Jose Pagan
Jose Pagan
Scroll
Chair and Professor of the Department of Public Health Policy and Management
-
Professional overview
-
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.
-
Areas of research and study
-
Applied EconomicsHealth EconomicsPopulation HealthPublic Health Policy
-
Publications
Publications
Diabetes and employment productivity: Does diabetes management matter?
AbstractBrown, 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 of <6.5%. Using the new ADA definition, diabetes was negatively associated with female productivity. Female productivity was also negatively associated with the new ADA definition of prediabetes (A1C levels between 5.7% and 6.4%). However, very few people with diabetes actually controlled their blood sugar or A1C levels. Conclusion: These results imply that in order to avoid productivity losses associated with diabetes, more scarce prevention resources should be spent on prevention of the onset of diabetes than on the management of A1C for those already diagnosed with diabetes. For women, the prevention of prediabetes is key.Living in the " land of no" ? Consumer perceptions of healthy lifestyle portrayals in direct-to-consumer advertisements of prescription drugs
AbstractFrosch, 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
AbstractAlley, 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
AbstractGrenard, 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.Telehealth and hospitalizations for medicare home healthcare patients
AbstractChen, H. F., Kalish, M. C., & Pagán, J. A. (n.d.).Publication year
2011Journal title
American Journal of Managed CareVolume
17Issue
6Page(s)
e224-e230AbstractObjective: To examine the effect of an integrated, clinician-focused telehealth monitoring system on the probability of hospitalization within the first 30-day episode of home healthcare. Study Design: Retrospective, nonexperimental design. Methods: The study sample includes 2009 data from 5873 Medicare beneficiaries receiving home healthcare services through a network of community-based home health agencies operating in Texas and Louisiana. Propensity-score matching was used to control for selection bias. Logistic regression and postestimation parameter simulation were used to assess how the use of an integrated, clinician-focused telehealth monitoring system might affect the probability of hospitalization during the first 30-day episode of home healthcare. Results: The 30-day probability of hospitalization for telehealth and non-telehealth patients was 10.3% and 17.1%, respectively. Patients in the telehealth group had a 7-percentage-point (95% confidence interval 4.2, 9.4) lower probability of hospitalization within the first 30-day episode of home healthcare than those in the non-telehealth group. Conclusion: The use of an integrated, clinician-focused telehealth monitoring system can substantially reduce the 30-day probability of hospitalization for home healthcare patients. Telehealth monitoring systems that integrate skilled clinicians can lead to substantial hospitalization-related cost savings.Acculturation and healthy lifestyle habits among Hispanics in United States-Mexico border communities
AbstractGhaddar, S., Brown, C. J., Pagán, J. A., & Díaz, V. (n.d.).Publication year
2010Journal title
Revista Panamericana de Salud Publica/Pan American Journal of Public HealthVolume
28Issue
3Page(s)
190-197AbstractObjective. To explore the relationship between acculturation and healthy lifestyle habits in the largely Hispanic populations living in underserved communities in the United States of America along the U.S.-Mexico border. Methods. A cross-sectional study was conducted from April 2006 to June 2008 using survey data from the Alliance for a Healthy Border, a program designed to reduce health disparities in the U.S.-Mexico border region by funding nutrition and physical activity education programs at 12 federally qualified community health centers in Arizona, California, New Mexico, and Texas. The survey included questions on acculturation, diet, exercise, and demographic factors and was completed by 2 381 Alliance program participants, of whom 95.3% were Hispanic and 45.4% were under the U.S. poverty level for 20Chi-square (χ2) and Student's t tests were used for bivariate comparisons between acculturation and dietary and physical activity measures. Linear regression and binary logistic regression were used to control for factors associated with nutrition and exercise. Results. Based on univariate tests and confirmed by regression analysis controlling for so- ciodemographic and health variables, less acculturated survey respondents reported a significantly higher frequency of fruit and vegetable consumption and healthier dietary habits than those who were more acculturated. Adjusted binary logistic regression confirmed that individuals with low language acculturation were less likely to engage in physical activity than those with moderate to high acculturation (odds ratio 0.75, 95% confidence interval 0.59-0.95). Conclusions. Findings confirmed an association between acculturation and healthy lifestyle habits and supported the hypothesis that acculturation in border community populations tends to decrease the practice of some healthy dietary habits while increasing exposure to and awareness of the importance of other healthy behaviors.Assessing willingness to pay for cancer prevention
AbstractMilligan, M. A., Bohara, A. K., & Pagán, J. A. (n.d.).Publication year
2010Journal title
International Journal of Health Care Finance and EconomicsVolume
10Issue
4Page(s)
301-314AbstractCancer is the second leading cause of death in the U. S. and its economic cost is very high. The objective of this study is to analyze the socioeconomic and demographic factors that are related to the willingness to pay (WTP) for cancer prevention. Data from an experimental module in the 2002 Health and Retirement Study (HRS) were used to identify WTP differences across different population subgroups. Respondents were asked whether they were willing and able to pay different dollar amounts per month for a new cancer prevention drug. Years of age were negatively related to WTP whereas income and the probability of developing cancer were positively related to WTP. Risk-relevant numeracy skills were positively related to self-assessed cancer risk, which may suggest that adults with poor numeracy skills underestimate their cancer risk. This has consequences not only on the relative perceived value of different cancer treatments across different population subgroups but also on perceived value as captured by WTP.Context matters: Where would you be the least worse off in the US if you were uninsured?
