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
Share of Mass Transit Miles Traveled and Reduced Motor Vehicle Fatalities in Major Cities of the United States
AbstractStimpson, J. P., Wilson, F. A., Araz, O. M., & Pagan, J. (n.d.).Publication year
2014Journal title
Journal of Urban HealthVolume
91Issue
6Page(s)
1136-1143AbstractThe USA leads the developed world in motor vehicle fatalities, presenting a critical public health threat. We examined whether an increasing share of mass transit use, relative to vehicle miles traveled on public roads, was associated with reduced motor vehicle fatalities. We used annual city-level data for the USA from 1982–2010 provided by the Fatality Accident Reporting System, the Texas A&M Transportation Institute, the Census Bureau, and the National Oceanic and Atmospheric Administration to estimate a structural equation model of the factors associated with mass transit miles and motor vehicle fatalities. The final analytic data included 2,900 observations from 100 cities over 29 years. After accounting for climate, year, and the economic costs of driving, an increasing share of mass transit miles traveled per capita was associated with reduced motor vehicle fatalities. The costs of congestion to the average commuter and gas prices were positively associated with increasing the share of mass transit miles traveled. The economic costs of driving increased over time, while both the fatality rate and the share of mass transit miles traveled decreased over time. Increasing the share of mass transit miles traveled may be associated with fewer motor vehicle miles traveled. Increasing mass transit uptake may be an effective public health intervention to reduce motor vehicle fatalities in cities.The community diabetes education (CoDE) program : Cost-effectiveness and health outcomes
AbstractPagan, J., Prezio, E. A., Pagán, J. A., Shuval, K., & Culica, D. (n.d.).Publication year
2014Journal title
American journal of preventive medicineVolume
47Issue
6Page(s)
771-779AbstractConclusions A simulated clinical trial suggests that a community health worker-led diabetes intervention is a cost-effective way to reduce diabetes-related complications for uninsured Mexican Americans during a 20-year horizon in comparison to usual medical care.Background Limited evidence exists regarding the long-term effects of community health worker-led diabetes management programs on health outcomes and cost-effectiveness, particularly in low-income, ethnic minority populations.Purpose To examine the long-term cost-effectiveness and improvements in diabetes-related complications of a diabetes education and management intervention led by community health workers among uninsured Mexican Americans.Methods Clinical data, changes in hemoglobin A1c over 12 months, and costs from an RCT of 180 uninsured Mexican Americans with type 2 diabetes conducted in 2006 were utilized for secondary analyses in 2012. Simulation modeling was used to estimate long-term cost and health outcomes using the validated Archimedes Model. The absolute differences for the incremental cost-effectiveness ratios and cumulative incidence of diabetes-related complications were derived by comparing intervention and control groups.Results During a 20-year time horizon, participants who received the intervention would be expected to have significantly lower hemoglobin A1c levels (pUninsurance, underinsurance, and health care utilization in Mexico by US border residents
AbstractPagan, J., Su, D., Pratt, W., Stimpson, J. P., Wong, R., & Pagán, J. A. (n.d.).Publication year
2014Journal title
Journal of Immigrant and Minority HealthVolume
16Issue
4Page(s)
607-612AbstractUsing data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 vs. 27.8 %). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population.Using systems science for population health management in primary care
AbstractPagan, J., Li, Y., Kong, N., Lawley, M. A., & Pagán, J. A. (n.d.).Publication year
2014Journal title
Journal of Primary Care and Community HealthVolume
5Issue
4Page(s)
242-246AbstractObjectives: Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. Methods: The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. Results: The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period ofAssessing long-term health and cost outcomes of patient-centered medical homes serving adults with poor diabetes control
AbstractPagan, J., Pagán, J. A., & Carlson, E. K. (n.d.).Publication year
2013Journal title
Journal of Primary Care and Community HealthVolume
4Issue
4Page(s)
