Interviewed in this newsletter (left to right): ASHEcon Award Winners Mark Satterthwaite, Amanda Kowalski, David Chan, and Travis Donahoe
By Lynn Bergeland Morgan and Nan Clement
The 2023 ASHEcon Plenary and Awards Luncheon provided useful tips for economists to effectively communicate with the media. Dan Gorenstein (Founder and Executive Editor of Tradeoffs, a podcast that explores the health care system) first offered four recommendations for economists when doing an interview:
- Be responsive – journalists often have tight deadlines and need a quick response.
- Keep it simple and succinct – clearly define your research question in simple terms.
- Couch your comments in context – economists often know the larger body of literature surrounding their research, but journalists do not. Explain the context of your research and how it builds on prior knowledge.
- Be zesty – self-explanatory!
Following Gorenstein’s media tips, he and Michael Chernew (Leonard D. Schaeffer Professor of Health Care Policy at Harvard University) conducted a mock interview to demonstrate how an effective interview should look. Gorenstein welcomes health economists to contact Tradeoffs for research publicity (Email us!). He suggested that health policy researchers be patient, engage generously with reporters, and show genuine interest in journalists’ work. “Being nice is also essential,” Gorenstein said.
Following the Plenary and Award Luncheon, we interviewed the four recipients of the 2023 ASHEcon awards. Mark Satterthwaite, the A.C. Buehler Professor in Hospital and Health Services Management, Professor of Strategy, and Professor of Managerial Economics at Northwestern’s Kellogg School of Management, received the Victor R. Fuchs Award for Lifetime Contributions to the Field of Health Economics. David Chan, Associate Professor of Health Policy at Stanford University, was the ASHEcon Medal winner. Amanda Kowalski, the Gail Wilensky Professor of Applied Economics and Public Policy at the University of Michigan, received the Willard G. Manning Memorial Award for the Best Research in Health Econometrics, and J. Travis Donahoe, former Ph.D. Candidate in Health Policy (Economics) at Harvard University, and now an assistant professor in the Department of Health Policy and Management at the University of Pittsburgh, was the Student Paper Award winner for his paper, “Supplier Enforcement and the Opioid Crisis”.
Interview with Mark Satterthwaite, Victor R. Fuchs Award Winner
Nan: How has your conception of research changed over the years?
Mark: Research takes a lot of time. And at every stage, finding the time to do it is one of the hardest things. When you work on a complicated problem, you need uninterrupted time to get it in your head. The time-management aspect keeps changing over time. When I was a Ph.D. student, boy, could I focus. Then early in one’s career, teaching takes a lot of time. Somehow, we must get things done in those years. As one gets better at juggling, more things come in because departments are a little organization and, inevitably, you help to run it. Research is juggling time and staying up so as to continue to contribute.
Nan: For job market candidates, what are the most crucial factors you consider when hiring new faculty?
Mark: That’s a good question. And I might point out that I no longer participate in that process. Here is what I looked for. A person who is asking a really interesting question that has a certain amount of originality and then answers with some empirical, theoretical, or experimental technique. I was seldom enthusiastic when the topic was just a simply literature-driven question. Finally, I always thought about how that person fits in the classroom. I remember when we interviewed someone many years ago, I said this guy was going to be terrific in the MBA classroom. And you know what? He has been.
Nan: You have mentioned that combining the big data of electronic medical records with ML and AI can improve physician-patient matching. Can you elaborate on your view on this important but hard question?
Mark: That is a hard question. If there are several doctors of the same specialty, each of them tends to be better with some diagnoses than others. There are four important players: the physicians, the patients, the hospital systems, and the regulatory structure, especially HIPAA. In any mechanism, each player contributes real constraints. For example, HIPAA makes it hard to combine data from more than one system. Each hospital system would like physicians to only refer you to within-system physicians. This creates conflicts of interest. An important question is how we divide the benefit that the mechanism creates. For it to work, you need good data. Nan, you work on information systems so you know the importance of accurate and informative medical records. Overall, it is a challenging question, but with existing tools like how mechanism design applies to the school choice problem, I can see that this research will in due course occur and be terribly important.
Nan: Can you tell us more what you think about how physicians embrace new information technologies?
Mark: It is great to have accessible IT, but the problem is when managers say you must make sure to click this box each time. Given the time pressures that physicians are already under, it is extraordinarily irritating. Paperwork may take 10 minutes out of a 15 minutes visit. It is unfortunate that physicians look at the screen and not the patient. Smoothing these issues out may be the biggest thing that AI does.