AbstractGarcia, C., Pagán, J. A., & Hardeman, R. (n.d.).Publication year
2010Journal title
Health policyVolume
94Issue
1Page(s)
76-83AbstractObjectives: We examined the health care access, quality, and cost experienced by uninsured Latino mothers in two communities in Minnesota and Texas. These communities differ substantially by the size of the local population without health insurance coverage. Methods: Four focus groups were conducted with uninsured Latino mothers who were caring for at least one child in their household. Seventeen mothers participated in each community. All focus groups were conducted by the same trained staff from a non-profit, community-based research organization. Results: Uninsured Latino mothers in Minnesota rated the quality of health care services in their community to be much higher than their Texas counterparts, but were more likely to emphasize the high costs of care and health insurance coverage. Participants in Texas also described having to go to Mexico to obtain health care services. Conclusions: Policies making provision for health care services to the uninsured are likely to be more effective when they take into account the context or composition of each specific local health care system as well as the financial and non-financial spillovers that these uninsurance-related contexts generate.Revenue enhancement and wealth effects of mergers and acquisitions in Asian emerging markets
AbstractMa, J., Pagán, J. A., & Chu, Y. (n.d.).Publication year
2010Journal title
International Journal of Revenue ManagementVolume
4Issue
2Page(s)
179-194AbstractRevenue enhancement and value creation are core issues of mergers and acquisitions (Mamp;A). Revenue enhancing synergy associated with crossindustry M&A is supported by Asian emerging markets. Both within-industry M&A and cross-industry M&A deals realise significant positive abnormal returns. The difference between the two categories of M&A is statistically significant in a three-day window, but not statistically significant in a two-day window. Information leakages may be driving the larger valuation effects because a three-day window includes one day before the announcement date. Since large firms tend to diversify their business, the result that cross-industry M&A deals realise lower abnormal returns than within-industry may be driven by the firm size effect.Assessing quality across healthcare subsystems in Mexico
AbstractPuig, A., Pagán, J. A., & Wong, R. (n.d.).Publication year
2009Journal title
Journal of Ambulatory Care ManagementVolume
32Issue
2Page(s)
123-131AbstractRecent healthcare reform efforts in Mexico have focused on the need to improve the efficiency and equity of a fragmented healthcare system. In light of these reform initiatives, there is a need to assess whether healthcare subsystems are effective at providing high-quality healthcare to all Mexicans. Nationally representative household survey data from the 2006 Encuesta Nacional de Salud y Nutrición (National Health and Nutrition Survey) were used to assess perceived healthcare quality across different subsystems. Using a sample of 7234 survey respondents, we found evidence of substantial heterogeneity in healthcare quality assessments across healthcare subsystems favoring private providers over social security institutions. These differences across subsystems remained even after adjusting for socioeconomic, demographic, and health factors. Our analysis suggests that improvements in efficiency and equity can be achieved by assessing the factors that contribute to heterogeneity in quality across subsystems.International competition and the demand for health insurance in the US: Evidence from the Texas-Mexico border region
AbstractBrown, H. S., Pagán, J. A., & Bastida, E. (n.d.).Publication year
2009Journal title
International Journal of Health Care Finance and EconomicsVolume
9Issue
1Page(s)
25-38AbstractConventional economic explanations for uninsurance should apply to all geographic regions in the United States. However, the border states of California, Arizona, New Mexico and Texas have the highest rates of uninsurance in the US, accounting for over 30% of the total US uninsured population. We use survey data from the fourth wave of the Border Epidemiologic Study on Aging (BESA), a survey from a predominantly Mexican American region of South Texas from 2005 to 2006, to analyze how health insurance coverage in the US is related to the use of health care services in Mexico. BESA includes data on the use of health care services in the US and Mexico. We estimate probit models to investigate the association between having insurance coverage in the US and having a regular doctor in Mexico, the independent variable of interest. Separate models are estimated with having private insurance, Medicare Part B insurance, and any type of public insurance as dependent variables. We deal with the endogeneity, due to reverse causality, of having a regular doctor in Mexico by using instrumental variables in a bivariate probit model. The instruments are dental care utilization in Mexico and a variable measuring frequently visiting Mexico. The results show that competition from Mexico lowers the demand for health insurance coverage in the US side of the border.Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age.
