The Milbank Quarterly

Cover image for Vol. 94 Issue 4

Edited By: Howard Markel

Impact Factor: 4.375

ISI Journal Citation Reports © Ranking: 2015: 3/75 (Health Policy & Services); 6/88 (Health Care Sciences & Services)

Online ISSN: 1468-0009

Author Guidelines


All potential authors submitting articles to the Quarterly must familiarize themselves with and agree to follow the recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals as delineated by the International Committee of Medical Journal Editors (ICMJE). See Submissions should be sent electronically to the Quarterly and include a cover letter. Please email Word files of the manuscript to

The editor-in-chief, Howard Markel, will make an initial determination about the suitability of the manuscript for the Quarterly. Manuscripts that are potentially suitable will be subject to blind peer review regarding scholarly soundness and substantive significance. When the manuscript is submitted, the corresponding author must submit two forms signed by each author indicating that he or she has read and complied with the Quarterly's publication policies. The corresponding author is the person to whom correspondence will be sent and the author responsible for the accuracy and completeness of the manuscript's acknowledgments, for communication with the other author(s) about changes made during copyediting and production, and for final approval of proofs. Upon acceptance of an article, the corresponding author will be directed to sign a copyright transfer form on behalf of his or her coauthor(s) before the article can be published.

Questions about the submission process may be directed to Tara Strome, publications associate, at


Before submitting your manuscript, please be sure you have prepared it according to the following instructions.


The length of submitted text ordinarily should not exceed thirty pages, excluding abstract, acknowledgments, figures, tables, and references.


All text must be typed double-spaced using Times New Roman 12-point font, with tabs to indicate new paragraphs. All pages must be paginated consecutively and include line numbers.

Title Pages

On the title page list the names of each author in the order the names should appear if the manuscript is published, including academic degrees and affiliations, as well as the complete address, telephone number, and email address of the corresponding author. Also provide the number of pages for text only as well as any necessary acknowledgments as described in the Quarterly's publication policies.

To facilitate blind review, include a second title page with only the manuscript title. In addition, please eliminate any internal information (including acknowledgment of funding sources and self-identifications in citations) that reveals authorship.

Policy Points

Manuscripts must include "policy points," a two-to-three bullet point synopsis (fewer than 100 words) of the article's import on explicating or advancing a particular set of health policies. As the abstract presents, in an abbreviated form, the scholarly design and results of a study, the policy points will serve as your "elevator pitch" to alert policy makers and policy implementers about the ramifications of the study.

Structured Abstract

Manuscripts must include a structured abstract of 250 to 300 words using the following headings:

Context: The abstract should begin by explaining the article's background, objectives, and salience for policy and research.

Methods: Describe the procedures used to obtain and analyze data and/or research materials.

Findings: Summarize the results of your analyses.

Conclusions: Summarize the implications of the findings for policy, practice, and further research.


The structured abstract should be accompanied by up to four keywords for indexing. Keywords used by MEDLINE/PubMed’s MeSH system are preferred because they facilitate searches (, but terms not in MeSH may be used when MeSH terminology is not adequate.

Systematic Reviews

For the convenience of reviewers, manuscripts that are systematic reviews should be accompanied by the protocol used by the authors to conduct the review unless that information is provided in the body of the manuscript.


Tables and figures should be explicitly mentioned in text and be numbered consecutively with arabic numerals in the order they are cited in the text (e.g., Table 1, Table 2, Figure 1, Figure 2). Tables and figures should be self-explanatory and include a title; each figure should have a separate legend. For both tables and figures use superscript lowercase letters in alphabetical order (a-z) to identify any footnotes. Any references cited for information used in the tables or figures should be numbered in sequence with references cited in the text (e.g., a Data from the US Census Bureau.5). Submitted artwork should be in printer-ready format, in black and white, and sized to fit within the Quarterly's page space of 4.3 by 6.9 inches, using Times New Roman for text. If you use data from another published or unpublished source, obtain written permission and acknowledge that source fully (e.g., a Reproduced with permission from the American Medical Association.41).


The Quarterly does not use footnotes, except in tables and figures, nor does it use endnotes. Such explanatory material should be incorporated into the text.


All sources used in preparing your manuscript must be properly acknowledged. Please be sure that all references are complete and accurate and cited correctly in text. References should be numbered consecutively in the order in which they are first cited in the text and should be identified in text, tables, and figures with superscript arabic numerals, inserted outside periods and commas, inside colons and semicolons. A reference first or only cited in a table or figure should be numbered so that it is in sequence with references cited in the text at the first text mention of the particular table or figure. When formatting references, follow the AMA Manual of Style, 10th edition, and abbreviate journal names according to their listing in PubMed. List all authors unless there are more than six, in which case list only the first three authors followed by "et al." The following are sample references:

1.  Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012;31(1):219-230. Accessed February 12, 2012.