Nan: Thank you for your time; I enjoyed both talking with you and learning from your acceptance speech. Do you have anything else to share with the younger generation of ASHEcon members?
Mark: That is an interesting set of questions you came up with. I enjoyed it, too. This has all been very nice. I am honored that people have thought I deserved this award. About my speech, every time you go and write something, you wonder how people will like it. One has to be brave. I guess that is my one piece of advice for you and every young person. Be brave and talk about something that you think is important.
Interview with Dave Chan, ASHEcon Medal Winner
Lynn: What was your favorite part of this year’s ASHEcon conference in St. Louis?
Dave: Being able to celebrate the award with my wife was really nice. This was the first time my wife got to see what we do, and what we talk about. Economics can be a bit of a black box, even to people in my family, so Dan Gorenstein’s talk was very accessible and perfect for someone like my wife.
Lynn: How far into your medical career were you when you decided to get your Ph.D. in Economics? What was it that you felt you were unable to accomplish with your medical degree that you felt a doctorate in economics would provide?
Dave: I really didn’t know about a career in economics until I took a class in health policy in the middle of medical school. This class was very different than any other classes I had taken and it really stood out. It just sparked an interest and it was pretty obvious that I was much more engaged in this course than I was in other courses I took in medical school. During my second year of medical school I applied to take two years off and was lucky enough to get a Marshall Scholarship where I was able to go to England and learn about international health policy. During this time, it became very clear that the stuff I was studying was a match for my interests.
Lynn: Do any of your articles stand out to you for having findings that are particularly impactful for society? What do you believe are the most important lessons we should take away from some of your most recent work?
Dave: A highlight is a paper I did with David Card and Lowell Taylor that is now forthcoming in the AER. It started as a cool thought idea to use a quasi-experiment to study the causal impact of going to a VA vs. non-VA hospital for veterans who could go to either. Once we started posting results it became clear they were relevant to a huge policy question about what the VA should do for its growing number of veterans who need care. The paper finds that veterans who get care at a VA hospital have substantially lower mortality than veterans who get care at non-VA hospitals.
Lynn: You have a unique perspective in that you are a medical doctor and a health economist. What is one thing that you believe is important for health economists to understand about the experience of medical doctors, and vis-a-versa?
Dave: Health economists need a nuanced view of behavior; it’s not purely a principal-agent problem. Humans are people making imperfect decisions who have limited bandwidth and care about what their peers think. The complexity of decision making and increasingly the importance of organizations within healthcare are very important things for health economists to think more about.
Health economists are much more interested in learning about how health care is delivered than physicians are in learning about health economics, although there is growing interest. All physicians should realize that being a doctor is not a solitary activity that solely requires what you learned in medical school. Making sure your patients get the best care requires understanding the drivers of health outside of the medical setting.
Lynn: In your speech at the awards luncheon, you mentioned that there were barriers to entry to many potential scholars in health economics. Can you talk about what a couple of those barriers are?
Dave: There are barriers to entry into the field. People of different backgrounds are not exposed to the pipeline it takes to become a Ph.D. economist, and the pipeline is non-trivial. We need these underrepresented groups in the field because they have unique life experiences that can contribute to our understanding.
Interview with Amanda Kowalski, The Willard G. Manning Memorial Award Winner
Lynn: How did you get interested in health economics?
Amanda: I have been interested in health for a long time because I thought that I wanted to be a doctor, but I did not have any exposure to economics. I did not start to consider an economics Ph.D. until the fall of my junior year of college. I was taking my first small economics course, and the professor, Ben Friedman, encouraged me and exposed me to the research process. I will also always remember a very helpful conversation with David Cutler in which he helped me to realize that I was more drawn to helping people at a population level through health economics than I was to helping people one-on-one through patient care.
Lynn: This is your second time in four years to receive an ASHEcon award. You won the ASHEcon medal in 2019, and you won the Willard G. Manning Award for the Best Research in Health Econometrics this year for “Behavior within a Clinical Trial and Implications for Mammography Guidelines,” published in the Review of Economic Studies. What do you believe it is about your work that stands out in the field?
Amanda: I was particularly honored to receive the Manning Award this year, in part because I had the pleasure of meeting Will Manning and getting his advice on my econometric work several times at the start of my career. My best papers answer specific policy-relevant questions in health economics and also combine econometrics, models, and data to expand the set of questions that can be answered.
Lynn: What is the role of econometrics in “Behavior within a Clinical Trial and Implications for Mammoography Guidelines,” and how can aspiring health economists best engage with it?