AbstractAlley, D. E., Soldo, B. J., Pagán, J. A., McCabe, J., DeBlois, M., Field, S. H., Asch, D. A., & Cannuscio, C. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Page(s)
S693-701AbstractOBJECTIVES: We examined associations between material resources and late-life declines in health. METHODS: We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15,441). RESULTS: Disadvantages in health care (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95% CI = 1.29, 2.22), and housing (OR = 1.20; 95% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95% CI = 1.29, 1.58) and food (OR = 1.64; 95% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage. CONCLUSIONS: Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.Racial and Ethnic Disparities in Awareness of Genetic Testing for Cancer Risk
AbstractPagán, J. A., Su, D., Li, L., Armstrong, K., & Asch, D. A. (n.d.).Publication year
2009Journal title
American journal of preventive medicineVolume
37Issue
6Page(s)
524-530AbstractBackground: Racial and ethnic disparities in awareness of genetic testing for cancer risk are substantial. Purpose: This study assesses the relative importance of contributing factors to gaps in awareness of genetic testing for cancer risk across racial and ethnic groups. Methods: Data from the 2005 National Health Interview Survey (N=25,364) were analyzed in 2009 to evaluate the contribution of demographic factors, SES, health status, nativity/length of residency in the U.S., personal/family history of cancer, and perceived cancer risk to racial and ethnic disparities in genetic testing awareness for cancer risk. The contribution of each factor was assessed using the Fairlie decomposition technique. Results: About 48% of non-Hispanic whites reported that they had heard about genetic testing, followed by 31% of blacks, 28% of Asians, and 19% of Hispanics. Education and nativity/length of residency in the U.S. explained 26% and 30% of the gap between whites and Hispanics, respectively. Education accounted for 22% of the white-black gap, with residential region explaining another 11%. Nativity/length of residency in the U.S. explained 51% of the white-Asian gap. Conclusions: The relative importance of factors contributing to racial and ethnic disparities in genetic testing awareness is specific to the particular groups under comparison. Diverse, culturally competent approaches are needed to improve awareness for different racial and ethnic groups.Which physicians have access to electronic prescribing and which ones end up using it?
AbstractPagán, J. A., Pratt, W. R., & Sun, J. (n.d.).Publication year
2009Journal title
Health policyVolume
89Issue
3Page(s)
288-294AbstractObjectives: This study examines the availability of electronic prescription and the utilization of e-prescribing by physicians in the US. Methods: Nationally representative data from the 2004-2005 Community Tracking Study Physician Survey were used to identify which subgroups of physicians have access to e-prescribing technology and which subgroups are using this technology more or less intensively. Exhaustive Chi-squared Automatic Interaction Detection (CHAID) was employed for statistical data segmentation. Results: Results indicate that the rapidly increasing adoption of electronic prescription is diminished by relatively low physician utilization. E-prescription utilization was segmented among practice size and type. There were also differences in e-prescription use by age, gender, and ethnicity/race in some subgroups. Actual use of e-prescription was very low for female physicians in surgical specialties, psychiatry, and obstetrics/gynecology, and for Hispanic physicians in pediatrics, internal medicine, and family/general practice in solo/two physician practices, medical schools, and hospitals. Conclusions: Insights from segmentation analyses could be used to identify adoption barriers and to develop targeted interventions to accelerate the implementation of e-prescription systems in physician practices.Written Informed-Consent Statutes and HIV Testing
AbstractEhrenkranz, P. D., Pagán, J. A., Begier, E. M., Linas, B. P., Madison, K., & Armstrong, K. (n.d.).Publication year
2009Journal title
American journal of preventive medicineVolume
37Issue
1Page(s)