281-285AbstractThe patient-centered medical home (PCMH) is an integrated primary care delivery model particularly suited for patients with poor diabetes control. Although PCMH models targeting adults with diabetes have shown some early success, little is known about the long-term benefits of medical homes in terms of health and cost outcomes. The performance of a PCMH model in adults with poor diabetes control was assessed using simulated controlled trial data obtained from the Archimedes model of disease progression and health care utilization. Using the Cardio-Metabolic Risk data set, we compared health and cost outcomes over a 20-year period between adults with poor diabetes control (HbA1c >9%) receiving standard care and these same adults receiving care under a PCMH model with a 49% HbA1c intervention improvement rate at a per-beneficiary per-month care management cost of $20 per month. The results suggest that the PCMH model has the potential to not only reduce the proportion of the population with bilateral blindness, foot amputations, and myocardial infarctions-and the mortality rate-but it can also do so in a cost-effective manner ($7898 per quality-adjusted life year). The PCMH model is cost saving for the population 50 to 64 years old and it is particularly cost-effective for men ($883 per quality-adjusted life year). Moreover, these effects are relatively large for adults 30 to 49 years old (lower bilateral blindness and death rates), women (lower foot amputation and death rates), and men (lower bilateral blindness and myocardial infarction rates). The PCMH model has potential long-term benefits to both patients with poor diabetes control as well as health care systems and providers willing to invest in this health care delivery approach.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.Rural-Urban Differences in Health Services Utilization in the US-Mexico Border Region
AbstractPagan, J., Su, D., Pratt, W., Salinas, J., Wong, R., & Pagán, J. A. (n.d.).Publication year
2013Journal title
Journal of Rural HealthVolume
29Issue
2Page(s)
215-223AbstractPurpose: Evaluate the association between driving distance to the US-Mexico border and rural-urban differences in the use of health services in Mexico by US border residents from Texas. Methods: Data for this study come from the Cross-Border Utilization of Health Care Survey, a population-based telephone survey conducted in the Texas border region in spring 2008. Driving distances to the border were estimated from the nearest border crossing station using Google Maps. Outcome measures included medication purchases, physician visits, dentist visits, and inpatient care in Mexico during the 12 months prior to the survey. A series of adjusted logit models were estimated after controlling for relevant confounding factors. Findings: The average driving distance to the nearest border crossing station among rural respondents was 4 times that of urban respondents (42.0 miles vs 10.3 miles [P < .001]). Rural respondents were more likely to be dissatisfied than urban respondents with the health care provided on the US side of the border, yet they were less likely to use health services in Mexico. Driving distance to the border largely explained the observed rural-urban differences in medication purchases from Mexico. In the case of inpatient care, however, rural respondents reported a higher utilization rate than urban respondents and this rural-urban difference became more pronounced after adjusting for the effect of driving distance to the border. Conclusions: Dissatisfaction with US health care services in rural communities in the US-Mexico border region seems to be compounded by the lack of access to health care services in Mexico due to travel distance constraints. No claim to original US government works.Alliance for a healthy border : Factors related to weight reduction and glycemic success
AbstractPagan, J., Wang, X., Ghaddar, S., Brown, C., Pagán, J. A., & Balboa, M. (n.d.).Publication year
2012Journal title
Population Health ManagementVolume
15Issue
2Page(s)
90-100AbstractWe examined the factors related to success in achieving weight reduction and glycemic control in Alliance for a Healthy Border (AHB), a chronic disease prevention program implemented from 2006 to 2009 through 12 federally qualified community health centers serving primarily Hispanics in communities located along the US-Mexico border region. We analyzed data from Phase I of AHB using logistic regression to examine the determinants of success in achieving weight reduction and glycemic control among the participants in AHB programs. Factors affecting weight reduction success were sex, age, employment status, income, insurance, diabetes, baseline body mass index (BMI), smoking status, family history of diabetes, session type, program duration, and physical activity changes. Factors affecting achievement of glycemic success included sex, age, employment status, diabetes, baseline BMI, family history of diabetes, program duration, and physical activity changes. We found that the AHB interventions were more successful in reducing participants' HbA1c level than BMI. In addition to sociodemographic factors, participants with better baseline health conditions (ie, participants without diabetes or family history of diabetes, normal BMI, former smokers) were more likely to achieve success after the interventions. Of the 4 key features defining each of the 12 interventions, session type and program duration were associated with success. Within a relatively short time period, physical activity improvements had a stronger effect on weight reduction and glycemic success than improvements in dietary habits. The effectiveness of diabetes and cardiovascular disease prevention programs can be improved substantially by considering these factors during program design and structure.Breast cancer genetic testing awareness, attitudes and intentions of Latinas living along the US-Mexico border: a qualitative study