Amanda: Econometrics allows me to examine behavior within a clinical trial and find that women more likely to receive mammograms within the trial are healthier and more likely to be overdiagnosed by them. The approach is fundamentally simple, and I show the main results graphically. Two of my undergraduate students and my full-time research assistant worked with me to develop a publicly available problem set that explains the econometrics by working through the main results of the paper.
Lynn: You conclude based on your paper that a weakening of U.S. mammography guidelines for women in their 40s could potentially improve health while decreasing cost. For health economists and patients new to mammography guidelines and the evidence behind them, this conclusion may seem counterintuitive. Could you give more context?
Amanda: I spent a long time sifting through the evidence on mammography as background for my research, and I shared what I learned in “Mammograms and Mortality: How Has the Evidence Evolved?” published in the Journal of Economic Perspectives. Most importantly, the evidence behind the guidelines shows that the main risk of mammography is overdiagnosis – the diagnosis of true breast cancers that would not cause symptoms during a woman’s lifetime. Overdiagnosis and associated overtreatment can have significant physical, emotional, and financial costs.
Lynn: At the ASHEcon Conference this year in St. Louis you had your young child with you. Did your experience being the patient during your pregnancy teach you anything about the healthcare system?
Amanda: One of my first published papers was a paper on newborns with Doug Almond, Joe Doyle, and Heidi Williams, and I used to joke that having a baby probably would have given me more context for it. Over a decade and two babies later, I am working on a new maternal health project with Engy Ziedan. Stay tuned!
Interview with J. Travis Donahoe, Student Paper Award Winner
Nan: How was your ASHEcon this year? Was there anything particularly insightful or interesting that you learned at the conference?
Travis: The Tuesday Plenary Luncheon: Matifadza Hlatshwayo-Davis’s discussion about leading St. Louis’s public health department through the COVID-19 crisis was incredible. I also found Darrell Gaskin’s metaphor about there being a “bully in the room” (when referring to systems and policies that deplete the public good in order to advance private interests) a very powerful statement. Receiving the award and getting to meet so many people that I admire in the health economics community was also amazing. I am so grateful to my advisors David Cutler, Nicole Maestas and Thomas McGuire, and other scholars in the Harvard community, like Ellen Meara, Timothy Layton, Mark Shepard, and Haiden Huskamp, who were all so generous with their advice about my research and helped me improve it to where it could win this recognition.
Nan: As an assistant professor at the University of Pittsburgh, what do you plan to focus on?
Travis: There are two broad areas I am thinking about right now. The first one is examining how to improve outcomes for people who end up in the criminal justice system due to having substance use disorders. A second area is to understand what are effective and scalable policies that could help prevent substance use disorders among youth.
Nan: How did you get interested in health economics, and is there a specific reason you focus on Appalachia?
Travis: I grew up in Appalachia. It is one of the areas that has been most heavily affected by the opioid crisis and other public health challenges, like obesity, and this is what originally got me interested in public health more generally. Since I was an undergraduate, I have been curious about how economic incentives and policies shape population health. The biggest thing that influenced me to study health economics specifically was I took an econometrics class when I was an undergraduate by Rishav Bista, where I worked on a project to study how investments in education affect people’s health behaviors. That was exciting and got me to keep going.
Nan: What inspired you to investigate opioid supplier closings and their impact on opioid deaths?
Travis: I grew up in Huntington, W.Va., which was an area that has really been at the epicenter of the opioid crisis. I did not really realize how severe the opioid crisis was in Huntington until after I had left to go to University of Michigan for a master’s degree and Harvard for a Ph.D. The scale of the problem in Huntington was just so far beyond what these other areas were experiencing, that it got me really trying to understand why. One of the articles that really inspired this project was a news report by the journalist Eric Eyre, which reported on absolutely inexcusable volumes of prescription opioids being shipped into small towns near Huntington by several drug distributors from 2006 to 2014 with fairly limited oversight. I learned the federal government took some initiatives to stop this kind of behavior and wanted to learn what the effects of that were.
Nan: In an ideal world, what kind of policy changes would we see as a result of your paper?
Travis: The paper shows that policies that target reducing harmful opioid supply can help address the opioid crisis. Much of the literature suggests supply-side policies do not help or do more harm than good, and that has led a lot of people to focus their attention away from the supply-side. I think this paper pushes back on that literature and shows there is a role for supply-side strategies to reduce overdose deaths and improve health. I would not make any policy recommendations because reducing deaths must be balanced with other considerations like harm done to physicians that are targeted by enforcement actions; however, I think the results showing a case where supply-side enforcement improved mortality should inform those policy discussions.