57-63AbstractBackground: Almost 1 million Americans are infected with HIV, yet it is estimated that as many as 250,000 of them do not know their serostatus. This study examined whether people residing in states with statutes requiring written informed consent prior to HIV testing were less likely to report a recent HIV test. Methods: The study is based on survey data from the 2004 Behavioral Risk Factor Surveillance System. Logistic regression was used to assess the association between residence in a state with a pre-test written informed-consent requirement and individual self-report of recent HIV testing. The regression analyses controlled for potential state- and individual-level confounders. Results: Almost 17% of respondents reported that they had been tested for HIV in the prior 12 months. Ten states had statutes requiring written informed consent prior to routine HIV testing; nine of those were analyzed in this study. After adjusting for other state- and individual-level factors, people who resided in these nine states were less likely to report a recent history of HIV testing (OR=0.85; 95% CI=0.80, 0.90). The average marginal effect was -0.02 (p<0.001, 95% CI=-0.03, -0.01); thus, written informed-consent statutes are associated with a 12% reduction in HIV testing from the baseline testing level of 17%. The association between a consent requirement and lack of testing was greatest among respondents who denied HIV risk factors, were non-Hispanic whites, or who had higher levels of education. Conclusions: This study's findings suggest that the removal of written informed-consent requirements might promote the non-risk-based routine-testing approach that the Centers for Disease Control and Prevention (CDC) advocates in its new testing guidelines.Acculturation and the use of complementary and alternative medicine
AbstractSu, D., Li, L., & Pagán, J. A. (n.d.).Publication year
2008Journal title
Social Science and MedicineVolume
66Issue
2Page(s)
439-453AbstractThe use of complementary and alternative medicine (CAM) has been growing substantially in the US in recent years. Such a growth in CAM use coincides with an ongoing increase in the proportion of the foreign-born population in the US. The main objective of this study is to examine the relation between acculturation and the use of CAM therapies among immigrants. Data from a CAM supplement to the 2002 National Health Interview Survey were analyzed to estimate the effects of acculturation on the likelihood of using different CAM therapies over the past 12 months prior to the survey. The results suggest that the level of acculturation-as measured by nativity/length of stay in the US and language of interview-is strongly associated with CAM use. As immigrants stay longer in the US or as their use of English becomes more proficient, the likelihood that they use CAM therapies increases as well, and it gradually approaches the level of CAM use by native-born Americans. Moreover, this relation between acculturation and CAM use generally persists even after the effects of socioeconomic status, health insurance coverage, self-reported health status, and other demographic variables have all been taken into consideration. The substantially lower rates of CAM use by recent immigrants and its possible causes warrant further research.Effect of guidelines on primary care physician use of PSA screening: Results from the community tracking study physician survey
AbstractGuerra, C. E., Gimotty, P. A., Shea, J. A., Pagán, J. A., Schwartz, J. S., & Armstrong, K. (n.d.).Publication year
2008Journal title
Medical Decision MakingVolume
28Issue
5Page(s)
681-689AbstractBackground. Little is known about the effect of guidelines that recommend shared decision making on physician practice patterns. The objective of this study was to determine the association between physicians' perceived effect of guidelines on clinical practice and self-reported prostate-specific antigen (PSA) screening patterns. Methods. This was a cross-sectional study using a nationally representative sample of 3914 primary care physicians participating in the 1998-1999 Community Tracking Study Physician Survey. Responses to a case vignette that asked physicians what proportion of asymptomatic 60-year-old white men they would screen with a PSA were divided into 3 distinct groups: consistent PSA screeners (screen all), variable screeners (screen 1%- 99%), and consistent nonscreeners (screen none). Logistic regression was used to determine the association between PSA screening patterns and physician-reported effect of guidelines (no effect v. any magnitude effect). Results. Only 27% of physicians were variable PSA screeners; the rest were consistent screeners (60%) and consistent nonscreeners (13%). Only 8% of physicians perceived guidelines to have no effect on their practice. After adjustment for demographic and practice characteristics, variable screeners were more likely to report any magnitude effect of guidelines on their practice when compared with physicians in the other 2 groups (adjusted odds ratio= 1.73; 95% confidence interval=1:25-2:38;P= 0:001). Conclusions. Physicians who perceive an effect of guidelines on their practice are almost twice as likely to exhibit screening PSA practice variability, whereas physicians who do not perceive an effect of guidelines on their practice are more likely to be consistent PSA screeners or consistent PSA nonscreeners.End-of-life medical treatment choices: Do survival chances and out-of-pocket costs matter?
