Jose Pagan
Jose Pagan
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Chair and Professor of the Department of Public Health Policy and Management
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Professional overview
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Dr. Pagán received his PhD in economics from the University of New Mexico and is a former Robert Wood Johnson Foundation Health & Society Scholar with expertise in health economics and population health. He has led research, implementation, and evaluation projects on the redesign of health care delivery and payment systems. He is interested in population health management, health care payment and delivery system reform, and the social determinants of health. Over the years his research has been funded through grants and contracts from the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the European Commission, and the Robert Wood Johnson Foundation, among others.
Dr. Pagán is Chair of the Board of Directors of NYC Health + Hospitals, the largest public healthcare system in the United States. He also served as Chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Health Policy Research Scholars and was a member of the Board of Directors of the Interdisciplinary Association for Population Health Science and the American Society of Health Economists.
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Areas of research and study
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Applied EconomicsHealth EconomicsPopulation HealthPublic Health Policy
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Publications
Publications
Explaining the effects of changes in labor market structure on the relative wages of Puerto Rican workers: 1982-1992
AbstractPagan, J. (n.d.).Publication year
1995Journal title
Ceteris Paribus (Revista de Investigaciones Socio-Económicas, Universidad de Puerto Rico)Volume
5Issue
2Page(s)
61-73Abstract~Fatal crashes from drivers testing positive for drugs in the U.S., 1993-2010
AbstractPagan, J., Wilson, F. A., Stimpson, J. P., & Pagán, J. A. (n.d.).Publication year
2014Journal title
Public Health ReportsVolume
129Issue
4Page(s)
342-350AbstractObjective. Illegal drug use is a persistent problem, prescription drug abuse is on the rise, and there is clinical evidence that drug use reduces driving performance. This study describes trends in characteristics of drivers involved in fatal motor vehicle crashes who test positive for drugs. Methods. We used the Fatality Analysis Reporting System-a census of motor vehicle crashes resulting in at least one fatality on U.S. public roads-to investigate suspected drug use for the period 1993-2010. Results. Drugged drivers who were tested for drug use accounted for 11.4% of all drivers involved in fatal motor vehicle crashes in 2010. Drugged drivers are increasingly likely to be older drivers, and the percentage using multiple drugs increased from 32.6% in 1993 to 45.8% in 2010. About half (52.4%) of all drugged drivers used alcohol, but nearly three-quarters of drivers testing positive for cocaine also used alcohol. Prescription drugs accounted for the highest fraction of drugs used by drugged drivers in fatal crashes in 2010 (46.5%), with much of the increase in prevalence occurring since the mid-2000s. Conclusions. The profile of a drugged driver has changed substantially over time. An increasing share of these drivers is now testing positive for prescription drugs, cannabis, and multiple drugs. These findings have implications for developing interventions to address the changing nature of drug use among drivers in the U.S.Federal Paid Sick Leave Is Needed to Support Prevention and Public Health and Address Inequities
AbstractPagan, J., Pomeranz, J. L., Pagán, J. A., & Silver, D. R. (n.d.).Publication year
2022Journal title
American journal of preventive medicineVolume
63Issue
2Page(s)
e75Abstract~Foreign direct investment and economic growth in East Asia and Latin America
AbstractElahee, M., & Pagan, J. (n.d.).Publication year
1999Journal title
Journal of Emerging MarketsVolume
4Issue
1Page(s)
59-67Abstract~Forging hospital and community partnerships to enable care coordination for opioid use disorder
AbstractPagan, J., Lindenfeld, Z., Franz, B., Lai, A., Pagán, J. A., Fenstemaker, C., Cronin, C. E., & Chang, J. E. (n.d.).Publication year
2025Journal title
Addiction Science and Clinical PracticeVolume
20Issue
