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Health Affairs, 23, no. 3 (2004):
7-8
doi: 10.1377/hlthaff.23.3.7 © 2004 by Project HOPE |
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From the Editor |
Global Health Policy And Free Access To Information
While many Americans grouse about the high cost of medical care in the United States, their willingness to pay is strong evidence of the value they place on having ready access to these services. But little real research has documented why Americans pay so much more than citizens in other industrialized countries and how U.S. medical prices compare with the growth of other personal consumption spending in this country. In our lead paper Uwe Reinhardt, Peter Hussey, and Gerard Anderson explore these subjects and compare the growth of medical spending with the growth of spending for food, housing, transportation, and household operation since 1970. In sharp contrast, Naoki Ikegami and John Campbell write in the next offering that tighter cost controls have led to an actual reduction in medical spending in Japan. Following, Simon Stevens discusses major changes in England’s National Health Service that the Blair government is pursuing in tandem with the infusion of new resources, and Wynand van de Ven and colleagues write on efforts to refine risk-adjusted premium subsidies in the Dutch health care system.
The Commonwealth Fund has once again joined us in our ongoing effort to provoke a richer dialogue of exchange on broad issues of health policy that face all countries, be they industrialized or developing nations. Following publication of this issue, our collaboration with the Commonwealth Fund will move largely from published content in the journal to our Web site. At the same time, we plan to expand the scope of international papers that we publish. The first of these papers, published in this issue, discuss the controversy over patents and access to drugs in developing countries and how the General Agreement on Trade in Services (GATS) may influence the shape of domestic health care systems.
Over the past decade the Internet has increasingly become the medium through which biomedical scientists and to a lesser degree health services researchers publish their work. Recently, advocates of open access to all online information have launched a movement that turns the way journals have typically been financed on its head. Instead of subscribers paying for original research that is posted on Web sites or published in journals, the movement, called the Public Library of Science (PLoS), charges authors $1,500 per accepted paper to cover the costs of processing them. Financed initially through a grant of $9 million from the Gordon and Betty Moore Foundation, PLoS is led by a former director of the National Institutes of Health, Harold Varmus, who is now chief executive of the Memorial-Sloan Kettering Cancer Center. Once a paper has been accepted and the author’s fee paid, the manuscript is then made freely available on PLoS’s initial publication, called PLoS Biology, which competes directly with the leading scientific journals—Cell, Nature, and Science. Next PLoS plans to launch PLoS Medicine, a new competitor of all general medical journals. An overriding goal of PLoS is to thwart further increases in the subscription price of scientific journals. The commercial leader, Reed Elsevier, charges upward of $20,000 per year for subscriptions to some of the 1,600 journals it publishes.
While the major target of PLoS is commercial publishing, its not-for-profit counterpart (of which Health Affairs is a part) also has become caught up in Varmus’s movement, which does not differentiate between the two. On March 16 I took part in a briefing to announce the Washington D.C. Principles for Free Access to Science. These principles were drafted and signed by a coalition of forty-eight not-for-profit scientific, technical, and medical publishers that publish 380 scholarly journals. Together, the journals have archived more than 800,000 papers online, of which some 447,000 are free. These nonprofit journals, which represent many of the "highest-impact" journals in their fields, have agreed to publish selected important articles free online at time of publication; make the full-text archives freely available to everyone worldwide within a relatively short time frame; make all journal content available free to scientists and researchers in many low-income nations; and make articles free online via reference linking between these journals. Readers can view the full set of principles on our Web site, www.healthaffairs.org.
Health Affairs currently offers Web Exclusives and many journal sections free immediately. The full online archive, which goes back to Volume 1, Number 1, is available free to all three years after publication. This twenty-three-year online archive is highly unusual in a field where most journals offer only several years of full text online. For researchers in developing countries, we offer free online subscriptions and are seeing a tremendous leap in international readership of Health Affairs online. Health Affairs is able to offer this high level of free access only with the generous support of many foundations.
Founding Editor
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