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
Trends and sociodemographic disparities in sugary drink consumption among adults in New York City, 2009–2017
AbstractPagan, J., Jiang, N., Yi, S. S., Russo, R., Bu, D. D., Zhang, D., Ferket, B., Zhang, F. F., Pagán, J. A., Wang, Y. C., & Li, Y. (n.d.).Publication year
2020Journal title
Preventive Medicine ReportsVolume
19AbstractDespite efforts to decrease sugary drink consumption, sugary drinks remain the largest single source of added sugars in diets in the United States. This study aimed to examine trends in sugary drink consumption among adults in New York City (NYC) over the past decade by key sociodemographic factors. We used data from the 2009–2017 NYC Community Health Survey to examine trends in sugary drink consumption overall, and across different age, gender, and racial/ethnic subgroups. We conducted a test of trend to examine the significance of change in mean sugary drink consumption over time. We also conducted multiple zero-inflated negative binomial regression to identify the association between different sociodemographic and neighborhood factors and sugary drink consumption. Sugary drink consumption decreased from 2009 to 2014 from 0.97 to 0.69 servings per day (p < 0.001), but then plateaued from 2014 to 2017 (p = 0.01). Although decreases were observed across all age, gender and racial/ethnic subgroups, the largest decreases over this time period were observed among 18–24 year old (1.75 to 1.22 servings per day, p < 0.001); men (1.12 to 0.86 servings per day, p < 0.001); Blacks (1.45 to 1.14 servings per day, p < 0.001); and Hispanics (1.26 to 0.86 servings per day, p < 0.001). Despite these decreases, actual mean consumption remains highest in these same sociodemographic subgroups. Although overall sugary drink consumption has been declining, the decline has slowed in more recent years. Further, certain age, gender and racial/ethnic groups still consume disproportionately more sugary drinks than others. More research is needed to understand and address the root causes of disparities in sugary drink consumption.Trends in Medical School Application and Matriculation Rates Across the United States from 2001 to 2015 : Implications for Health Disparities
AbstractZhang, D., Li, G., Mu, L., Thapa, J., Li, Y., Chen, Z., Shi, L., Su, D., Son, H., & Pagan, J. (n.d.).Publication year
2021Journal title
Academic MedicineVolume
96Issue
6Page(s)
885-893AbstractPurpose Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity to a medical school, and medical school application and matriculation rates. Method Data were obtained from the Association of American Medical Colleges, including the age, gender, and Federal Information Processing Standards code for county of legal residence for each applicant and matriculant to U.S. MD-granting medical schools from 2001 through 2015. The application and matriculation rates in each county were calculated using the number of applicants and matriculants per 100,000 residents. Counties were classified into 4 groups according to the county median family income (high-income, middle-income, middle-low-income, low-income). The authors performed chi-square tests to assess trends across the study period and the association of county median family income with application and matriculation rates. Results There were 581,833 applicants and 262,730 (45.2%) matriculants to MD-granting medical schools between 2001 and 2015. The application rates per 100,000 residents during 2001-2005, 2006-2010, and 2011-2015 were 57.2, 62.7, and 69.0, respectively, and the corresponding matriculation rates were 27.5, 28.1, and 29.8. The ratios of the application rate in high-income counties to that in low-income counties during the 3 time periods were 1.9, 2.4, and 2.8, respectively. Conclusions The application and matriculation rates to MD-granting medical schools increased steadily from 2001 to 2015. Yet, applicants and matriculants disproportionately came from high-income counties. The differences in the application and matriculation rates between low-income and high-income counties grew during this period. Exploring these differences can lead to better understanding of the factors that drive geographic differences in physician access and the associated health disparities across the United States.Trends in Reported Health Care Affordability for Men and Women with Employer-Sponsored Health Insurance Coverage in the US, 2000 to 2020
AbstractPagan, J., Gupta, A., & Pagán, J. A. (n.d.).Publication year
2022Journal title
JAMAVolume
328Issue
24Page(s)
2448-2450Abstract~Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals : 2015-2021
AbstractPagan, J., Chang, J. E., Cronin, C. E., Pagán, J. A., Simon, J., Lindenfeld, Z., & Franz, B. (n.d.).Publication year
2023Journal title
Journal of Addiction MedicineVolume
17Issue
4Page(s)
E217-E223AbstractObjectives Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs. Methods We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or χ2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave. Results Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital-and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates. Conclusions Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.U.S./Mexico border economic development and the informal sector in Mexico: 1987-1997
