The Department's research agenda aims not only to generate evidence, but also to explore is implications and uses for policies on medical research, the funding and regulation of care, payment to providers, and other variables that shape the ability of health care systems, Western and other, to sustain affordable universal coverage and high quality care. Our large dataset analyses have focused on important policy challenges, such as volume-outcome relationships, readmission models, and learning curves. Our economic research is mostly centered on cost-effectiveness analysis.
Health policy denotes public (i.e. governmental) interventions in the workings of health care institutions and the system(s) of which they are part. Public policies and programs (mainly federal and state) have become the source of coverage for a sizable share of the citizenry, account for roughly half of US health care spending, and now aggressively seek to reshape the financing and delivery systems. The study of healthcare policy is therefore centrally important to the theory and practice of population health management. The Division’s policy interests center on five areas:
Health care as an economic challenge.
The US healthcare system spends about 17 percent of the nation’s GDP and roughly $9000 per capita annually, figures that far exceed those of comparable Western nations with affordable universal coverage. Some contend that as much as 30 percent of this spending is “waste”; others view it mainly as the fruit of medical innovation that produces “good stuff” highly valued by consumers. The recent slowdown in the rise of health care spending has led some observers to argue that policy innovations—a shift from fee for service to value based payment, the advent of accountable care organizations, and more—are finally getting the cost problem under control; others insist that the nation’s health care spending remains economically unsustainable. Illuminating the debate on these tangled issues is crucial to forging strategies to define and advance population health management, which is expected, among other things, to save money.
Healthcare as a multisectoral enterprise.
The institutional complexity and heterogeneity of the US health care system is striking. Health care institutions inhabit the nonprofit, for profit, and public sectors of society and all three ownership types are found at local, state, and national levels of government. The reluctance of the US to adopt overarching rules of the game for the system as a whole implies, indeed creates, extensive variation in the balance of power among providers, payers, and other actors, who defy easy generalization about “the system” and can be understood only by close inspection of, and comparison among, a range of communities and markets.
Healthcare as a system of organizations in flux.
The core missions of health care organizations are increasingly beclouded and ambiguous. For example, hospitals that fill their beds may be failing in their mission to keep “their” populations healthy and out of emergency rooms and inpatient wards. Amid persistent efforts to reorganize the system by means of ACOs and other innovative entities, providers and payers increasingly seek to protect their power by integrating, horizontally and/or vertically. How all this organizational disruption shapes the potential for effective population health management is an inquiry that stands high on the department’s research agenda.
Healthcare as a nexus of (inter)dependencies.
The practical meaning of population health management has been complicated recently by growing attention to the “social determinants” of health. Perhaps such forces as income distribution, education, job conditions, stress, social isolation, the built environment, and more shape health outcomes more powerfully than does health care per se. It is increasingly recognized too that strong local links between health care providers and social service agencies—mental health, housing, transportation, nutrition, substance abuse treatment, and others-- is crucial to the management of the health of populations, especially ones with chronic conditions. Following these challenging “social” arguments wherever they lead is a high priority of the department.
Health care as an object of multidisciplinary research.
The points above contain one central implication for the conduct of productive academic research on populations, on their healthcare needs, and on the systems entrusted with managing their care, namely the need for intellectual breadth of view and a softening of specialized academic siloes. This proposition implies in turn that the department should seek to expand its faculty with expertise in economics (value for money, cost effectiveness analysis), clinical practice (evidence based medicine, new provider teams), sociology (organizational analysis and studies of professional behavior), ethnographers (how culture shapes perceptions of, demand for, and responses to care), and political scientists (how health care policies are advanced, articulated, adopted, assessed, and amended over time). In particular, we plan to expand our health economics concentration by expanding our work in cost-effectiveness analysis, which will require recruiting additional faculty with economics and modelling backgrounds. There is a strong demand for including economic endpoints in our clinical trials and large dataset studies examining technology use. The Department aims for a broad and balanced portfolio of researchers who, individually and in collaboration, shed light on the aims and achievements of public efforts to enhance the system’s capacities to manage the health of the US population.
Bart Ferket, PhD
Annetine Gelijns, PhD
Alan Moskowitz, MD
Norma Padron, PhD
Jose Pagan, PhD