1AbstractBackground: Programs that aim to increase access to substance use disorder (SUD) treatment in hospital-based settings have proliferated in recent years. These efforts include transitional opioid programs (TOPs), which navigate patients to community-based SUD treatment programs post-discharge. Successful navigation from TOPs to outpatient treatment hinges on effective coordination between hospitals and post-discharge endpoints, yet it is unclear how hospitals can best develop effective partnerships with outpatient treatment organizations. The objective of this study is to synthesize the common themes underpinning the development of partnerships to facilitate care transitions between TOPs and ongoing SUD treatment. Methods: Qualitative study with staff and providers from hospitals affiliated with four safety-net health systems (n = 21) and leaders from community-based organizations (CBOs) and treatment facilities that had established referral partnerships with one of the four health systems in our study (n = 4). Results: Analysis of interview transcripts revealed seven common themes that underpinned the development of care transitions partnerships: (1) Active, intentional outreach; (2) Responding to a community need; (3) External Enabling Factors; (4) Leveraging reputations and community connections; (5) Focusing on operations; (6) Reciprocal relationships; and (7) Building Infrastructure and Processes to Ensure Collaboration. The seven identified themes were categorized into three groups corresponding to different partnership development stages. The first group revolves around the initial stage of meeting and developing a relationship (themes #1–4). The second set focuses on navigating and resolving challenges that arise in the partnership (themes #5–6). Lastly, the third group pertains to sustaining a partnership long-term (theme #7). Conclusions: This study identifies seven core themes underlying the development of care transition partnerships for SUD patients within four safety net health systems and their CBO partners. These themes demonstrate how partner organizations can establish the trust, reciprocity, and commitment necessary to support patients through the critical transition period.Gender differences in labor market decisions : Evidence from rural Mexico
AbstractPagan, J., Pagán, J. A., & Sánchez, S. M. (n.d.).Publication year
2000Journal title
Economic Development and Cultural ChangeVolume
48Issue
3Page(s)
618-637Abstract~Gender differences in labor market decisions in rural Guatemala
AbstractPagan, J., & Pagán, J. A. (n.d.).Publication year
2002Journal title
Review of Development EconomicsVolume
6Issue
3Page(s)
428-441AbstractThis study analyzes male-female differences in workforce participation and self-employment in rural Guatemala. Gender differences in rural labor market outcomes are examined using the 1997 Survey of Rural Entrepreneurs and Financial Services, conducted in the rural areas of the departments of San Marcos. Quezaltenango, Huehuetenango. Alta Verapaz, Petén, and Chimiquimula. There are substantial differences in the labor force participation rates of men and women (86.5 vs 24.0 percent) and in self-employment (49.8 vs 31.9 percent). The empirical results suggest that external constraints explain almost all of the observed gender gap in employment. Gender differences in individual endowments and human capital contribute to increase the male-female self-employment gap: however, structural factors help to reduce gender differences in rural entrepreneurship.Gender Issues in Workforce Participation and Self- Employment in Rural Mexico
AbstractPagan, J., & Sánchez, S. M. (n.d.). (M. Correia & E. Katz, Eds.).Publication year
2001Abstract~Gender pay and occupational-attainment gaps in Costa Rica and El Salvador : A relative comparison of the late 1980s
AbstractPagan, J., Dávila, A., & Pagán, J. A. (n.d.).Publication year
1999Journal title
Review of Development EconomicsVolume
3Issue
2Page(s)
215-230AbstractThis study investigates gender occupational attainment and earnings differentials in El Salvador and Costa Rica at the end of the 1980s. During this decade, El Salvador experienced a civil war and an economic depression. Costa Rica was also mired in a recession in the early 1980s, but programs adopted in the mid-1980s led to rapid economic recovery. It is found that the gender pay gap in El Salvador is 30.4% and 23.6% in Costa Rica. The intercountry difference in the gap disappears after accounting for high gender differences in occupational attainment and hours worked in El Salvador.Generational differences in beliefs about COVID-19 vaccines
AbstractPagan, J., Wang, V. H., Silver, D. R., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Preventive MedicineVolume