AbstractBrown, C., Pagan, J., & Petrie, A. (n.d.).Publication year
2001Journal title
Journal of Emerging MarketsVolume
6Issue
1Page(s)
37-46Abstract~Uncertainty and human capital accumulation along the U.S./Mexico Border
AbstractLeMaster, J., & Pagan, J. (n.d.).Publication year
1997Journal title
Ensayos (Center for Economic Research, Department of Economics, Universidad Autónoma de Nuevo León)Volume
16Issue
2Abstract~Uninsurance, 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.United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico
AbstractPagan, J., McSorley, A. M., Rivera-González, A. C., Lopez Mercado, D., Pagán, J. A., Purtle, J., & Ortega, A. N. (n.d.).Publication year
2024Journal title
American journal of public healthVolume
114Page(s)
S478-S484AbstractPuerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico's deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico's limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico.Use of calibration to improve the precision of estimates obtained from All of Us data
AbstractPagan, J., Wang, V. H., Holm, J., & Pagán, J. A. (n.d.).Publication year
2024Journal title
Journal of the American Medical Informatics Association : JAMIAVolume
31Issue
12Page(s)
2985-2988AbstractOBJECTIVES: To highlight the use of calibration weighting to improve the precision of estimates obtained from All of Us data and increase the return of value to communities from the All of Us Research Program. MATERIALS AND METHODS: We used All of Us (2017-2022) data and raking to obtain prevalence estimates in two examples: discrimination in medical settings (N = 41 875) and food insecurity (N = 82 266). Weights were constructed using known population proportions (age, sex, race/ethnicity, region of residence, annual household income, and home ownership) from the 2020 National Health Interview Survey. RESULTS: About 37% of adults experienced discrimination in a medical setting. About 20% of adults who had not seen a doctor reported being food insecure compared with 14% of adults who regularly saw a doctor. CONCLUSIONS: Calibration using raking is cost-effective and may lead to more precise estimates when analyzing All of Us data.Use of Telehealth to Address Depression and Anxiety in Low-income US Populations : A Narrative Review
AbstractPagan, J., Sultana, S., & Pagán, J. A. (n.d.).Publication year
2023Journal title
Journal of Primary Care and Community HealthVolume
14AbstractSymptoms of anxiety and depressive disorders have been increasing substantially among adults in the United States (US) during the COVID-19 pandemic, particularly for low-income populations. Under-resourced communities have difficulties accessing optimal treatment for anxiety and depression due to costs as well as the result of limited access to health care providers. Telehealth has been growing as a digital strategy to treat anxiety and depression across the country but it is unclear how best to implement telehealth interventions to serve low-income populations. A narrative review was conducted to evaluate the role of telehealth in addressing anxiety and depression in low-income groups in the US. A PubMed database search identified a total of 14 studies published from 2012 to 2022 on telehealth interventions that focused on strengthening access to therapy, coordination of care, and medication and treatment adherence. Our findings suggest that telehealth increases patient engagement through virtual therapy and the use of primarily telephone communication to treat and monitor anxiety and depression. Telehealth seems to be a promising approach to improving anxiety and depressive symptoms but socioeconomic and technological barriers to accessing mental health services are substantial for low-income US populations.Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity : A Scoping Review
AbstractPagan, J., McNeill, E., Lindenfeld, Z., Mostafa, L., Zein, D., Silver, D. R., Pagán, J., Weeks, W. B., Aerts, A., Rosiers, S. D., Boch, J., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of the American Heart AssociationVolume
12Issue
21AbstractBACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. METHODS AND RESULTS: After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geo-coded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. CONCLUSIONS: Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.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 ofUsing systems science to inform population health strategies in local health departments : A case study in San Antonio, Texas
AbstractPagan, J., Li, Y., Padrón, N. A., Mangla, A. T., Russo, P. G., Schlenker, T., & Pagán, J. A. (n.d.).Publication year
2017Journal title
Public Health ReportsVolume
132Issue
5Page(s)
