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This meta-analysis of 47 studies on 42 473 physicians found that burnout is associated with 2-fold increased odds for unsafe care, unprofessional behaviors, and low patient satisfaction. The depersonalization dimension of burnout had the strongest links with these outcomes; the association between unprofessionalism and burnout was particularly high across studies of early-career physicians. (Panagioti et al, 9/4)

During the last century, California policy makers tried multiple approaches to achieve the goal of affordable health coverage for all: employer and individual requirements, single payer, and hybrids. All failed, primarily because of the amount of financing needed to cover the large numbers of uninsured Californians and the supermajority vote requirements for tax increases. These failures, however, provided important lessons for state and national reform efforts. More immediate success was achieved with incremental reforms, such as child health insurance, Medicaid section 1115 waivers, and the creation of purchasing pools. These reforms, as well as the experience derived from the broader coverage expansion efforts, contributed to the intellectual and policy frameworks that underlay major national reforms and created building blocks for the state’s successful implementation of the Affordable Care Act. That act allowed California to meet its greatest need: the financing required to make a truly sizable dent in the numbers of uninsured Californians. (Zelman and Wulsin, 9/1)

The historical narrative on diversity, race, and health would predict that California’s population change from 22 percent racial/ethnic minority in 1970 to 62 percent in 2016 would lead to a massive health crisis with high mortality rates, low life expectancy, and high infant mortality rates—particularly given the state’s high rates of negative social determinants of health: poverty, high school incompletion, and uninsurance. We present data that suggest an alternative narrative: In spite of these negative factors, California has very low rates of mortality and infant mortality and long life expectancy. This alternative implies that racial diversity may offer opportunities for good health outcomes and that community agency may be a positive determinant. Using national-level mortality data on racial/ethnic groups, we suggest that new theoretical models and methods be developed to assist the US in achieving high-level wellness as it too becomes “majority minority.” (Hsu, 9/1)

Federal and state policymakers are weighing changes to federal programs that help low-income people meet their basic needs for food, medical care, and shelter. As policymakers consider these changes to the public safety net, they run the risk of increasing material hardship, which could have detrimental short- and long-term impacts on children and adults. (Michael Karpman, Stephen Zuckerman and Dulce Gonzalez, 8/28)

In this cohort study of data from a large commercial health plan from 2008 to 2015, emergency department visits per enrollee for the treatment of low-acuity conditions decreased by 36%, whereas utilization of non–emergency department acute care venues increased by 140%. There was a net increase in overall utilization of acute care venues for the treatment of low-acuity conditions and in associated spending. (Poon, Schuur and Mehrotra, 9/4)

As a federal court considers a challenge to the Affordable Care Act’s constitutionality, the public, including most Republicans, wants protections for people with pre-existing conditions preserved, the latest Kaiser Family Foundation tracking poll finds. Large majorities of Americans say it is “very important” to retain the ACA provisions that prevent insurance companies from denying coverage based on a person’s medical history (75%) and from charging sick people more (72%). This includes majorities of Democrats, independents and Republicans, as well as majorities of those with and without people with pre-existing conditions in their households. (9/5)