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
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.Spillovers and vulnerability: The case of community uninsurance
AbstractPauly, M. V., & Pagán, J. A. (n.d.).Publication year
2007Journal title
Health AffairsVolume
26Issue
5Page(s)
1304-1314AbstractThis paper studies the uninsured as a vulnerable population. We contend that reducing the size of the uninsured population yields important spillover benefits to the insured population, benefits that go beyond a lower charity care burden. Evidence presented in this paper reinforces studies in the literature that show that problems of health services quality and access facing insured people increase when the proportion of uninsured people in their local communities is greater. The size of such spillover benefits is reduced if the local market is large enough to be segmented based on insurance status.Access to health care for migrants returning to Mexico
AbstractRoss, S. J., Pagán, J. A., & Polsky, D. (n.d.).Publication year
2006Journal title
Journal of health care for the poor and underservedVolume
17Issue
2Page(s)
374-385AbstractContinued migration from Mexico over the past several decades has created a large population of elderly Mexicans in the U.S. There is no system in Mexico for those Mexicans who would like to retire there to obtain health insurance during their retirement years. Using a nationally representative dataset of Mexican elders, we explore the current state of health insurance status for Mexican elders with a history of migration to the U.S. We find a robust negative association between years spent in the U.S. and the probability of being insured. Coordination between the U.S. and Mexico on policy options to insure Mexicans migrants may prove beneficial to the social security systems in both countries as well as to migrants themselves.Community-level uninsurance and the unmet medical needs of insured and uninsured adults
AbstractPagán, J. A., & Pauly, M. V. (n.d.).Publication year
2006Journal title
Health Services ResearchVolume
41Issue
3Page(s)
788-803AbstractObjective. To examine the relationship between community-level uninsurance rates and the self-reported unmet medical needs of insured and uninsured adults in the U.S. Data Sources. 2000-2001 Community Tracking Study, which includes data from 60 randomly selected U.S. communities. The sample is representative of the contiguous U.S. states. Study Design. Multilevel logistic regressions were employed to investigate whether the local uninsurance rate was related to having reported unmet medical needs within the last year. The models also included individual and community variables that could be potentially related to both community uninsurance rates and having reported unmet medical needs. Principal Findings. The community uninsurance rate was positively associated with having reported unmet medical needs, but only for insured adults. On average, a five percentage point increment in the local uninsured population is associated with a 10.5 percent increase in the likelihood that an insured adult will report having unmet medical needs during the 12-month period studied. Conclusion. Local health care delivery systems seem to be negatively affected by high uninsurance rates. These effects could have negative consequences for health care access, even for individuals who are themselves insured.Managed care and the scale efficiency of US hospitals
AbstractBrown, 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
AbstractPuig, 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
AbstractPagán, 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
AbstractPagán, 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
Pagan, J., & Puig, A. (n.d.).Publication year
2005Journal title
Diabetes CareVolume
28Issue
2Page(s)
425-6Start-up capital, microenterprises and technical efficiency in Mexico
AbstractHernández-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
AbstractBrown, 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
AbstractBrown, 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
AbstractCho, 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
AbstractPagán, 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
Pagan, J., & Asgary, N. (n.d.).Publication year
2004Journal title
Journal of Developing AreasVolume
38Issue
1Page(s)
93-106Sectoral selection and informality: A Nicaraguan case study
AbstractPisani, 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
AbstractPisani, 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.