Careers in Health Economics: Agency for Healthcare Research and Quality
By Adam I. Biener
On my first day of work as an economist in the Center for Financing, Access and Cost Trends in the Agency for Healthcare Research and Quality, I wore a tie.
After finishing my dissertation on the medical care costs of obesity, I found myself embedded in the office that oversaw the collection of my primary data source, the Medical Expenditure Panel Survey. My new colleagues were the authors of papers and documentation I had immersed myself in during graduate school. The same colleagues who, on my first day, very kindly informed me I had overdressed for my first day of work.
The Agency for Healthcare Research and Quality (AHRQ) is a federal agency in the US Department of Health and Human Services (DHHS) comprised of centers with different data collection and research dissemination missions. The Center for Financing, Access and Cost Trends (CFACT) oversees the Medical Expenditure Panel Survey (MEPS), an annual nationally representative household survey collecting detailed information on medical care use and expenditures now in its third decade of data collection. CFACT is comprised of staff involved in every aspect of MEPS, from the survey design, to the creation of sampling weights, and the use of the data for behavioral and policy research. The entire agency includes a mix of health services researchers, physicians, project officers, statisticians, and economists.
The responsibility of an economist in CFACT, like other offices that oversee the collection of federal surveys, is divided between original research, and participating in the larger effort of managing the survey. Survey work can be bewildering to an economist more comfortable with an econometric model. MEPS respondents are walked through five interviews over two years by a field interviewer (FI) using a computer assisted personal interview (CAPI) laptop, detailing all their medical events such as office-based (OB) or hospital outpatient (OP) visits, then signing authorization forms (AFs) granting permission to contact providers to verify expenditure data for the Medical Provider Component (MPC) of MEPS, or to collect practice characteristics for the new Medical Organizations Survey (MOS).
Deciphering the alphabet soup takes some time, but the process builds a deep understanding of the data generating process in MEPS and other federal surveys that is integral to making meaningful contributions to the survey design and can inform more careful research using these data. There is no need to secure outside funding, as research is a main job responsibility, and thus working in a federal agency can be characterized as a “hard-money” job. A large majority of research conducted by CFACT incorporates MEPS in some capacity, although this is not a requirement. For economists, there is an expectation that you generate policy relevant research in high visibility journals that are often not economics journals, although it is not uncommon to publish articles in health economics, econometrics or survey methods field journals. Collaboration with researchers outside the agency is encouraged, though all research conducted by federal economists is subject to internal review to ensure accurate representation of the data; a process that usually functions like journal peer-review and often solicits many constructive comments.
Working in federal government can be very exciting, as you are very close to policy discussions in Washington. The agency routinely consults for other federal agencies and committees, answers requests and provides information directly to lawmakers or the department, and disseminates findings that fuel the national discourse on health care, patient safety and health policy. It is an immense privilege to work at AHRQ precisely because you serve the American people, and the data products and research are ultimately for the consumption all Americans. An acute reminder of this occurred when the center director informed me that I would participate in a closed door meeting with the HHS secretary to articulate how our center could meet new department priorities, a rare opportunity even for a federal employee. Nervous, I asked the director if there was anything I should know for the meeting. I was cautioned to avoid the acronyms, and speak plainly about the work the agency did and, after a pensive pause, he said, “You should probably wear a tie.”
Adam Biener is an Assistant Professor of Economics at Lafayette College and a Guest Researcher at AHRQ. He was previously an Economist at the Center for Financing, Access and Cost Trends at AHRQ. He has a Ph.D. from Lehigh University