157AbstractVaccine uptake variation across demographic groups remains a public health barrier to overcome the coronavirus pandemic despite substantial evidence demonstrating the effectiveness of COVID-19 vaccines against severe illness and death. Generational cohorts differ in their experience with historical and public health events, which may contribute to variation in beliefs about COVID-19 vaccines. Nationally representative longitudinal data (December 20, 2020 to July 23, 2021) from the Understanding America Study (UAS) COVID-19 tracking survey (N = 7279) and multilevel logistic regression were used to investigate whether generational cohorts differ in COVID-19 vaccine beliefs. Regression models adjusted for wave, socioeconomic and demographic characteristics, political affiliation, and trusted source of information about COVID-19. Birth-year cutoffs define the generational cohorts: Silent (1945 and earlier), Boomer (1946–1964), Gen X (1965–1980), Millennial (1981–1996), and Gen Z (1997–2012). Compared to Boomers, Silents had a lower likelihood of believing that COVID-19 vaccines have many known harmful side effects (OR = 0.52, 95%CI = 0.35–0.74) and that they may lead to illness and death (OR = 0.53, 95%CI = 0.37–0.77). Compared to Boomers, Silents had a higher likelihood of believing that the vaccines provide important benefits to society (OR = 2.27, 95%CI = 1.34–3.86) and that they are useful and effective (OR = 1.97, 95%CI = 1.17–3.30). Results for Gen Z are similar to those reported for Silents. Beliefs about COVID-19 vaccines markedly differ across generations. This is consistent with the idea of generational imprinting—the idea that some beliefs may be resistant to change through adulthood. Policy strategies other than vaccine education may be needed to overcome this pandemic and future public health challenges.Genetic Variant Reinterpretation : Economic and Population Health Management Challenges
AbstractPagan, J., Pagán, J. A., Brown, H. S., Rowe, J., Schneider, J. E., Veenstra, D. L., Gupta, A., Berger, S. M., Chung, W. K., & Appelbaum, P. S. (n.d.).Publication year
2021Journal title
Population Health ManagementVolume
24Issue
3Page(s)
310-313Abstract~Geographical and Temporal Analysis of Tweets Related to COVID-19 and Cardiovascular Disease in the US
AbstractPagan, J., Zhang, X., Mu, L., Zhang, D., Mao, Y., Shi, L., Rajbhandari-Thapa, J., Chen, Z., Li, Y., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Annals of GISVolume
28Issue
4Page(s)
491-500AbstractThe COVID-19 pandemic has resulted in more than 600 million confirmed cases worldwide since December 2021. Cardiovascular disease (CVD) is both a risk factor for COVID-19 mortality and a complication that many COVID-19 patients develop. This study uses Twitter data to identify the spatiotemporal patterns and correlation of related tweets with daily COVID-19 cases and deaths at the national, regional, and state levels. We collected tweets mentioning both COVID-19 and CVD-related words from February to July 2020 (Eastern Time) and geocoded the tweets to the state level using GIScience techniques. We further proposed and validated that the Twitter user registration state can be a feasible proxy of geotags. We applied geographical and temporal analysis to investigate where and when people talked about COVID-19 and CVD. Our results indicated that the trend of COVID-19 and CVD-related tweets is correlated to the trend of COVID-19, especially the daily deaths. These social media messages revealed widespread recognition of CVD’s important role in the COVID-19 pandemic, even before the medical community started to develop consensus and theory supports about CVD aspects of COVID-19. The second wave of the pandemic caused another rise in the related tweets but not as much as the first one, as tweet frequency increased from February to April, decreased till June, and bounced back in July. At the regional level, four regions (Northeast, Midwest, North, and West) had the same trend of related tweets compared to the country as a whole. However, only the Northeast region had a high correlation (0.8–0.9) between the tweet count, new cases, and new deaths. For the second wave of confirmed new cases, the major contributing regions, South and West, did not ripple as many related tweets as the first wave. Our understanding is that the early news attracted more attention and discussion all over the U.S. in the first wave, even though some regions were not impacted as much as the Northeast at that time. The study can be expanded to more geographic and temporal scales, and with more physical and socioeconomic variables, with better data acquisition in the future.Global prevalence of violence against children and adolescents during COVID-19 : A meta-analysis
AbstractPagan, J., Niu, L., Li, Y., Bai, R., Pagán, J. A., Zhang, D., & Diaz, A. (n.d.).Publication year
2024Journal title
Child Abuse and NeglectVolume
154AbstractBackground: Recent studies suggest that children and adolescents are at an increased risk of experiencing violence during the COVID-19 pandemic. However, there is limited knowledge about the prevalence of violence against children and adolescents across different regions in the world. Objective: To estimate the pooled prevalence of violence against children and adolescents during the COVID-19 pandemic and explore how geographical and methodological factors explain the variation across studies. Methods: We conducted a systematic search of MEDLINE, Embase, and PsycInfo databases for articles published from January 1, 2020 to October 1, 2022. The study protocol was pre-registered with PROSPERO (CRD42022338181). We included published and unpublished studies available in English that reported the prevalence of violence (e.g., physical, emotional, or sexual violence, neglect, bullying) against children and adolescents (ageGovernment spending, taxation, and oil revenues in Mexico
