM practice authority (independent, collaborative, or restricted) using American College of Nurse-Midwives state practice environment data (March 2026). CNM workforce density was calculated from American Midwifery Certification Board data (2022-2023). The primary outcome was the maternal vulnerability index (MVI), a composite of 43 indicators excluding provider density. The secondary outcome was March of Dimes preterm birth report card grades. We used one-way analysis of variance, multiple linear regression, and Baron and Kenny mediation analysis with Sobel tests and bias-corrected bootstrap confidence intervals to test whether workforce density mediated the relationship between practice authority and maternal vulnerability. States allowing independent practice had significantly higher CNM densities than collaborative states (6.5 vs. 2.9 per 1,000 births, P < .001), as well as lower MVI scores (2.1 vs. 4.1, P < .001). The effect sizes were large (Cohen's d = 1.34 for CNM density, d = -1.62 for MVI). CNM density was found to mediate 26.7% of the practice authority-MVI association (Sobel z = -2.10, P = .036; 95% bias-corrected and accelerated [BCa] bootstrap CI [-0.88, -0.08]). The remaining 73.3% represented a direct policy effect that is not explained by workforce numbers. These results were robust to alternative classifications using nurse practitioner regulatory data. State CNM scope-of-practice regulations are a modifiable policy lever associated with both clinician workforce distribution and population-level maternal vulnerability. Both regulatory reform and complementary workforce investments are needed to address maternal health inequities.
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4. The Czech Conundrum: Institutional Trust Erosion and COVID-19 Pandemic Mortality.
4. 捷克之谜：制度信任侵蚀与COVID-19大流行死亡率PMID:日期:2026-09-12Policy Points Institutional trust appears to constitute an essential component of pandemic preparedness. Czech excess mortality-49% higher than Austria's and approximately twice the European mean-illustrates that governance failures can undermine functional preparedness assets. The observed 8-10-week lag between trust decline and mortality divergence is consistent with a potential early-warning window. Regular monitoring of public trust may identify governance deterioration before preventable mortality escalates, thereby operationalizing trust as a measurable governance outcome. Competent health leadership continuity is a protective factor, not a guarantee. Five Czech health ministers in 15 months coincided with the deterioration in public cooperation, demonstrating how political instability weakens pandemic-response capacities even where technical preparedness exists. The Czech Republic's COVID-19 excess mortality represents a preparedness paradox. Despite entering the pandemic with substantial technical capacity-including the highest intensive care unit density in the Organisation for Economic Co-operation and Development, an early national mask mandate, and an initially effective contact-tracing system-that country experienced age-standardized excess mortality of 15.24 per 10,000, approximately twice the European mean and 49% higher than neighboring Austria. This mixed-methods comparative case analysis examined relevant data from March 2020 through December 2023. Austria was chosen as a comparative governance benchmark to the Czech Republic because it closely matched that country's initial governmental trust level (entering the pandemic within approximately two percentage points), and Slovakia is a historically and geographically proximate comparator. Age-standardized excess mortality was examined alongside government trust measures, mobility indicators, vaccination data, and policy stringency indices. Exploratory lag correlations assessed the temporal relationship between changes in trust and subsequent mortality. Czech governmental trust declined from approximately 71% to 19% during the pandemic period, among the largest declines in Europe. Austrian trust remained comparatively stable, whereas Slovakia also experienced a substantial decline in trust alongside high excess mortality. Czech mortality divergence from Austria emerged approximately 8-10 weeks after trust deterioration. Four mechanisms are proposed through which trust erosion may have influenced mortality: reduced compliance with public health measures, vaccine hesitancy, collapse of contact tracing, and governance-associated misperceptions of the scientific consensus. This analysis suggests that governance stability and institutional trust appear to function as important public health pandemic preparedness measures.
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5. Addressing Social and Cultural Needs with Lean Management in a National Sample of US Physician Practices.