549-555AbstractObjectives: Because of state and federal health care reform, local health departments play an increasingly prominent role leading and coordinating disease prevention programs in the United States. This case study shows how a local health department working in chronic disease prevention and management can use systems science and evidence-based decision making to inform program selection, implementation, and assessment; enhance engagement with local health systems and organizations; and possibly optimize health care delivery and population health. Methods: The authors built a systems-science agent-based simulation model of diabetes progression for the San Antonio Metropolitan Health District, a local health department, to simulate health and cost outcomes for the population of San Antonio for a 20-year period (2015-2034) using 2 scenarios: 1 in which hemoglobin A1c (HbA1c) values for a population were similar to the current distribution of values in San Antonio, and the other with a hypothetical 1-percentage-point reduction in HbA1c values. Results: They projected that a 1-percentage-point reduction in HbA1c would lead to a decrease in the 20-year prevalence of end-stage renal disease from 1.7% to 0.9%, lower extremity amputation from 4.6% to 2.9%, blindness from 15.1% to 10.7%, myocardial infarction from 23.8% to 17.9%, and stroke from 9.8% to 7.2%. They estimated annual direct medical cost savings (in 2015 US dollars) from reducing HbA1c by 1 percentage point ranging from $6842 (myocardial infarction) to $39 800 (endstage renal disease) for each averted case of diabetes complications. Conclusions: Local health departments could benefit from the use of systems science and evidence-based decision making to estimate public health program effectiveness and costs, calculate return on investment, and develop a business case for adopting programs.Utilizing Publicly Available Community Data to Address Social Determinants of Health : A Compendium of Data Sources
AbstractPagan, J., Lindenfeld, Z., Pagán, J. A., & Chang, J. E. (n.d.).Publication year
2023Journal title
Inquiry (United States)Volume
60AbstractTo compile a compendium of data sources representing different areas of social determinants of health (SDOH) in New York City. We conducted a PubMed search of the peer-reviewed and gray literature using the terms “social determinants of health” and “New York City,” with the Boolean operator “AND.” We then conducted a search of the “gray literature,” defined as sources outside of standard bibliographic databases, using similar terms. We extracted publicly available data sources containing NYC-based data. In defining SDOH, we used the framework outlined by the CDC’s Healthy People 2030, which uses a place-based framework to categorize 5 domains of SDOH: (1) healthcare access and quality; (2) education access and quality; (3) social and community context; (4) economic stability; and (5) neighborhood and built environment. We identified 29 datasets from the PubMed search, and 34 datasets from the gray literature, resulting in 63 datasets related to SDOH in NYC. Of these, 20 were available at the zip code level, 18 at the census tract-level, 12 at the community-district level, and 13 at the census block or specific address level. Community-level SDOH data are readily attainable from many public sources and can be linked with health data on local geographic-levels to assess the effect of social and community factors on individual health outcomes.Valued-added tax revenues in Mexico : An empirical analysis
AbstractPagan, J., Tijerina-Guajardo, J. A., & Pagán, J. A. (n.d.).Publication year
2000Journal title
Public Finance ReviewVolume
28Issue
6Page(s)
561-575AbstractThis article analyzes the effect of changes in the valued-added tax (VAT) rate on real VAT revenue in Mexico. Recently, there has been a heated debate on the optimal VAT system and the potential economic impact of a reduction in the VAT rate in the country. The results from estimating a VAT revenue model suggest that there seems to be a positive relationship between VAT revenue and the tax rate around the actual VAT rate, contrary to the assertion that there is a Laffer curve for the VAT in Mexico. A 1 percentage point change in the VAT rate results in a 2.4% change in real VAT revenues. Leaving aside other fiscal reform considerations, the results appear to be robust to alternative empirical specifications.Views on the need to implement restriction policies to be able to address COVID-19 in the United States
AbstractPagan, J., Wang, V. H., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Preventive MedicineVolume
143AbstractSeveral restriction policies implemented in many states in the United States have demonstrated their effectiveness in mitigating the spread of the coronavirus disease (COVID-19), but less is known about the differences in views on the restriction policies among different population segments. This study aimed to understand which different population groups of adults in the United States consider several key restriction policies as necessary to combat COVID-19. Survey data from Wave 64 (March 19–24, 2020) of the Pew Research Center's American Trends Panel (n=10,609) and logistic regression were used to evaluate the association between socioeconomic and demographic characteristics, employment status, political party affiliation, news exposure, census region, and opinions about COVID-19 restriction policies. The policies included restricting