AbstractPagan, J., Tijerina-Guajardo, J. A., & Pagán, J. A. (n.d.).Publication year
2003Journal title
Review of Development EconomicsVolume
7Issue
1Page(s)
152-164AbstractThe paper analyzes the intertemporal relationship between oil duties, taxes, government spending, and GDP in Mexico during the 1981-98 period. The results from estimating a VAR model, impulse response functions. and variance decompositions on the quarterly series of taxes, government spending, oil duties, and GDP suggest that there seems to be a substitution effect between oil duties and tax revenues, and that tax revenues are not able to absorb temporary decreases in oil duties. Also, increases in tax revenue might lead to increasing government spending, but short-run increases in government spending are not likely to lead to political pressure to reduce the expected budget deficit via increased taxation and/or oil revenues. Lastly. GDP is not stimulated in the short-run by temporary increases in government spending and, thus, stabilization measures adopted in recent years to reduce the size of the government are not likely to significantly undermine GDP growth.Group heterogeneity and the gender earnings gap in Mexico
AbstractPagan, J., & Ullibarri, M. (n.d.).Publication year
2000Journal title
Economía MexicanaVolume
9Issue
1Page(s)
23-40Abstract~Health care affordability and complementary and alternative medicine utilization by adults with diabetes
AbstractPagan, J., Pagán, J. A., & Tanguma, J. (n.d.).Publication year
2007Journal title
Diabetes CareVolume
30Issue
8Page(s)
2030-2031Abstract~Health insurance coverage and health care utilization along the U.S.-Mexico Border : Evidence from the border epidemiologic study on aging
AbstractPagan, J., Bastida, E., Brown, H. S., & Pagán, J. A. (n.d.).Publication year
2007Page(s)
222-234AbstractOne-fifth of the U.S. adult population does not have health insurance coverage and it is projected that the ranks of the uninsured will continue to grow due to increasing health care costs and rising health insurance premiums (DeNavas-Walt, Proctor and Lee, 2005; Gilmer and Kronick, 2001; Rowland, 2004). The U.S. uninsured population is not only relatively large (almost 46 million people) but it is not homogenously distributed across states and communities. Incidentally, the four Southwestern border states, California, Arizona, New Mexico, and Texas, are also the only states where the percentage of the total state population without health insurance coverage exceeds 18%.Health insurance coverage and the use of preventive services by Mexican adults
AbstractPagan, J., Pagán, J. A., Puig, A., & Soldo, B. J. (n.d.).Publication year
2007Journal title
Health EconomicsVolume
16Issue
12Page(s)
1359-1369AbstractThe lack of health insurance coverage could be a potentially important deterrent to the use of preventive health care by older adults with high rates of chronic co-morbidities. We use survey data from 12 100 Mexican adults ages 50 and older who participated in the 2001 Mexican Health and Aging Study (MHAS) to analyze the relation between health insurance coverage and the use of preventive health-care services in Mexico. Uninsured adults were less likely to use preventive screenings for hypertension, high cholesterol, diabetes and (breast, cervical and prostate) cancer than insured adults. After adjusting for other factors affecting preventive care utilization in a logistic regression model, we found that these results still hold for high cholesterol and diabetes screening. Similar results hold for the population not working during the survey week and for adults earning below 200% of the poverty line. Our results suggest that insured adults are in a relatively better position to detect some chronic diseases - and have them treated promptly - than uninsured adults because they have better access to cost-effective preventive screenings. Recent public policy initiatives to increase health insurance coverage rates in Mexico could lead to substantially higher preventive health-care utilization rates and improvements in population health.Health insurance coverage, income distribution and healthcare quality in local healthcare markets
AbstractPagan, J., Damianov, D. S., & Pagán, J. A. (n.d.).Publication year
2013Journal title
Health Economics (United Kingdom)Volume
22Issue
8Page(s)
