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
Managed care and the scale efficiency of US hospitals
AbstractPagan, J., Brown, H. S., & Pagán, J. A. (n.d.).Publication year
2006Journal title
International Journal of Health Care Finance and EconomicsVolume
6Issue
4Page(s)
278-289AbstractManaged care penetration has been partly responsible for slowing down increases in health care costs in recent years. This study uses a 1992-1996 Health Care Utilization Project sample of hospitals to analyze the relationship between managed care penetration in local insurance markets and hospital scale efficiency. After controlling for hospital and market area variables, we find that managed care insurance, particularly the preferred provider type, is associated with increases in hospital scale efficiency in tertiary cases. The results presented here are consistent with the view that managed care can lead to reductions in health cost inflation by controlling the diffusion of technology via improvements in the scale efficiency of hospitals.Notas y comentarios envejecimiento, salud y economía la encuesta nacional sobre salud y envejecimiento en México
AbstractPagan, J., Puig, A., Pagán, J. A., & Soldo, B. J. (n.d.).Publication year
2006Journal title
Trimestre EconomicoVolume
73Issue
2Page(s)
407-418AbstractMexico is experiencing a demographic transition in which the percentage of the population older than 50 years of age is growing rapidly as a result of increases in life expectancy. This population has special needs that must be taken into account when formulating policy, especially in terms of access to health care services and social security. In this article we present a general description of the Mexican Health and Aging Survey (MHAS), a panel study that began in 2001 and that provides a unique opportunity to study complex demographic and economic issues through the exploration of personal characteristics, socioeconomic transfers and health indicators for a sample of 15 186 middle and older age adults. We also present the most important results from different studies that have used MHAS up to date. Our review shows that Mexico faces substantial challenges in order to be able to satisfy the demand for health services for a population that is being increasingly threatened by chronic disease, particularly the elderly population that lacks health insurance coverage.Self-medication and health insurance coverage in Mexico
AbstractPagan, J., Pagán, J. A., Ross, S., Yau, J., & Polsky, D. (n.d.).Publication year
2006Journal title
Health policyVolume
75Issue
2Page(s)
170-177AbstractSelf-medication is a common practice in many developing countries but little is known about its determinants. This study analyzes the factors that are associated with the use of self-medication in Mexico using the Mexican Health and Aging Study, a new nationally representative survey on adults aged 50 and over. We find that self-medication is related to socioeconomic status and the lack of access to professional healthcare. Our empirical results suggest that lack of government-sponsored health insurance coverage increases the propensity to self-medicate. A 10% increase in the proportion of adults with health insurance coverage could decrease the use of pharmacy consultations by .8% for public sector workers and by 1.7% for private sector workers. Increasing health insurance coverage could reduce the demand for self-medication by making healthcare more affordable and by changing the population perceptions about the benefits of modern medicine.Access to conventional medical care and the use of complementary and alternative medicine
AbstractPagan, J., Pagán, J. A., & Pauly, M. V. (n.d.).Publication year
2005Journal title
Health AffairsVolume
24Issue
1Page(s)
255-262AbstractThe use of complementary and alternative medicine (CAM) in the United States has greatly increased during the past decade. Using survey data from the 2002 National Health Interview Survey (NHIS), we show that adults who did not get, or delayed, needed medical care because of cost in the prior twelve months were also more likely than all other adults to use CAM. Recent increases in CAM use could be the result of not only the desire for individual empowerment and patient dissatisfaction with conventional medicine, as has been claimed, but also of increases in the relative cost of conventional health care.Differences in access to health care services between insured and uninsured adults with diabetes in Mexico
AbstractPagan, J., & Puig, A. (n.d.).Publication year
2005Journal title
Diabetes CareVolume
28Issue
2Page(s)
425-6Abstract~Start-up capital, microenterprises and technical efficiency in Mexico
AbstractPagan, J., Hernández-Trillo, F., Pagán, J. A., & Paxton, J. (n.d.).Publication year
2005Journal title
Review of Development EconomicsVolume
9Issue
3Page(s)
434-447AbstractAccess to adequate start-up capital has been identified as an important deterrent to microenteprise development and growth. Using firm level data from Mexico's National Survey of Microenterprises, we estimate a stochastic frontier production function with inefficiency effects related to the main sources of start-up capital. Microenterprises utilizing bank loans, carryover business capital, moneylenders and credit from clients and suppliers are more technically efficient than those relying on family, friends and on own financial sources. Bank loans led to the highest degree of technical efficiency, indicating a well-functioning screening process despite information asymmetries.Banks tend to offer the largest average loan size with the longest terms which are significant factors in allowing microentrepreneurs to overcome financing constraints.The decision-making process of health care utilization in Mexico
AbstractPagan, J., Brown, C. J., Pagán, J. A., & Rodríguez-Oreggia, E. (n.d.).Publication year
2005Journal title
Health policyVolume
72Issue
1Page(s)
81-91AbstractUsing individual-level data from the 2000 Mexican Survey of Satisfaction with Health Services we estimate a two-part negative binomial hurdle model to evaluate the decision-making process of health care utilization in Mexico. We find that there are income-related differences in utilization associated with the first visit to a physician, as well as substantial utilization differences by region, employment, insurance and financial status. There are also income-related differences in the first visit to a specialist but not in the number of days hospitalized. The results suggest that increasing initial access to services via income and insurance coverage and providing financial resources to underserved regions can substantially improve access to care and, ultimately, population health.The impact of diabetes on employment : Genetic IVs in a bivariate probit
AbstractPagan, J., Brown, H. S., Pagán, J. A., & Bastida, E. (n.d.).Publication year
2005Journal title
Health EconomicsVolume
14Issue
5Page(s)
537-544AbstractDiabetes has been shown to have a detrimental impact on employment and labor market productivity, which results in lost work days and higher mortality/disability. This study utilizes data from the Border Epidemiologic Study on Aging to analyze the endogeneity of diabetes in an employment model. We use family history of diabetes as genetic instrumental variables. We show that assuming that diabetes is an exogenous variable results in an overestimate (underestimate) of the negative impact of diabetes on female (male) employment. Our results are particularly relevant in the case of populations where genetic predisposition has an important role in the etiology of diabetes.Complementary and alternative medicine : personal preference or low cost option?