2.  Sweeney P, Gardner LI, Buchacz K, et al. Shifting the paradigm: using HIV surveillance data as a foundation for improving HIV care and preventing HIV infection. Milbank Q. 2013;91(3):558-603. doi:10.1111/milq.12018.

3.  World Health Organization. The World Health Report: Health Systems Financing: The Path to Universal Coverage. Geneva, Switzerland: World Health Organization; 2010. Accessed September 9, 2012.

4.  Bosk CL. Forgive and Remember: Managing Medical Failure. 2nd ed. Chicago, IL: University of Chicago Press; 2003.

5.  Glanz K, Rimer BK. Perspectives on using theory: past, present, and future. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass; 2008:509-518.

6.  Ellis J, Luther M. Restaurants want a piece of food stamp pie. USA Today. September 7, 2011. Accessed November 15, 2011.

7.  Appleby J. California law likely resulted in lower bills, free care for uninsured. Kaiser Health News website. Published June 3, 2013. Accessed July 25, 2013.

8.  Pioneering applied scientific research in healthcare. ECRI Institute website. Accessed August 7, 2013.

9.  Patient Protection and Affordable Care Act, Pub L No. 111–148, 124 Stat 119 (2010).

10.   Arnett P. Local Health Department Changes Over the Past Twenty Years [dissertation]. Lexington: University of Kentucky; 2011.

11.   Durie M. An indigenous model of health promotion. Paper presented at: 18th World Conference on Health Promotion and Health Education; April 27, 2004; Melbourne, Australia.

12.   Chapman BP, Hampson SH, Clarkin J. Personality-based interventions for healthy aging: results from a National Institute on Aging workgroup. Dev Psychol. In press.

References to material not yet accepted for publication or to personal communications are not acceptable as listed references and instead should be cited parenthetically in the text, e.g., "Similar findings have been noted by Johnson6 and by P.J. Martin, MD (written communication, August 2013)." Written permission should be obtained from the person whose unpublished data or personal communication is thus cited.


All potential authors submitting articles to the Quarterly must familiarize themselves with and agree to follow the recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals as delineated by the International Committee of Medical Journal Editors (ICMJE). See When the manuscript is submitted, the corresponding author must submit two forms signed by each author indicating that he or she has read and complied with the Quarterly's policies regarding (1) authorship; (2) financial support and potential conflicts of interest; and (3) prior dissemination. The corresponding author is the person to whom correspondence will be sent and the author responsible for the accuracy and completeness of the manuscript's acknowledgments, for communication with the other author(s) about changes made during copyediting and production, and for final approval of proofs. Upon acceptance of an article, the corresponding author will be directed to sign a copyright transfer form on behalf of his or her coauthor(s) before the article can be published. The policies are described below.

Forms may be sent by mail, fax, or email to:

Tara Strome
Publications Associate
Milbank Memorial Fund
645 Madison Avenue
15th Floor
New York, NY 10022

Phone: 212-355-8400
Fax: 212-355-8599

Questions about the submission process may be directed to Tara Strome, publications associate, at Click here for instructions for preparing your manuscript.


Each author of a manuscript submitted to The Milbank Quarterly must meet the following authorship criteria set forth by the ICMJE, certifying that he or she has (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and (2) made substantial contributions to the drafting of, or critical revisions to, the work for important intellectual content; and (3) given final approval of the version to be published; and (4) agreed to be accountable for all aspects of the work.

Accepted manuscripts are copyedited according to Quarterly style and returned to the corresponding author for approval. Authors are responsible for all statements made in their work, including changes made during copyediting and production that are authorized by the corresponding author.

All other persons who have contributed substantially to the work reported in the manuscript (e.g., who provided assistance with study design, data collection or analysis, or manuscript preparation) but who do not fulfill the authorship criteria must be named in the manuscript's acknowledgments, including their specific contributions. The corresponding author must obtain written permission to include the names of all individuals in the acknowledgments as readers may infer their endorsement of the work's data and conclusions. The corresponding author must submit this documentation if requested by the editorial office.

Financial Support and Potential Conflicts of Interest

When a manuscript is submitted, all authors of the manuscript must complete the ICMJE Form for Disclosure of Potential Conflicts of Interest. In addition, the manuscript's acknowledgments must include any potential conflicts of interest or situations that could give the appearance of a conflict of interest, as disclosed in the ICMJE Form, resulting from authors' financial, personal, or professional affiliations as well as any financial and material support for the work reported in the manuscript. This information will be published in conjunction with the manuscript. The corresponding author is responsible for ensuring that the disclosures reported in the manuscript's acknowledgments are accurate, current, and consistent with the information provided in each author's ICMJE Form.