international travel, imposing business closures, banning large group gatherings, cancelling entertainment events, closing schools, limiting restaurants to carry-out only, and postponing state primary elections. Most survey respondents viewed COVID-19 restriction policies as necessary. Views on each restriction policy varied substantially across some population segments such as age, race, and ethnicity. Regardless of population segments, those who followed news closely or considered themselves Democrat/lean Democrat were more likely to consider all the policies as necessary than those not following the news closely or those who considered themselves Republican/lean Republican. The effectiveness of key COVID-19 restriction policies is likely to vary substantially across population groups given that views on the need to implement these policies vary widely. Tailored health messages may be needed for some population segments given divergent views on COVID-19 restriction policies.Violent crime victimization and mental health among adolescents in Mexico
AbstractPagan, J., Balmori-de-la-Miyar, J., Tennyson, S., Silverio-Murillo, A., & Pagán, J. A. (n.d.).Publication year
2025Journal title
Preventive Medicine ReportsVolume
53AbstractObjectives: To understand the association between violent crime victimization and mental health outcomes among adolescents in Mexico, and to define the link between the nominal classification of violent crime and mental health outcomes. Methods: We used fixed-effects linear and logistic regressions and survey data from the 2018–2019, 2021, 2022, and 2023 National Health and Nutrition Survey (n = 26,187). Survey waves were conducted in all 32 Mexican states during: July 2018–June 2019, July–December 2021, July–December 2022, and July–October 2023. Results: Violent crime victimization was associated with higher scores of having depressive symptoms (CESD-7) (b = 1.93 points, ± 0.26), and greater likelihood of suicidal ideation (adjusted odds ratio (aOR) = 5.32, ± 0.86) and suicide attempts in the last twelve months (aOR = 6.87, ± 2.74). More serious classes of violent crime relate to worse mental health outcomes among adolescents. Specifically, kidnapping, the most serious class of violent crime in our data, correlates with worse mental health outcomes when compared to robbery or aggravated assault. Conclusions: Violent crime victimization is linked to increased depressive symptoms, suicidal ideation, and suicide attempts among adolescents. More serious classes of violent crime are associated with worse mental health outcomes in this population.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.Weighting the United States All of Us Research Program data to known population estimates using raking
AbstractPagan, J., Wang, V. H., Lei, J., Shi, T., & Pagán, J. A. (n.d.).Publication year
2024Journal title
Preventive Medicine ReportsVolume
43AbstractBackground: The All of Us Research Program aims to collect longitudinal health-related data from a million individuals in the United States. An inherent challenge of a non-probability sampling strategy through voluntary participation in All of Us is that findings may not be nationally representative for addressing health and health care at the population level. We generated survey weights for the All of Us data that can be used to address the challenge. Research design: We developed raked weights using demographic, health, and socioeconomic variables available in both the 2020 National Health Interview Survey (NHIS) and All of Us. We then compared the unweighted and weighted prevalence of a set of health-related variables (health behaviors, health conditions, and health insurance coverage) estimated from All of Us data with the weighted prevalence estimates obtained from NHIS data. Subjects: The sample included 100,391 All of Us participants 18 years of age and older with complete data collected between May 2017 and January 2022 across the United States. Results: Final variables in the raking procedure included age, sex, race/ethnicity, region of residence, annual household income, and home ownership. The mean percentage difference between known proportions obtained from the NHIS and All of Us was reduced by 18.89% for health-related variables after applying the raked weights. Conclusions: Raking improved the comparability of prevalence estimates obtained from All of Us to known national prevalence estimates. Refining the process of variable selection for raking may further improve the comparability between All of Us and nationally representative data.What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals
AbstractFranz, B., Cronin, C. E., & Pagan, J. (n.d.).Publication year
2021Journal title
Public Health ReportsVolume
136Issue
2Page(s)
228-238AbstractObjectives: Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. Methods: We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. Results: Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). Conclusions: Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.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.Which physicians have access to electronic prescribing and which ones end up using it?