AbstractPagan, J., & Pauly, M. V. (n.d.).Publication year
2004Journal title
LDI issue briefVolume
10Issue
4Page(s)
1-4AbstractFrom acupuncture to yoga, Americans' use of complementary and alternative medicine (CAM) is widespread and growing. The reasons that people give for using CAM are as diverse as the CAM therapies themselves: some perceive that conventional health care is ineffective, while others consider CAM to be more consistent with their own values and beliefs about health. As conventional health care costs rise, it is also possible that some people turn to CAM as a low cost alternative. This Issue Brief summarizes research that evaluates the relationship between CAM use and perceived access to conventional health care.Economic growth and interfactor/interfuel substitution in Korea
AbstractPagan, J., Cho, W. G., Nam, K., & Pagán, J. A. (n.d.).Publication year
2004Journal title
Energy EconomicsVolume
26Issue
1Page(s)
31-50AbstractThis paper investigates the impact of increases in oil consumption and changes in wage rates on the interfactor/interfuel substitution in Korea. A two-stage translog cost function is estimated to incorporate the feedback effect between the interfactor and interfuel substitution. Empirical results show that the substitutability/complementarity relationships among factors and fuels exhibit substantially different patterns before and after 1989.Reformas al sistema de seguridad social y el mercado laboral en los estados unidos y Canadá
AbstractPagan, J., & Pagán, J. A. (n.d.).Publication year
2004Journal title
Trimestre EconomicoVolume
71Issue
4Page(s)
943-962AbstractThis study evaluates the labor market impact of the most recent reforms that have been proposed or implemented in the social security systems of the - United States and Canada. The demographic changes experienced by both countries in recent years are an important challenge to the financial solvency of the public pension systems. It is inevitable that in the not too distant future the level of benefits will have to fall, the retirement age will edge up or the payroll taxes will increase so that the systems become financially sustainable. The demographic changes also indicate that privatization schemes will become more popular in the future because they do not redistribute income across generations but rather they are simply forced retirement savings schemes.Relative employment and earnings of female household heads in Mexico
AbstractPagan, J., & Asgary, N. (n.d.).Publication year
2004Journal title
Journal of Developing AreasVolume
38Issue
1Page(s)
93-106Abstract~Sectoral selection and informality : A Nicaraguan case study
AbstractPagan, J., Pisani, M. J., & Pagán, J. A. (n.d.).Publication year
2004Journal title
Review of Development EconomicsVolume
8Issue
4Page(s)
541-556AbstractUsing microdata from the 1998 and 1993 Nicaraguan Living Standards Measurement Survey, this paper analyzes the relative size and attractiveness of formal and informal sector employment. Switching regression models of the formal/informal sector employment choice indicate that education across years and gender are the primary determinants of formal sector participation. Furthermore, the formal sector is characterized by positive selection. The results for the informal sector are less definitive, but are also suggestive of positive selection. These findings imply that the informal and formal sectors in Nicaragua contribute positively to the overall economy by attracting those individuals best suited for (in)formal sector employment.Self-employment in the era of the new economic model in Latin America : A case study from Nicaragua
AbstractPagan, J., Pisani, M. J., & Pagán, J. A. (n.d.).Publication year
2004Journal title
Entrepreneurship and Regional DevelopmentVolume
16Issue
4Page(s)
335-350AbstractUsing data from the 1993 and 1998 Nicaraguan Living Standards Measurement Survey, this paper analyses the desirability of self-employment for Nicaraguan men and women over two points in time in a changing economic environment characterized by market-based reforms called the New Economic Model. Switching regressions of the self-employed and waged and salaried sectoral choice suggest that experience is the major determinant of self-employment for both Nicaraguan men and women. Mixed findings are reported for sectoral selection suggesting that the self-employed men, depending upon current economic conditions, may alternate back and forth between the sector (self-employment or waged and salaried employment) with the highest returns. For women, improvement in economic conditions reflected negative selection in both sectors suggesting that much of the economic gains in the 1990s accrued to men.The Economic Impact of Worker Displacement in the US/Mexico Border Region
AbstractPagan, J. (n.d.). (J. Pagán, Ed.).Publication year
2004Abstract~Worker Displacement in the US/Mexico Border Region
AbstractPagan, J. (n.d.).Publication year