A potential conflict of interest exists when an author has relationships with organizations or involvements in activities that could inappropriately influence his or her research or presentation of results and conclusions, whether or not such influence occurs. The most important potential conflicts of interest are financial relationships of an author and/or a member of his or her immediate family or household with organizations that have a pecuniary interest in any data or findings reported in the manuscript. Such relationships include, but are not limited to, a role in the governance of an organization, employment, paid or voluntary consultation or expert testimony, stock ownership, and receipt of honoraria or other financial support. (Persons invited to review manuscripts submitted to the Quarterly must also disclose to the editor-in-chief any conflicts of interest that could bias their evaluation of the manuscript.)

Prior Dissemination

The policy of The Milbank Quarterly is to consider for publication only original work that has not previously been published and is not being considered for publication elsewhere. Below is guidance on this issue.

There are legitimate reasons why research may be disseminated before submission to a journal. Active communication among researchers about preliminary findings or the circulation of draft reports for discussion and critique contributes to the eventual quality of published work. In addition, organizations that support or carry out research have an understandable interest in disseminating their work. These reasons for dissemination must be balanced against two considerations. The first is the value of the peer-review process. The rule against prior publication is intended to increase the credibility of published research. Papers are often improved during the peer-review process, with findings, conclusions, and recommendations sometimes changed in response to reviewers' comments. The public and policymakers might be confused or misled if there are multiple versions of a paper in the public domain. Second, journal space is limited, and both time and expense are involved in the evaluation, publication, and distribution of journal articles. The Milbank Quarterly must make difficult choices about what to include; there is less value in publishing papers that have already been disseminated to their target audiences.

Below, we discuss several types of dissemination and provide guidelines with respect to the prior publication question. This discussion is essentially an elaboration of two rules, the first emphasizing previous dissemination of the material, the second stressing disclosure.

Rule One: If the material in a paper has already been disseminated to the Quarterly's audience, particularly in a format that appears to be a final product, then it is unlikely that a second version will be worth publishing in the journal.

Rule Two: It is the responsibility of authors to let the editor-in-chief know at the time of submission if a paper's contents have been previously disseminated in any manner so that the editor-in-chief can determine whether to proceed with the review process.

Previous Presentation at Meetings. Presentation of a paper at conferences or seminars does not constitute prior publication and does not jeopardize the possibility of publication.

Working Papers. Dissemination of "working papers" to a limited audience will not ordinarily jeopardize publication. Working paper series are used by many organizations as a means of enabling researchers to obtain critiques from fellow researchers. Working papers covered by this policy are those that are released by the author or an organization rather than by a publisher, are not advertised to the public, and are marked as drafts that are subject to future revision.

Internet Postings. Release via the Internet may jeopardize journal publication under some circumstances. Presentation of the work as a final report is a marker of an attempt to reach a wide audience, particularly when combined with efforts to direct traffic to the work (e.g., via links on other sites) and efforts to attract attention (e.g., press releases). In contrast, if a document is posted on the Internet only to facilitate communication among colleagues with the aim of getting feedback, and if there has been no attempt to otherwise attract the attention of journalists, the public, or the broader research community to the document, then this is unlikely to preclude journal publication.

In general, when posting on the Internet serves similar functions as presentation at professional meetings—facilitating the development of papers and the improvement of the research, influencing future revisions, and not constituting a "finished" product—it would not be considered prior publication. However, when the website posting functions as a virtual version of a conventional publication, which may even be copyrighted by the posting organization, the benefit of an additional publication in the journal will be scrutinized carefully.

In cases where there has been little to no exposure at the time that a paper is submitted to the journal, but the circumstances surrounding the posting make it likely that a high level of exposure (press coverage, etc.) might occur, then the author should remove a posting as a condition for further consideration of the manuscript.

Authors who post a paper on a website and do not want it to constitute prior publication should also post a disclosure statement such as: "This draft paper is intended for review and comments only. It is not intended for citation, quotation, or other use in any form." This statement should be kept on the website throughout the review process and until the paper is actually accepted for publication in the journal. Once accepted, authors must amend this statement as follows: "This is a preprint of an Article accepted for publication in The Milbank Quarterly © (year) The Milbank Memorial Fund."

Formal Reports from Foundations, Academic Institutions, Institutes, Trade Associations, and Government Agencies. The dissemination efforts of foundations, government agencies, research institutes, and other organizations that support or carry out research can complement publication in peer-reviewed journals. If publication in The Milbank Quarterly is desired, organizational publications should be timed to coincide with or follow publication of the article in The Milbank Quarterly, with appropriate copyright permissions having been obtained. This sequence ensures that any deficiencies of method or presentation noted during the peer-review process will be able to be corrected.

Formal, published reports that have gone through an editorial process, that have been intended to reach a wide audience, and that are publicized and available to any interested party (whether free or not) usually will not be considered for journal publication. A paper that is based on such a report might be considered for publication if it were sufficiently different in emphasis or intent. In such instances, the author should explain at the time of submission (or before) how the paper differs from the previously released report and why its publication would represent a distinct and important contribution beyond that version.

