Research Interests: health insurance, health policy, medical economics, other insurance, public finance/public choice, regulation
PhD, University of Virginia, 1967; MA, University of Delaware, 1965; AB, Xavier University, 1963
Office of Assistant Secretary for Policy Evaluation, U.S. Department of Health and Human Services – Merck, Inc. American Enterprise Institute
Spencer Kimball Article Award from the Journal of Insurance Regulation for “Terrorism Losses and All Perils Insurance” with Howard Kunreuther, December 2006 National Institute of Health Care Management Foundation’s Research Award for “Is Health Insurance Affordable for the Uninsured?” with M. Kate Bundorf (Journal of Health Economics, July 2006), May 2007 John M. Eisenberg Excellence in Mentorship Award, Agency for Health Care Research and Quality, June 2007 Distinguished Investigator Award, AcademyHealth, June 2007
Wharton: 1983-present (Chairperson, Health Care Systems Department, 1997-2004; Vice Dean and Director, Doctoral Programs, 1995-99; named Bendheim Professor, 1990; Chairperson, Health Care Systems Department, 1990-94; Robert D. Eilers Professor of Health Care Management and Economics, 1984-89). University of Pennsylvania: 1984-present (Co-Director, Roy and Diana Vagelos Program in Life Sciences and Management, 2005-present; Professor of Economics, 1983-present; Executive Director, Leonard Davis Institute of Health Economics, 1984-89). Previous appointments: Northwestern University; University of Virginia. Visiting appointments: International Institute for Applied Systems Analysis, Laxenburg, Austria; International Institute of Management, Berlin, Germany
Professional Leadership 2005-2009
Co-Editor-in-Chief, International Journal of Health Care Finance and Economics, 2001-present; Advisory Editor, Journal of Risk and Uncertainty, 1987-present;
Corporate and Public Sector Leadership 2005-2009
Medicare Technical Advisory Panel; National Advisory Committee, National Institutes of Health, National Center for Research Resources; National Vaccine Advisory Commission Finance Working Group; Board Member, Independent Health
Mark V. Pauly and Ashley Swanson (Forthcoming), Social Impact Bonds in Nonprofit Health Care: New Product or New Package?.
Abstract: Considers a relatively new form of financing for social services, the "Social Impact Bond." Proponents of Social Impact Bonds argue that they present a solution to several problems in funding social services, including performance measurement and the distribution of risk. Using a simple model, we demonstrate that Social Impact Bonds have many features present in standard financing arrangements. They will lead to greater program success when investors’ effort can positively influence outcomes, but are unlikely to do so otherwise. We conclude that the value of this funding innovation will be strongly context-dependent.
Howard Kunreuther and Mark V. Pauly (Work In Progress), Behavioral Economics and Insurance: Principles and Solutions.
J Doshi, P Li, Sean McElligott, Aditi Sen, M Olfson, Mark V. Pauly, Robert Rosenheck, Steven C. Marcus (Draft), Antipsychotic Copayment, Adherence, and Hospital Admission in Dual Eligibles with Schizophrenia.
Abstract: BACKGROUND: Limited evidence exists on the impact of cost-sharing on access to prescription drugs among vulnerable patients enrolled in both Medicare and Medicaid (“dual-eligibles”), in particular, those with schizophrenia. METHODS: Medicare Part D, passed in 2006, required dual-eligibles to switch from prescription coverage through Medicaid to a private Part D plan and resulted in higher drug copayments for dual-eligibles in many states. We use a quasi-experimental design to compare changes in antipsychotic use and schizophrenia-related hospitalization before (2005) and after (2006-2007) the implementation of Part D among dual-eligibles with schizophrenia. Patients in a state that provided copayment assistance to eliminate copayments (Connecticut) are compared to patients in a state that did not provide such assistance (Florida). RESULTS: The increase in copayments among dual-eligibles in Florida was associated with significantly higher odds of having continuous medication gaps of ≥60 days in 2006 than in 2005 compared to the change over the same period in Connecticut (odds ratio OR: 1.18, 95% confidence interval CI: 1.06-1.32) and in 2007 (OR: 1.28, 95% CI: 1.12-1.46). This reduction in antipsychotic use among dual-eligibles in Florida was accompanied by higher odds of an inpatient hospitalization related to schizophrenia in 2006 (OR: 1.58, 95% CI: 1.30-1.94) and in 2007 (OR: 1.73, 95% CI: 1.39-2.15). CONCLUSIONS: Dual-eligibles with schizophrenia appeared to suffer adverse consequences from copayment increases due to the transition to Part D. The increase cost in hospital admissions in the state that did not provide assistance likely offset any savings from not providing copayment assistance.
Lawton R. Burns and Mark V. Pauly (2012), Accountable Care Organizations May Have Difficulty Avoiding The Failures of Integrated Delivery Networks Of The 1990s, Health Affairs, 31, pp. 2407-2416. 10.1377/hlthaff.2011.0675
Abstract: Accountable care organizations are intended to improve the quality and lower the cost of health care through several mechanisms, such as disease management programs, care coordination, and aligning financial incentives for hospitals and physicians. Providers employed several of these mechanisms in forming the integrated delivery networks of the 1990s. The networks failed, however, because of heavy financial losses stemming from hospitals’ purchase of physician practices and their inability to align incentives, garner capitated contracts, and develop the infrastructure to manage risk. Although the current mechanisms underlying accountable care organizations continue to evolve, whether and how they will have an impact on quality and costs remains open to question. Care coordination and information technology are proving more complicated and expensive to implement than anticipated, providers may lack the ability to implement these mechanisms, and primary care providers are in short supply. As in the 1990s, success depends on targeting specific populations, such as people with multiple chronic conditions who need and may benefit from coordinated care.