AbstractPagan, J., Pagán, 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.Who does not reduce their sodium intake despite being advised to do so? A population segmentation analysis
AbstractPagan, J., Li, Y., Berenson, J., Moran, A. E., & Pagán, J. A. (n.d.).Publication year
2017Journal title
Preventive MedicineVolume
99Page(s)
77-79AbstractExcessive sodium intake is linked to an increased risk for hypertension and cardiovascular disease. Although health care providers and other health professionals frequently provide counseling on healthful levels of sodium consumption, many people who consume sodium in excess of recommend levels still do not watch or reduce their sodium intake. In this study, we used a population segmentation approach to identify profiles of adults who are not watching or reducing their sodium intake despite been advised to do so. We analyzed sodium intake data in 125,764 respondents sampled in 15 states, the District of Columbia and Puerto Rico through the Behavioral Risk Factor Surveillance System to identify and segment adults into subgroups according to differences in sodium intake behaviors. We found that about 16% of adults did not watch or reduce their sodium intake despite been told to do so by a health professional. This proportion varied substantially across the 25 different population subgroups identified. For example, about 44% of adults 18 to 44 years of age who live in West Virginia were not reducing their sodium intake whereas only about 7.2% of black adults 65 years of age and older with diabetes were not reducing their sodium intake. Population segmentation identifies subpopulations most likely to benefit from targeted and intensive public health and clinical interventions. In the case of sodium consumption, population segmentation can guide public health practitioners and policymakers to design programs and interventions that change sodium intake in people who are resistant to behavior change.Why Are Some US Nonprofit Hospitals Not Addressing Opioid Misuse in Their Communities?
AbstractPagan, J., Cronin, C. E., Franz, B., & Pagán, J. A. (n.d.).Publication year
2020Journal title
Population Health ManagementVolume
23Issue
6Page(s)
407-413AbstractThe US opioid epidemic is national in scope, but many local solutions have been shown to have efficacy. Many nonprofit hospitals have the resources and infrastructure to lead these community-based efforts, but there is evidence that some organizations are not adopting opioid services as part of their community benefit requirements to assess and address critical community health needs. This paper assesses why hospitals do not address opioid abuse after completing a community health needs assessment. For a 20% random sample of nonprofit hospitals, a unique data set was constructed of hospital efforts to address opioid abuse using the most recent publicly available community health needs assessments and implementation strategies adopted by hospitals (calendar years 2015, 2016, 2017, or 2018). Multinomial logistic regression was used to assess the relationship between 5 different reasons hospitals cited for not addressing opioid abuse and both hospital and community characteristics. Results indicate that opioid abuse was not addressed by 32% (143) of hospitals in their formal implementation strategies. State community benefit laws, county overdose level, county poverty rate, hospital region, and hospital system membership all were significantly related to the reasons hospitals cited for not addressing opioid abuse as part of their community health engagement. Hospitals in communities with significant substance abuse needs and few institutional resources may need support to address opioid misuse and adopt treatment and harm reduction initiatives. Policies that support hospital-public health partnerships may be especially important to assist hospitals to address nonmedical or behavioral health needs in their communities.Why do pets have better web portals for medical records than humans?
AbstractPagan, J. (n.d.).Publication year
2015Abstract~