PMID:日期:2026-09-12Policy Points This national study of US physician practices finds that lean management, an approach to operational excellence and continuous quality improvement, can support integration of social and cultural services in primary care. The Centers for Medicare & Medicaid Services and commercial payers can expand programs including value-based, two-sided risk and global budget payment models that incentivize social screening and follow-up, language assistance, and workforce training to improve quality for vulnerable populations while reducing inequities in health care. The Centers for Medicare & Medicaid Services may also consider requirements that physician practices implement operational or performance excellence systems, such as lean management for quality and process improvement, as a condition for participating in value-based programs. Health-related social needs-including stable housing, food security, and interpersonal safety-and patient race, ethnicity, and language (REAL) are key contributors to health equality. Although primary care practices are well positioned to connect patients with resources and provide ongoing support, integrating interventions into clinical workflows remains challenging. This study examines how lean management, a quality improvement approach that emphasizes standardized work processes and respect for people, can support practices in addressing the needs of diverse populations. We leveraged data gathered from a nationally representative sample of 1,245 US physician practices. Key independent variables included lean implementation and practice use of specific techniques such as value stream mapping, daily management systems with standard work, and rapid-cycle process improvement. We conducted multivariate regressions to assess relationships between the extent of lean implementation and availability of social and cultural support in primary care. Practices that implemented lean displayed 2.72 times the odds of having social screening, referral, and follow-up systems in place (95% CI, 1.20-6.19), and 2.85 times the odds of training providers on how to care for underserved populations (95% CI, 1.53-5.28). These practices also offered more language assistance (odds ratio [OR], 2.16; 95% CI, 1.22-3.82), routine collection of patient REAL data (OR, 3.75; 95% CI, 1.98-7.09), and more confidently addressed issues of race and/or discrimination among patients and staff (β: 0.12, P = .040). Value stream mapping, care team huddles, daily management, rapid-cycle improvement, and use of analytic tools were associated with higher odds of all sociocultural support measures, except for clinician representativeness of patients in terms race/ethnicity. Lean management can support efforts to address patient needs by facilitating social risk intervention and culturally responsive care. Attending to social and cultural needs in US physician practices may improve patient experiences and health outcomes, while reducing avoidable health care costs for individuals and populations.
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6. The Inverted Circuit: Attribution, Answerability, and Accountability in Canadian Health Governance.
6. 倒置的回路：加拿大卫生治理中的归因、问责与责任追究PMID:日期:2026-09-11Policy Points Canada and the United States have not failed for want of accountability mechanisms in health governance. They have failed because accountability is repeatedly invoked where attribution and answerability are not already standing, so the result is the punishment of visible individuals rather than structural correction. The corrective is to restore the order of dependency: first name which institution is responsible for an outcome, then require it to report against a benchmarked standard set in advance, and only then attach consequences. Applied in this order, the framework transfers to any federated system in which central funding flows without binding accountability for results. Structural correctives require independent oversight bodies whose mandate, funding, and membership are insulated from the institutions they regulate; proactive mandatory reporting against pre-set standards; and explicit attribution of population-level outcomes to named institutional responsibilities. Canada and the United States have pursued health-system accountability for decades through inquiries, commissions, and public reporting, yet the same governance failures recur. This Perspective argues that accountability has repeatedly been reached for before the conditions that make it coherent were in place. The paper develops a conceptual framework, the fiduciary circuit. The analysis draws on inquest and commission records, the safety-science and governance literature, and illustrative program- and system-level cases from cardiac care and intergovernmental health financing in Canada and the United States. Attribution, answerability, and accountability stand in a relation of logical dependency rather than temporal sequence: accountability is incoherent unless responsibility has first been assigned and answerability secured. Where the circuit is closed, as in Manitoba's CODE STEMI program for acute heart-attack care, outcomes improve; where it is entered at accountability after a failure, as in federal-provincial transfers, it produces the scapegoating of visible individuals while structural conditions persist. The recurring signature is that improvement which is not structurally protected is not retained. The corrective is not another comprehensive reform but Popperian piecemeal engineering paired with independent statutory bodies whose mandate, funding, and membership are insulated from the institutions they regulate. Naming who is responsible, requiring them to answer against standards set in advance, and only then holding them to account is the order the fiduciary tradition has always demanded.
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7. The State of Primary Care in the United States.
PMID:日期:2026-09-11Policy Points Primary care, when done well, is the country's most cost-effective solution to runaway costs and widening health outcome gaps. Primary care is increasingly starved for resources, with associated reductions in relational continuity and comprehensiveness that collectively increase the risk of losing patient trust. The 2021 National Academies of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, supported a cascade of federal initiatives to strengthen, coordinate, and create accountability for primary care strategies, and although several derailed, they remain options for improving health and health care. The 2021 National Academies of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, spurred a cascade of federal payment, access, and accountability initiatives, but inconsistent federal leadership has derailed several of them. Congressional and HHS health goals would benefit from reviving stalled primary care infrastructure projects, establish outcome accountability for graduate medical education investment, and build on state models in Maryland, Rhode Island, Vermont, and California. Primary care is the foundation of a high-functioning health system, yet it has been weakened for decades, and the consequences for patients, population health, and costs are increasingly apparent. The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report offered 16 recommendations across five objectives for rebuilding primary care through payment, access, workforce training, health information technology, and accountability. This Perspective reviews federal and state policy developments since the NASEM report against its five-objective framework, examining payment demonstration models, minimum primary care spend legislation, graduate medical education financing, and federal data infrastructure initiatives to assess where reform has taken hold, stalled, or been abandoned amid shifting administration priorities. Partial payment successes, including the Advanced Primary Care Management code, the AHEAD model, and minimum-spend policies in nearly a dozen states, demonstrate that reform is feasible. Yet inconsistent federal leadership has undermined progress: the Making Care Primary model was abruptly terminated, and several near-complete Agency for Healthcare Research and Quality initiatives-a primary care dashboard, Healthcare Extension Cooperatives, and a clinician/practice database-were lost amid the agency's proposed dissolution. Meanwhile, cuts to Affordable Care Act subsidies and Medicaid threaten to disrupt care for millions and widen mortality gaps. States are increasingly serving as policy laboratories, with Maryland, Rhode Island, Vermont, and California offering replicable models for payment and accountability reform. The technical solutions needed to strengthen primary care largely already exist. What is missing is durable, coordinated federal and state investment paired with accountability. Securing primary care's future requires treating it as essential public infrastructure.