AbstractChao, L. W., Pagán, J. A., & Soldo, B. J. (n.d.).Publication year
2008Journal title
Medical Decision MakingVolume
28Issue
4Page(s)
511-523AbstractBackground. Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion. Objectives. To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs. Methods. Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s. Results. Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects. Conclusions. Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.Lack of community insurance and mammography screening rates among insured and uninsured women
AbstractPagán, J. A., Asch, D. A., Brown, C. J., Guerra, C. E., & Armstrong, K. (n.d.).Publication year
2008Journal title
Journal of Clinical OncologyVolume
26Issue
11Page(s)
1865-1870AbstractPurpose: To evaluate whether the proportion of the local population without health insurance coverage is related to whether women undergo mammography screening. Methods: Survey data on 12,595 women 40 to 69 years of age from the 2000 to 2001 Community Tracking Study Household Survey were used to analyze the relation between community lack of insurance and whether the respondent had a mammogram within the past year. Results: Women age 40 to 69 were less likely to report that they had a mammogram within the last year if they resided in communities with a relatively high uninsurance rate, even after adjusting for other factors. After adjusting for individual insurance and other factors, a 10-percentage-point decrease in the proportion of the local insured population is associated with a 17% (95% CI, 13% to 21%) decrease in the odds that a woman age 40 to 69 years will undergo mammography screening within a year. Conclusion: Women living in communities with high uninsurance are substantially less likely to undergo mammography screening. These results are consistent with the view that the negative impact of uninsurance extends to everyone in the community regardless of individual health insurance status.Persistent disparities in the use of health care along the US-Mexico border: An ecological perspective
AbstractBastida, E., Brown, H. S., & Pagán, J. A. (n.d.).Publication year
2008Journal title
American journal of public healthVolume
98Issue
11Page(s)
1987-1995AbstractObjectives. We examined disparities in health care use among US-Mexico border residents, with a focus on the unique binational environment of the region, to determine factors that may influence health care use in Mexico. Methods. Data were from 2 waves of a population-based study of 1048 Latino residents of selected Texas border counties. Logistic regression models examined predictors of health insurance coverage. Results from these models were used to examine regional patterns of health care use. Results. Of the respondents younger than 65 years, 60% reported no health insurance coverage. The uninsured were 7 and 3 times more likely in waves 3 and 4, respectively, to use medical care in Mexico than were the insured. Preference for medical care in Mexico was an important predictor. Conclusions. For those who were chronically ill, old, poor, or burdened by the lengthy processing of their documents by immigration authorities, the United States provided the only source of health care. For some, Mexico may lessen the burden at the individual level, but it does not lessen the aggregate burden of providing highly priced care to the region's neediest. Health disparities will continue unless policies are enacted to expand health care accessibility in the region.Transcribed Speech: Immigrant Health Care: Social and Economic Costs of Denying Access
Pagan, J. (n.d.).Publication year
2008Journal title
Annals of Health LawVolume
17Issue
2Page(s)
345-350Health care affordability and complementary and alternative medicine utilization by adults with diabetes
Pagán, J. A., & Tanguma, J. (n.d.).Publication year
2007Journal title
Diabetes CareVolume
30Issue
8Page(s)
2030-2031Health insurance coverage and health care utilization along the U.S.-Mexico Border
AbstractBastida, E., Brown, H. S., & Pagán, J. A. (n.d.). In The Health of Aging Hispanics: Evidence from the border epidemiologic study on aging (1–).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
AbstractPagán, 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.Physicians' career satisfaction, quality of care and patients' trust: The role of community uninsurance
AbstractPagán, J. A., Balasubramanian, L., & Pauly, M. V. (n.d.).Publication year
2007Journal title
Health Economics, Policy and LawVolume
2Issue
4Page(s)
347-362AbstractThere is evidence that health care providers located in communities with relatively large uninsured populations face financial difficulties because of low service demand and high levels of uncompensated care. Data on 4,920 physicians from the 2000-2001 Community Tracking Study Physician Survey and from 25,637 adults from the 2003 Community Tracking Study Household Survey were used to analyze whether the relative size of the local uninsured population is associated with the level of career satisfaction and the quality of care provided by physicians and to assess whether patient trust is associated with the level of community uninsurance. The results indicate that the proportion of uninsured adults in a given community is negatively related to physicians' career satisfaction and the perceived quality of health care provided. Community uninsurance is also negatively related to patient trust in their doctor and positively related to whether insured patients believed that their doctor was influenced by rules from health insurance companies. Physicians in communities with relatively large uninsured populations may have lower career satisfaction and lower perceptions of the quality of care provided due to financial difficulties. Patients in these communities are also less likely to trust their physician.