Media Publicity. If results reported in a working paper have become widely known as a result of media exposure (or even if the potential for widespread exposure remains during review), and that working paper is readily available to interested readers (e.g., through a website), an editorial judgment will be made whether journal publication would be appropriate. Authors can help protect their work from unwanted media exposure by making clear on working drafts, copies presented at conferences, and other versions that it is a draft that has not yet undergone peer review for publication and that findings and conclusions are subject to change. Authors should also request that any "stories" derived from interviews with the media be embargoed until the article has been published or released by the publisher (see, for example, P.B. Fontanarosa and C.D. DeAngelis, "The Importance of the Journal Embargo," 2002;288(6):748-750. doi:10.1001/jama.288.6.748). Any accepted manuscript released to the media must contain the statement: "This is a preprint of an Article accepted for publication in The Milbank Quarterly © (year) The Milbank Memorial Fund." Authors should check with the editor-in-chief before speaking with or distributing papers to members of the media.

Importance of Disclosure. Prior to, or at the time of, submission of a paper that has been disseminated in any of the ways discussed above, authors must bring this to the attention of the editor-in-chief so a determination can be made whether the paper has been disseminated too widely for publication in The Milbank Quarterly. In so doing, authors should describe in what form and how the work was previously disseminated and how the submitted manuscript differs from previously disseminated versions. The editor-in-chief might be receptive to a modified version of a paper that has been widely disseminated if the submitted version has a different focus (e.g., more emphasis on methods, more sophisticated analytic approach, or a discussion of developments that have transpired since the initial dissemination). The key point is to let the editor-in-chief know about any dissemination that will have, or is likely to have, occurred before the article goes through the Quarterly's peer-review and editorial processes. Authors should also include copies of other related papers that might be seen as covering the same material.

Failure to disclose prior dissemination could preclude publication in The Milbank Quarterly or, if already published, could result in a notice in the journal about the failure and may result in a retraction of the article.

Copyright Transfer

The Milbank Quarterly requires the corresponding author of an article accepted for publication to transfer copyright to the Milbank Memorial Fund on behalf of his or her coauthor(s), except for authors who cannot transfer copyright because they were employees of the U.S. federal government when the work described in the manuscript was conducted.

Author Rights

Authors who register their article on Author Services will have free online access to their published article on Wiley Online Library (John Wiley & Sons publishes The Milbank Quarterly on behalf of the Milbank Memorial Fund). Copyright in the article rests with the Milbank Memorial Fund. The Milbank Memorial Fund grants back to both the corresponding author and all coauthors the right to arrange for free online access to their article to up to ten colleagues each for noncommercial use; to use all or part of the article and abstract, without revision or modification, in personal compilations or other publications of their own works; and to make copies of all or part of such materials for their use for lecture or classroom purposes (excluding the preparation of course pack material for onward sale by libraries and institutions), provided that the first page of such use or copy prominently displays the bibliographic data and the following copyright notice: "© (year) The Milbank Memorial Fund."

Following publication of their article, authors may continue to post the accepted version of their manuscript on the Internet with the following amended notice: “This is a preprint of an electronic version of an Article published in The Milbank Quarterly” along with complete citation information including identifying the Milbank Memorial Fund as the copyright holder. Authors are encouraged to include a link to the published article on Wiley Online Library. Posting of the published version of the article on the Internet can only be done with written permission from John Wiley & Sons. For information on obtaining permission please click here.

Authors also have the option of giving their published article permanent open access status by registering their article on Online Open, a service of John Wiley & Sons. The article will be immediately available free of charge in both HTML and PDF formats on Wiley Online Library. Additionally, authors may post a link to their article on Wiley Online Library and/or post the final, published PDF on a website, institutional repository, or other free public server. The cost for Online Open is US$3,000. For further information and to register, please click here.

For authors choosing OnlineOpen

If you decide to select the OnlineOpen option, please use the links below to obtain an open access agreement to sign [this will supersede the journal’s usual license agreement]. By selecting the OnlineOpen option you have the choice of the following Creative Commons License open access agreements:

Creative Commons Attribution Non-Commercial License OAA

Creative Commons Attribution Non-Commercial -NoDerivs License OAA

To preview the terms and conditions of these open access agreements please click the license types above and visit

If you select the OnlineOpen option and your research is funded by The Wellcome Trust and members of the Research Councils UK (RCUK) you will be given the opportunity to publish your article under a CC-BY license supporting you in complying with Wellcome Trust and Research Councils UK requirements. For more information on this policy and the Journal’s compliant self-archiving policy please visit:

For RCUK and Wellcome Trust authors click on the link below to preview the terms and conditions of this license:

Creative Commons Attribution License OAA