AbstractChalela, P., Pagan, J., Su, D., Muñoz, E., & Ramirez, A. (n.d.).Publication year
2012Journal title
Journal of Community Medicine & Health EducationVolume
2Issue
5Abstract~Cost-effectiveness analysis of a community health worker intervention for low-income hispanic adults with diabetes
AbstractPagan, J., Shelton Brown, H., Wilson, K. J., Pagán, J. A., Arcari, C. M., Martinez, M., Smith, K., & Reininger, B. (n.d.).Publication year
2012Journal title
Preventing Chronic DiseaseVolume
9Issue
8AbstractIntroduction: The objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes. Methods: We forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs. Results: The incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters. Conclusion: The CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.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.Income inequality and obesity prevalence among oecd countries
AbstractPagan, J., Su, D., Esqueda, O. A., Li, L., & Pagán, J. A. (n.d.).Publication year
2012Journal title
Journal of Biosocial ScienceVolume
44Issue
4Page(s)
417-432AbstractUsing recent pooled data from the World Health Organization Global Infobase and the World Factbook compiled by the Central Intelligence Agency of the United States, this study assesses the relation between income inequality and obesity prevalence among 31 OECD countries through a series of bivariate and multivariate linear regressions. The United States and Mexico well lead OECD countries in both obesity prevalence and income inequality. A sensitivity analysis suggests that the inclusion or exclusion of these two extreme cases can fundamentally change the findings. When the two countries are included, the results reveal a positive correlation between income inequality and obesity prevalence. This correlation is more salient among females than among males. Income inequality alone is associated with 16% and 35% of the variations in male and female obesity rates, respectively, across OECD countries in 2010. Higher levels of income inequality in the 2005-2010 period were associated with a more rapid increase in obesity prevalence from 2002 to 2010. These associations, however, virtually disappear when the US and Mexico have been excluded from the analysis. Findings from this study underscore the importance of assessing the impact of extreme cases on the relation between income inequality and health outcomes. The potential pathways from income inequality to the alarmingly high rates of obesity in the cases of the US and Mexico warrant further research.Persistent disparities in cholesterol screening among immigrants to the United States
AbstractStimpson, J. P., Wilson, F. A., Murillo, R., & Pagan, J. (n.d.).Publication year
2012Journal title
International Journal for Equity in HealthVolume
11Issue
1AbstractBackground: This study compared differences in cholesterol screening among immigrant populations and US born race/ethnic groups and whether improving access to health care reduced differences in screening. Methods: Self-reported cholesterol screening for adults was calculated from multivariate logistic regression analysis of the 1988-2008 National Health and Nutrition Examination Surveys (N = 17,118). Immigrant populations were classified by place of birth and length of residency. Results: After adjusting for individual characteristics and access to health care, the multivariate adjusted probability of cholesterol screening is significantly lower for persons originating from Mexico (70.9%) compared to persons born in the US (80.1%) or compared to US born Hispanic persons (77.8%). Adjustment for access to care did significantly reduce the difference in screening rates between immigrants and natives because the rate for natives remained the same, but the rate for immigrants improved. For example, the difference in screening between US born persons and persons born in Mexico was reduced by nearly 10% after adjustment for access to care. Conclusions: There are persistent disparities in cholesterol screening for immigrants, particularly recent immigrants from Mexico, but improved access to health care may be a viable policy intervention to reduce disparities.Reducing racial and ethnic disparities in colorectal cancer screening is likely to require more than access to care
AbstractPagan, J., Stimpson, J. P., Pagán, J. A., & Chen, L. W. (n.d.).Publication year
2012Journal title
Health AffairsVolume
31Issue
12Page(s)
2747-2754AbstractColorectal endoscopy, an effective screening intervention for colorectal cancer, is recommended for people age fifty or older, or earlier for those at higher risk. Rates of colorectal endoscopy are still far below those recommended by the US Preventive Services Task Force. This study examined whether factors such as the supply of gastroenterologists and the proportion of the local population without health insurance coverage were related to the likelihood of having the procedure, and whether these factors explained racial and ethnic differences in colorectal endoscopy.We found evidence that improving access to health care at the county and individual levels through expanded health insurance coverage could improve colorectal endoscopy use but might not be sufficient to reduce racial and ethnic disparities in colorectal cancer screening. Policy action to address these disparities will need to consider other structural and cultural factors that may be inhibiting colorectal cancer screening.Revenue enhancement through mergers and acquisitions : Wealth effects of method of payment