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8. Building a Resilient Substance Use Disorder Treatment Safety Net in An Era of Austerity: Challenges for US State Governments.
PMID:日期:2026-09-09Policy Points State governments play a central role in reducing the health harms of substance use. This role has grown over the past two decades because of the evolving opioid crisis, expanded Medicaid eligibility, and new federal grants. Recent declines in drug overdose and improvements in services have been spurred by supportive federal policies and Medicaid funding, but progress could be undercut by ongoing federal policy changes. States seeking to maintain their progress in reducing overdose mortality and addressing substance use disorders will need to sustain investments in strategies that have expanded the continuum of specialty services and promoted integration with primary care, with vigilance to not backslide toward siloed, short-term services. State governments play a central role in the delivery of substance use care in the United States, which has a profound impact on public health. Their role has grown substantially over time, as they have assumed more functions and confronted an unprecedented drug overdose crisis. While states have a wide array of regulatory and financing tools, they are confronting both longstanding challenges coordinating services and new headwinds from federal policy. We examine historical and recent case studies in state substance use policy and synthesize key lessons. States have undergone a massive transformation since the Affordable Care Act in their financing, but treatment services mostly remain segregated from general health care and partnerships across agencies remains a challenge. We highlight promising examples where states have pioneered new approaches to oversight, quality of care, or standards. Anticipated budgetary pressures, including the impact of the "One Big Beautiful Bill" on Medicaid funding, will put further pressure on states to innovate, but also place major gains-such as the recent decline in overdose deaths-at risk.
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9. Improving the Outlook for Infectious Disease Control in the United States Through State-Led Initiatives.
9. 通过州主导的举措改善美国传染病控制的前景PMID:日期:2026-09-04Policy Points This is a pivotal time for state leaders and policymakers to lean into opportunities to enhance infectious disease control in the United States. There are extensive opportunities for state-led initiatives to be influential in the areas of public health infectious disease detection, public health funding, and public health infrastructure. It is imperative to remember that "all responses are local" and that the ultimate authority to detect, investigate, control, and prevent the spread of infectious diseases in the United States falls to states. Over the last decade, the United States has encountered numerous infectious disease-related public health threats, observed declines in life expectancy and childhood vaccination rates, and experienced rapid changes and reorganizations to the domestic public health system. There is a window of opportunity for state leaders and policymakers to strengthen state, tribal, local, and territorial public health infrastructure amidst a changing federal landscape in order to ensure optimized infectious disease control in the United States. This perspective synthesizes evidence from the public health literature and draws on the collective experience of the authors working in the applied public health field. We offer considerations for state leaders and policymakers to ensure optimized infectious disease control in the United States though state-led initiatives and direction. Although many public health activities related to infectious disease detection, investigation, control, and prevention are funded and directed by federal public health authorities, state, tribal, local, and territorial health departments have held the legal authority for this work since the early 19 century. Recent changes and relative instability at the federal level are noteworthy; however, "all responses are local" and the ultimate authority to detect, investigate, control, and prevent the spread of infectious diseases in the United States falls to states. State leaders have a duty and responsibility to protect the health of their population and ensure a posture of readiness to effectively respond to infectious disease health threats. States can step forward and embrace innovation in this space to ensure optimized infectious disease control in the United States prior to the next emerging infectious disease public health threat.
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10. Vaccine Policy: The State Role in a Time of Public Health Disruption.
10. 疫苗政策：公共卫生危机时期的州角色PMID:日期:2026-09-04Policy Points Over the past year, the nation's highest-ranking public health officials have pursued a concerted strategy of degrading access to childhood vaccines and undermining public confidence in vaccine safety and efficacy. As primary regulators of medical care, states have the power to maintain strong public health protections. A strong childhood vaccination policy has three components: maintaining a robust routine childhood vaccination schedule; focusing on broad vaccine access; and restoring public confidence in the safety and efficacy of childhood immunization. Beginning in 2025, longstanding opponents of vaccines have held the highest positions of federal public health policy powers. Using these powers, high ranking officials have sought to disrupt vaccine coverage and delivery and sow public mistrust in vaccine safety and efficacy. The results of their efforts have been confusion and declining levels of childhood immunization. As of summer 2026, a federal court has enjoined efforts to degrade the childhood vaccine schedule and the public health expertise of the Advisory Committee on Immunization Practices, whose recommendations lie at the heart of US vaccine policy. As the nation's most important regulators of public health practice, states play a critical role in countering these efforts and protecting vaccine accessibility and acceptance.