2004Abstract~Government 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.Just-in-time purchasing and technical efficiency in the US manufacturing sector
AbstractPagan, J., Kaynak, H., & Pagán, J. A. (n.d.).Publication year
2003Journal title
International Journal of Production ResearchVolume
41Issue
1Page(s)
1-14AbstractThis paper analyses the technical productive efficiency effects of implementing just-in-time purchasing (JITP) techniques in the US manufacturing industry. The impact of JITP techniques on technical efficiency is modelled using a stochastic frontier production function that explicitly accounts for JITP-induced efficiency effects. The empirical results suggest that characteristics internal to the organization, such as top management commitment to implementing JITP, are related to higher productive efficiency. External characteristics, such as supplier value-added, or transportation issues, do not appear to be associated with increasing productive efficiency.Sectoral queuing in a transitional economy : The case of Nicaragua in the 1990s
AbstractPagan, J., Pisani, M. J., & Pagán, J. A. (n.d.).Publication year
2003Journal title
LabourVolume
17Issue
4Page(s)
571-597AbstractUsing microdata from the 1993 and 1998 Living Standards Measurement Survey (LSMS) of Nicaragua, this paper analyzes the propensity of informal sector workers to queue for formal sector employment as well as employer behavior related to the selection of individuals from the informal sector queue. The nature of the queue is also examined over time to determine informal sector workers' response to national market-based reforms. The results indicate that informal workers do indeed queue for formal sector employment and the nature of the queue has become more pronounced during the time period under consideration.Employment shifts, economic reform and the changes in public/private sector wages in Mexico : 1987-1997
AbstractPagan, J., Pagán, J. A., Gil, J. V., & Tijerina Guajardo, J. A. (n.d.).Publication year
2002Journal title
Empirical EconomicsVolume
27Issue
3Page(s)
447-460AbstractOver the last decade, the public sector in Mexico experienced substantial fiscal reform, divestiture of public enterprises, and the elimination of many regulations affecting pay and employment. This study analyzes the changes in the public/private sector differences in wages during the 1987-1997 period. The results from analyzing microdata from the Encuesta Nacional de Empleo Urbano show that relative public sector wages increased from 1987 to 1997. Most of the relative wage increase in the public sector can be explained by increases in the price of skills and by changes in sorting across sectors. The results have important public policy implications since they suggest that public sector workers earn more and their wages have grown faster than those of their private sector counterparts. As such, policies contemplating public sector reform should take into account the effect of these measures on the inter-sectoral income distribution and the overall economic growth.Executive compensation and corporate production efficiency: a stochastic frontier approach
AbstractBaek, H., & Pagan, J. (n.d.).Publication year
2002Journal title
Quarterly Journal of Business and EconomicsVolume
41Issue
1-2Page(s)
27-42Abstract~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.Introduction [Symposium: Contemporary Economic Issues in Mexico]
AbstractPagan, J. (n.d.).Publication year
2002Journal title
Eastern Economic JournalVolume
28Issue
3Page(s)
363-4Abstract~Job queuing in Mexico’s Maquiladoras
AbstractOtero, R., & Pagan, J. (n.d.).Publication year
2002Journal title
Eastern Economic JournalVolume
28Issue
3Page(s)
393-408Abstract~The impact of diabetes on adult employment and earnings of Mexican Americans : Findings from a community based study
AbstractPagan, J., Bastida, E., & Pagán, J. A. (n.d.).Publication year
2002Journal title
Health EconomicsVolume
11Issue
5Page(s)
403-413AbstractEpidemiological studies indicate that minority populations in the US - including African Americans, Native Americans and Mexican Americans - are particularly at risk for diabetes and that their complications are more frequent and severe. Using microdata from a 1994-1999 population based study of middle aged and older Mexican Americans in the Southwest, this study analyzes the impact of diabetes on the employment and earnings outcomes of adults 45 years of age and older. The empirical results from estimating maximum likelihood employment and earnings models suggest that diabetes leads to lower productivity and earnings for women but has no statistically significant impact on their employment probability. In the case of men, however, diabetes leads to a lower employment propensity but has no effect on earnings. Thus, the problems associated with this condition could lead to potential future financial difficulties particularly for high-risk populations in their later years.