AbstractPagan, J., Ma, J., Pagán, J. A., Chu, Y., & Soydemir, G. (n.d.).Publication year
2012Journal title
International Journal of Revenue ManagementVolume
6Issue
3-4Page(s)
274-290AbstractMany firms enhance revenue through mergers and acquisitions deals because synergy occurs when the value of the combined firm after the merger is greater than the sum of the value of the bidding firm and the value of the target firm before the merger. This paper analyses value creation of mergers and acquisitions in ten Asian emerging markets over the past 12 years. The stock markets react positively to M&A deals around the time of the announcement in spite of variation in the method of payment or the types of the target form. Method of payment affects abnormal returns. The difference between cash only payment and stock only payment is statistically significant. When the target is a private firm or a subsidiary, bidder firms realise higher positive abnormal returns than that when the target is a public firm. However, the differences (public vs. private and public vs. subsidiary) are not statistically significant at conventional levels.Substitution of formal health care services by Latinos/hispanics in the US-Mexico border region of south Texas
AbstractPagan, J., Pisani, M. J., Pagán, J. A., Lackan, N. A., & Richardson, C. (n.d.).Publication year
2012Journal title
Medical careVolume
50Issue
10Page(s)
885-889AbstractBACKGROUND: Pervasive poverty and high uninsurance rates in the US-Mexico border region coupled with rising US health care costs and the availability of alternatives to formal US health services-both in the United States and Mexico-have resulted in widespread use of alternatives to formal US health care. OBJECTIVES: We investigate variation in the purchase of substitutes for formal US health services among border residents reporting health-related cost constraints. Preferences for various means of substitution (informal US services, formal Mexican services, and informal Mexican services) are identified. RESEARCH DESIGN: Cross-sectional study of purposive interview data from the Texas Borderlife Project regarding the purchase of a continuum of informal services/goods, including health care services and prescription medications. SUBJECTS: Study respondents included 320 Latino/Hispanic residents of the Texas border region. MEASURES: Eight health substitutes (medical care, prescription medication, and dental care) were ordered from formal services/goods in Mexico to informal services/goods in Mexico and the US. The independent variable was reporting having gone without seeing a physician in the past 12 months because of cost. RESULTS: Border residents reporting cost constraints were significantly more likely to purchase substitutes for formal US health services. Further, our findings suggest that when substitutes to formal US health care are used, Texas border residents prefer to access formal Mexican health care first, followed by informal US health services. CONCLUSIONS: Increasing access to US health services may require greater effort and resources in border communities given the availability of substitutes for formal health care services in this region.Wealth effects of bank mergers and acquisitions in Asian emerging markets
AbstractPagan, J., Ma, J., Pagán, J. A., & Chu, Y. (n.d.).Publication year
2012Journal title
Journal of Applied Business ResearchVolume
28Issue
1Page(s)
47-58AbstractThrough analysis of stock responses to two different types of banking M&A deals, specifying M&A and diversifying M&A, we find that specifying M&A deals incur positive cumulative abnormal returns (CAR) in both two-day and three-day windows without controlling for firm size. Diversifying M&A deals incur positive CAR in two different event windows. However, the differences between the two windows are not statistically significant. Contrary to previous studies on M&A in the banking industry of developed markets, the results of our study indicate that markets do not distinguish among various types of M&A deals in the banking industry around the date of announcement. Diversifying M&A generate positive three-day CARs but they are not significantly better than specifying M&A.Where would you rather live if you were insured? assessing community uninsurance spillover effects on the insured
AbstractPagan, J., Hardeman, R. R., García, C., & Pagán, J. A. (n.d.).Publication year
2012Journal title
Journal of Immigrant and Minority HealthVolume
14Issue
4Page(s)