987-1002AbstractWe develop a theoretical model of a local healthcare system in which consumers, health insurance companies, and healthcare providers interact with each other in markets for health insurance and healthcare services. When income and health status are heterogeneous, and healthcare quality is associated with fixed costs, the market equilibrium level of healthcare quality will be underprovided. Thus, healthcare reform provisions and proposals to cover the uninsured can be interpreted as an attempt to correct this market failure. We illustrate with a numerical example that if consumers at the local level clearly understand the linkages between health insurance coverage and the quality of local healthcare services, health insurance coverage proposals are more likely to enjoy public support.Health literacy and breast cancer screening among Mexican American women in South Texas
AbstractPagan, J., Pagán, J. A., Brown, C. J., Asch, D. A., Armstrong, K., Bastida, E., & Guerra, C. (n.d.).Publication year
2012Journal title
Journal of Cancer EducationVolume
27Issue
1Page(s)
132-137AbstractBreast cancer is the main cause of cancer deaths for Hispanic women. This study analyzes the role of functional health literacy on mammography screening behavior and adherence of Hispanic women. Survey data from 722 Mexican American women age 40 and over residing in the Lower Rio Grande Valley of Texas in 2008 were used to estimate logistic regression models to assess the role of functional health literacy on mammography screening behavior and adherence. About 51% of survey respondents had a functional health literacy level deemed as inadequate or marginally functional. After adjusting for other factors, women with adequate health literacy levels were more likely to report to have ever had a mammogram (odds ratio [OR]=2.92; 95% confidence interval [CI]=1.62-5.28), to have had a mammogram within the last 2 years (OR=1.70; 95% CI=1.14-2.53) or to have had one within the last year (OR=2.30; 95% CI=1.54- 3.43), compared to women with inadequate or marginally adequate functional health literacy levels. Inadequate/ marginal functional health literacy is strongly associated with lower mammography screening. Large improvements in breast cancer control in this population may come from either basic advances in health literacy or by tailored approaches to help women with low literacy navigate local health care systems.Housing strain, mortgage foreclosure, and health
AbstractPagan, J., Cannuscio, C. C., Alley, D. E., Pagán, J. A., Soldo, B., Krasny, S., Shardell, M., Asch, D. A., & Lipman, T. H. (n.d.).Publication year
2012Journal title
Nursing outlookVolume
60Issue
3Page(s)
134-142.e1AbstractBackground: Foreclosure rates have risen rapidly since 2005, reaching historically high levels. The purpose of this study was to examine the health implications of the current housing crisis. Methods: We conducted a cross-sectional online consumer panel survey including residents of California, Arizona, Nevada, and Florida (n = 798) to determine the feasibility of contacting distressed homeowners via the Internet and to assess mental and physical health among respondents across the spectrum from those having no housing strain to those in loan default or home foreclosure. Results: Homeowners in default or foreclosure exhibited poorer mental health and more physical symptoms than renters, homeowners with moderate strain, and homeowners with no strainöfollowing a gradient that was consistent across multiple health indicators. Conclusions: Internet panel sampling was an efficient method of contacting distressed homeowners. Record-high foreclosure rates may have broad implications for nursing and public health. Homeowners in default or foreclosure represent an identifiable high-risk group that may benefit from coordinated, affordable health and social services.How Patient-Centered Medical Homes Integrate Dental Services Into Primary Care : A Scoping Review
AbstractPagan, J., Gupta, A., Akiya, K., Glickman, R. S., Silver, D. R., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Medical Care Research and ReviewVolume
79Issue
4Page(s)
487-499AbstractIntegrated care delivery is at the core of patient-centered medical homes (PCMHs). The extent of integration of dental services in PCMHs for adults is largely unknown. We first identified dental–medical integrating processes from the literature and then conducted a scoping review using PRISMA guidelines to evaluate their implementation among PCMHs. Processes were categorized into workforce, information-sharing, evidence-based care, and measuring and monitoring. After screening, 16 articles describing 21 PCMHs fulfilled the inclusion criteria. Overall, the implementation of integrating processes was limited. Less than half of the PCMHs reported processes for information exchange across medical and dental teams, referral tracking, and standardized protocols for oral health assessments by medical providers. Results highlight significant gaps in current implementation of adult dental integration in PCMHs, despite an increasing policy-level recognition of and support for dental-medical integration in primary care. Understanding and addressing associated barriers is important to achieve comprehensive patient-centered primary care.Identifying policy levers and opportunities for action across states to achieve health equity
