Health Economists’ View of
Policy Questions
AcademyHealth Annual Meeting – Seattle, WA
June 24, 2006
Michael A. Morrisey
University of Alabama at Birmingham
and
John Cawley
Cornell University
Thanks to:
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
AcademyHealth
Advisory Committee:

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
iHEA



Roger Feldman
Richard Arnould
Kate Bundorf
Michael Hagan
David Knutson
Kristine Metter
Sharron Arnold
Survey Issues:

Web based survey:

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Sample Universe:
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Invitation & two follow-up emails issued
October 21 – November 21, 2005
All U.S. members of iHEA
All members of AcademyHealth
Health Economics Interest Group
Unduplicated total . . . . . . . . . . . . . . . . . . . . . 1,439
Response Rate. . . . . . . . . . . . . . . . . . . . . . 32 %
Do You Consider Yourself To Be:
A.
B.
C.
A health economist
An economist who works in health
Neither
53%
21%
26%
For this presentation we exclude those
answering neither.
Outline

Report policy views of health economists

Use factor analysis and probit regression to
identify patterns of responses

Identify the extent to which health economists
participate in policy discussions
We asked 19 Questions About Views on Health
Policy Questions or the Effects of Open Empirical
Questions in Health Economics

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We substantially agree on 8
We modestly agree on 4
We substantially disagree on 7
Substantial Agreement
“Workers pay for employer-sponsored health
insurance in the form of lower wages or
reduced benefits”
Percent
100
90.7
75
50
25
5.3
3.9
Don't Know
Disagree
0
Agree
“Education has a causal impact on health”
Percent
100
80.6
75
50
25
6.8
12.6
0
Agree
Don't Know
Disagree
“Recent horizontal and vertical integration in
the health care sector is driven by the pursuit
of market power”
Percent
100
77.3
75
50
25
17.7
5.1
0
Agree
Don't Know
Disagree
“Health insurance premiums charged to individuals
born with genetic defects that result in above-average
use of medical care should be higher than those
charged to individuals without such defects.”
Percent
100
76.2
75
50
25
9.4
14.4
0
Agree
Don't Know
Disagree
“Health insurance premiums should be higher
for those who engage in unhealthy behaviors
(e.g., smoking, excess drinking, obesity)”
Percent
100
75
73.7
50
25
16.6
9.7
0
Agree
Don't Know
Disagree
“Rapidly advancing medical technology is the
most important cause of rising health care
spending in the U.S.”
Percent
75
67.6
46% in 1989
50
25.1
25
7.2
0
Agree
Don't Know
Disagree
“Insurance markets suffer significantly from
adverse selection”
Percent
75
67.1
50
25
17.0
15.9
Don't Know
Disagree
0
Agree
“Third-party payment results in patients using
services whose costs exceed their benefits, and this
excess of costs over benefits amounts to at least 5 %
of total health care expenditures”
Percent
75
65.5
50
20.9
25
13.7
0
Agree
Don't Know
Disagree
Modest Agreement
“The U.S. should permit ‘re-importation’ of
pharmaceuticals”
Percent
75
55.3
50
28.7
25
16.0
0
Agree
Don't Know
Disagree
“Physicians induce substantial demand for
their services”
Percent
75.0
55.0
81% in 1989
50.0
29.4
25.0
15.6
0.0
Agree
Don't Know
Disagree
“Controlling for the average income in an
area, greater income inequality worsens
health”
Percent
75
51.4
50
25.9
25
22.7
0
Agree
Don't Know
Disagree
“The U.S. should continue to subsidize
graduate medical education”
Percent
75
51.3
50
29.2
25
19.4
0
Agree
Don't Know
Disagree
Substantial Disagreement
“The U.S. should continue the current tax
treatment of employer-sponsored health
insurance”
Percent
75
49.3
50
30.8
25
19.9
0
Agree
Don't Know
Disagree
“The U.S. should adopt a Canadian-style
system of universal and compulsory health
insurance”
Percent
50
47.1
43.2
52% in 1989
25
9.7
0
Agree
Don't Know
Disagree
“The U.S. should require employers to provide
a minimum level of health insurance for their
workers”
Percent
50
45.1
37.5
38% in 1989
25
17.5
0
Agree
Don't Know
Disagree
“The U.S. should implement a refundable tax
credit to encourage people to buy private
health insurance”
Percent
50.0
43.0
34.7
22.4
25.0
0.0
Agree
Don't Know
Disagree
“The current profits of pharmaceutical
companies are necessary to give them
incentives for optimal R&D”
Percent
50
43.2
38.9
25
18.0
0
Agree
Don't Know
Disagree
“The benefits of the Medicare prescription
drug benefit exceed the costs”
Percent
50
25
38.6
37.9
Don't Know
Disagree
23.5
0
Agree
“If a payer (e.g., an HMO) negotiates a lower
price for hospital services, the hospital will
raise prices to other payers”
Percent
50
46.9
63% in 1989
30.7
22.4
25
0
Agree
Don't Know
Disagree
Factor Analysis of Disagreement and Modest
Agreement Issues
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Views do not particularly “lump”
Factor 1
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Agree on cost shifting
Agree on employer mandates
Agree on Canadian system
Agree that income inequality affects health
Factor 2
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Disagree on profits and Pharm R&D
Agree on drug re-importation
Agree on Canadian system
Probit Descriptive Analysis of Disagreement
and Modest Agreement

Agree = f (degree type, training, experience,
demographics, and employment
setting)

No consistent pattern of responses across issues
Few statistically significant associations

Health Economists’ Impact on Policy
Discussions

85.5% of health economists report having some
impact on policy discussions

Measured as responding affirmatively to at least one
of the 7 questions we asked about involvement
296 respondents to these questions
Health Economists’ Impact on Policy
Discussions
I have testified before a state or federal agency or
committee
34.1%
I have discussed my research with agency or
legislative staff
60.5%
Agency or legislative staff have attended
presentations of my work
57.1%
Agency or legislative staff have asked for copies
of my research
61.5%
Health Economists’ Impact on Policy
Discussions
I have discussed my research with private sector
organizations such as firms, unions, trade
associations, advocacy groups
My research and/or expertise has led to
consulting or related activities with private sector
organizations
My work has been cited by proponents or
opponents of legislation
59.5%
49.0%
41.9%
Who Participates?

Using the same descriptive probit model used
with the views on policy…
Those with MDs more likely to participate
 Those with master’s degrees less likely
 Those with less than 4 years of experience
are less likely to participate

Overall

Health economists agree on a number of
important policy questions

We disagree on many topics as well, but there
seems to be little systematic disagreement

We are active in promoting our research in the
policy arena