706-714AbstractThis study sought to understand the cost, quality of, and access to health care for the insured population in the context of spillover effects resulting from community-level uninsurance. We examined the health care access, quality, and cost experienced by insured Latina mothers in two communities, Minneapolis, Minnesota and McAllen, Texas. These communities differ substantially by the size of the local population without health insurance coverage. Four focus groups were conducted with insured Latina mothers who were caring for at least one child in their household. Eleven and thirteen mothers participated in each community, respectively. The experiences of the insured population in McAllen were substantially different from the experiences of the insured population in Minneapolis. The perceptions of health care quality and access by insured Latina mothers were substantially lower in McAllen while out-of-pocket costs were perceived to be higher in Minneapolis. Our study provides key insights about the US health care system and the role that the relative size of the local uninsured population may have in impacting the health care experiences of the insured. Health insurance coverage rates are expected to increase substantially across US communities within the next few years but local health care system challenges related to cost, quality, and access will remain for both the insured and the uninsured.An Integrated, Clinician-focused Telehealth Monitoring System to Reduce Hospitalization Rates for Home Health Care Patients with Diabetes
AbstractPagan, J., Pagán, J. A., Chen, H. F., & Kalish, M. C. (n.d.).Publication year
2011Journal title
Journal of Primary Care & Community HealthVolume
2Issue
3Page(s)
153-156AbstractDiabetes is one of the leading causes of death and disability in the United States, and hospitalization rates related to this health condition are high and costly to the United States health care system. The purpose of this study was to examine the effect of an integrated, clinician-focused telehealth monitoring system on the probability of hospitalization for home health care patients with diabetes. The study included 2009 data from 699 Medicare beneficiaries receiving home health services in Texas and Louisiana. Propensity score matching, logistic regression, and post-estimation parameter simulation were used to assess how telehealth affects the probability of hospitalization during the first 30 days of home health care. The 30-day hospitalization probability for telehealth and non-telehealth patients was 7% and 19%, respectively. Patients in the telehealth group had a 12 (95% confidence interval = 4.2-20.3) percentage point-lower probability of hospitalization within the first 30 days of home health care than non-telehealth matched patients. The results suggest that telehealth monitoring systems that integrate skilled clinicians with critical care experience can lead to substantially lower hospitalization rates during the first 30 days of home health care, large cost savings, and more effective home health management of patients with diabetes.Cross-border utilization of health care : Evidence from a population-based study in South Texas
AbstractPagan, J., Su, D., Richardson, C., Wen, M., & Pagán, J. A. (n.d.).Publication year
2011Journal title
Health Services ResearchVolume
46Issue
3Page(s)
859-876AbstractObjective. To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods. This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings. Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions. The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.-Mexico border region.Diabetes and employment productivity : Does diabetes management matter?
AbstractPagan, J., Brown, H. S., Peŕez, A., Yarnell, L. M., Pagán, J. A., Hanis, C. L., Fisher-Hoch, S. P., & McCormick, J. B. (n.d.).Publication year
2011Journal title
American Journal of Managed CareVolume
17Issue
8Page(s)
569-576AbstractObjective: To determine whether labor market effects were the result of diabetes per se or rather depended on the degree to which diabetes was controlled through management of blood sugar levels. Methods: This study utilized data from a recently completed survey of households in Brownsville, Texas, a largely Mexican American community with a high prevalence of diabetes that is located on the Texas-Mexico border. Diabetes management, or control, was measured by blood sugar levels, glycosylated hemoglobin (A1C) levels, and interaction terms. Methods used were probit and Heckman regression. Results: Management of diabetes did not appear to have a discernible impact on labor market outcomes in the short run. However, diabetes was negatively associated with male productivity, particularly in males' propensity to work. The new American Diabetes Association (ADA) definition of diabetes is based on having an A1C level ofLiving in the " land of no" ? Consumer perceptions of healthy lifestyle portrayals in direct-to-consumer advertisements of prescription drugs
AbstractPagan, J., Frosch, D. L., May, S. G., Tietbohl, C., & Pagán, J. A. (n.d.).Publication year
2011Journal title
Social Science and MedicineVolume
73Issue
7Page(s)