AbstractPagan, J., Berenson, J., Li, Y., Lynch, J., & Pagán, J. A. (n.d.).Publication year
2017Journal title
Health AffairsVolume
36Issue
6Page(s)
1048-1056AbstractIn the United States, steps to advance health equity often take place at the state and local levels rather than the national level. Using publicly available data sources, we developed a scorecard for all fifty states and the District of Columbia that measures indicators of the use of five evidence-based policies to address domains related to health equity. The indicators are the cigarette excise tax rate, a state's Medicaid expansion status and the size of its coverage gap, percentage of four-year olds enrolled in state-funded pre-kindergarten, minimum wage level, and the presence of state-funded housing subsidy programs and homelessness prevention and rapid rehousing programs. We found that states varied significantly in their implementation of the selected policies and concluded that a variety of approaches to encourage policy changes at the state level will be needed to create healthier and more equitable communities. We describe promising, feasible state-level approaches for states to "do something, do more, do better" when they take action on the five selected policies that can promote health equity.Immigration reform, the INS, and the distribution of interior and border enforcement resources
AbstractPagan, J., Dávila, A., Pagán, J. A., & Grau, M. V. (n.d.).Publication year
1999Journal title
Public ChoiceVolume
99Issue
3-4Page(s)
327-345AbstractThis paper investigates the Immigration and Naturalization Service (INS) interior and border enforcement effort allocation choice following the enactment of IRCA in 1986. The INS increasingly allocated a disproportionate amount of resources along the border as a result of the new law. It is contended that this behavior is consistent with that of a public agency intent on maximizing its budget and not in accord with minimizing the undocumented population in the United States. The theory developed here is then used to evaluate proposals that could potentially reconcile the INS's objectives with those of the policy makers and the public.Implementation Strategies to Enhance Safety-Net Hospitals’ Adoption of Screening, Brief Intervention, and Referral to Treatment for Opioid Use Disorder
AbstractLindenfeld, Z., Franz, B., Fenstemaker, C., Lai, A., Pagan, J., Cronin, C. E., & Chang, J. E. (n.d.).Publication year
2025Journal title
Journal of general internal medicineAbstractBackground: To support adoption of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for opioid use disorder (OUD), hospitals are likely to benefit from implementation strategies that are responsive to their unique environments. Yet there remains a gap in knowledge regarding which implementation strategies are needed to support SBIRT implementation and sustainment for OUD within safety-net hospitals. Objectives: To obtain expert consensus on the most effective implementation strategies to enhance the adoption of SBIRT for OUD in safety-net hospitals. Design and Setting: A modified Delphi study, with two rounds of online surveys. Participants: Eighteen US-based experts from within the fields of OUD-focused health services research, addiction medicine, and emergency medicine. Main Measures: The primary outcome was consensus on 35 potential SBIRT implementation strategies, ranked on a 5-point Likert scale across three domains: Effectiveness, Feasibility, Impact on Equity. Consensus across respondents within both rounds was evaluated using the interquartile range. If the IQR was 1 or below on the 0 to 5 Likert scale, consensus was considered obtained. Items with a median value of 4 or higher were considered high priority. Results: Following two rounds of ranking, consensus was achieved for all survey items. In total, 62.85% strategies (n = 22) were rated as High in Effectiveness, 20.0% (n = 7) were rated as High in Feasibility, and 11.42% (n = 4) were rated High in Impact on Equity. Seven strategies ranked high in two areas, with three—Identify and Prepare Champions, Identify Early Adopters, and Conduct Educational Meetings—ranked as highly effective and feasible. Conclusions: This consensus process provides strong support for implementation strategies that can be used to guide future practice and study. This work can encourage implementation of SBIRT for OUD within safety-net hospitals, and set the stage for future studies to evaluate the impact of different implementation strategies on patient outcomes following SBIRT.