995-1002AbstractDirect-to-consumer advertising (DTCA) of prescription drugs is the most common form of health communication Americans are exposed to. The effects of DTCA on prescription requests and utilization are well established, but little is known about the effects of advertisements on health behaviors. Many advertisements, especially those promoting drugs to prevent or treat cardiovascular disease, refer to lifestyle change as a way to improve health. However, no studies have examined how consumers interpret these frequently ambiguous messages. We used in-depth interviews with 45 participants, recruited in Los Angeles, USA between April 2007 and July 2008, to explore perceptions of 5 advertisements for drugs that prevent or treat cardiovascular disease (Lipitor ®, Vytorin ®, Zetia ®, Caduet ®, Plavix ®). We found that participants interpreted advertising messages within their own life context and identified four trajectories for enacting behavior change versus taking prescription drugs: Negotiators, Avoiders, Embracers and Jumpstarters. Underlying these four typologies were beliefs about whether lifestyle change was something an individual could do or was willing to do. Our results also show how an advertisement narrative could potentially shift perceptions of causality by suggesting that high cholesterol is primarily hereditary, thereby obviating the need for lifestyle change. Some participants stated that they would prefer lifestyle change to a particular prescription drug, but felt that others would be more likely to embrace taking a prescription drug. This " Third Person Effect" may be masking participants' intentions by identifying a more socially desirable route to therapeutic change. These findings raise questions about how the typologies are distributed in the population and how advertising may shift consumers' beliefs over time, thereby contributing to new forms of medicalization. Effective regulation of DTCA may require expanding scrutiny beyond the accuracy of claims about benefits and risks, to also considering the broader narratives in which these claims are made.Mortgage delinquency and changes in access to health resources and depressive symptoms in a nationally representative cohort of Americans older than 50 years
AbstractPagan, J., Alley, D. E., Lloyd, J., Pagán, J. A., Pollack, C. E., Shardell, M., & Cannuscio, C. (n.d.).Publication year
2011Journal title
American journal of public healthVolume
101Issue
12Page(s)
2293-2298AbstractObjectives: We evaluated associations between mortgage delinquency and changes in health and health-relevant resources over 2 years, with data from the Health and Retirement Study, a longitudinal survey representative of US adults older than 50 years. Methods: In 2008, participants reported whether they had fallen behind on mortgage payments since 2006 (n=2474). We used logistic regression to compare changes in health (incidence of elevated depressive symptoms, major declines in self-rated health) and access to health-relevant resources (food, prescription medications) between participants who fell behind on their mortgage payments and those who did not. Results: Compared with nondelinquent participants, the mortgage-delinquent group had worse health status and less access to health-relevant resources at baseline. They were also significantly more likely to develop incident depressive symptoms (odds ratio [OR]=8.60; 95% confidence interval [CI]=3.38, 21.85), food insecurity (OR=7.53; 95% CI=3.01, 18.84), and cost-related medication nonadherence (OR=8.66; 95% CI=3.72, 20.16) during follow-up. Conclusions: Mortgage delinquency was associated with significant elevations in the incidence of mental health impairments and health-relevant material disadvantage. Widespread mortgage default may have important public health implications.Seniors' perceptions of prescription drug advertisements : A pilot study of the potential impact on informed decision making
AbstractPagan, J., Grenard, J. L., Uy, V., Pagán, J. A., & Frosch, D. L. (n.d.).Publication year
2011Journal title
Patient Education and CounselingVolume
85Issue
1Page(s)
79-84AbstractObjective: To conduct a pilot study exploring seniors' perceptions of direct-to-consumer advertising (DTCA) of prescription drugs and how the advertisements might prepare them for making informed decisions with their physicians. Methods: We interviewed 15 seniors (ages 63-82) individually after they each watched nine prescription drug advertisements recorded from broadcast television. Grounded Theory methods were used to identify core themes related to the research questions. Results: Four themes emerged from the interviews about DTCA: (1) awareness of medications was increased, (2) information was missing or misleading and drugs were often perceived as more effective than clinical evidence would suggest, (3) most seniors were more strongly influenced by personal or vicarious experience with a drug - and by their physician - than by DTCA, and (4) most seniors were circumspect about the information in commercial DTCA. Conclusions: DTCA may have some limited benefit for informed decision making by seniors, but the advertisements do not provide enough detailed information and some information is misinterpreted. Practical implications: Physicians should be aware that many patients may misunderstand DTCA, and that a certain amount of time may be required during consultations to correct these misconceptions until better advertising methods are employed by the pharmaceutical industry.