Mark V. Pauly and Robert J. Town (2012), “Counterpoint: Maryland Exceptionalism? All-Payers Regulation and Health Care System Efficiency”, Journal of Health Politics, Policy and Law, 37 (4), pp. 697-707.
Mark V. Pauly, TG McGuire, PP Barros, Handbook of Health Economics, Vol. 2 (2012)
Mark V. Pauly and A Saxena (2012), Health Employment, Medical Spending, and Long Term Health Reform, CESifo Economic Studies, 58 (1), pp. 49-72.
Mark V. Pauly (Forthcoming), Medical Spending Reform and the Fiscal Future of the United States.
Mark V. Pauly, Kai Menzel, Howard Kunreuther, Richard A. Hirth (2011), Guaranteed Renewability Uniquely Prevents Adverse Selection in Individual Health Insurance, Journal of Risk and Uncertainty, 43(2):127-139.
This introductory course takes a policy and politics angle to health care's three persistent issues - access, cost and quality. The roles of patients, physicians, hospitals, insurers, and pharmaceutical companies will be established. The interaction between the government and these different groups will also be covered. Current national health care policy initiatives and the interests of class members will steer the specific topics covered in the course. The course aims to provide skills for critical and analytical thought about the U.S. health care system and the people in it.
The course provides an application of economic models to demand, supply, and their interaction in the medical economy. Influences on demand, especially health status, insurance coverage, and income will be analyzed. Physician decisions on the pricing and form of their own services, and on the advice they offer about other services, will be considered. Competition in medical care markets, especially for hospital services, will be studied. Special emphasis will be placed on government as demander of medical care services. Changes in Medicare and regulation of managed care are among the public policy issues to be addressed.
This course examines the structure of health care systems in different countries, focusing on financing, reimbursement, delivery systems and adoption of new technologies. We study the relative roles of private sector and public sector insurance and providers, and the effect of system design on cost, quality, efficiency and equity of medical services. Some issues we address are normative: Which systems and which public/private sector mixes are better at achieving efficiency and equity? Other issues are positive: How do these different systems deal with tough choices, such as decisions about new technologies? Our main focus is on the systems in four large, prototypical OECD countries--Germany, Canada, Japan, and the United Kingdom--and then look at other countries with interesting systems- including Italy, Chile, Singapore, Brazil, China and India. We draw lessons for the U.S. from foreign experience and vice versa.
This course, co-taught with Brad Fluegel (former Executive VP of Wellpoint, Inc and current Chief Strategy Officer at Walgreens) will focus on two interrelated topics: managed care and market structure. The section on managed care will cover strategic planning and marketing of managed care services, operational issues in developing a managed care network, actuarial issues, and the management of physician behavior. The section on health care market structure will analyze strategies of vertical integration and horizontal integration (M+As), and their attempt to alter the balance of power in local healthcare markets. The section will also analyze the operational issues in managing cost and quality in an integrated system, integration along the supply chain, and the performance of these systems, and the bargaining and negotiation between hospitals, physicians, and health plans.
This course will provide students a broad overview of the current U.S. healthcare system. The course will focus on the challenges facing the health care system, an in-depth understanding of the Affordable Care Act (ACA) and of its potential impact upon health care access, delivery, cost, and quality as well as its effect on firms within the health care sector. The course will examine potential reforms, including those offered by liberals and conservatives and information that can be extracted from health care systems in other developed countries. The course will also explore key facets of the ACA, including improving access to care and health insurance exchanges, improving quality and constraining costs through health care delivery system reforms, realigning capacity through changes in the health care workforce and in medical education, the potential impact on biomedical and other innovations, and the impact on economic outcomes such as employment, wage growth, and federal budget deficits. The course will also examine the political context and process of passing major legislation in general and health care legislation in particular, including constitutional arguments surrounding the Affordable Care Act. Throughout the course, the key lessons will integrate the disciplines of health economics, health and social policy, law and political science to elucidate key principles.
This course examines the structure of health care systems in different countries, focusing on financing, reimbursement, delivery systems and adoption of new technologies. We study the relative roles of private sector and public sector insurance and providers, and the effect of system design on cost, quality, efficiency and equity of medical services. Some issues we address are normative: Which systems and which public/private sector mixes are better at achieving efficiency and equity? Other issues are positive: How do these different systems deal with the tough choices, such as decisions about new technologies? Our focus first on the systems in four large, prototypical OECD countries- Germany, Canada, Japan, and the United Kingdom -and then look at other developed and emerging countries with interesting systems - including Italy, Chile, Singapore, Brazil, China and India. We will draw lessons for the U.S. from foreign experience and vice versa.
This course provides an overview of the management, economic and policy issues facing the pharmaceutical and biotechnology industries. The course perspective is global, but with emphasis on the U.S. as the largest and most profitable market. Critical issues we will examine include: R&D intensive cost structure with regulation and rapid technological change; strategic challenges of biotech startups; pricing and promotion in a complex global marketplace where customers include governments and insurers, as well as physicians and consumers; intense and evolving M&A, joint ventures, and complex alliances; government regulation of all aspects of business including market access, pricing, promotion, and manufacturing. We use Wharton and industry experts from various disciplines to address these issues.
HCMG 890-001: This course examines issues related to the Services Sector of thehealth care industry. For those interested in management, investing, or bankingto the health care industry, the services sector will likely be the largest and most dynamic sector within all of health care. We will study key management issues related to a number of different health care services businesses with a focus on common challenges related to reimbursement, regulatory, margin, growth, and competitive issues. We will look at a number of different businesses and subsectors that may have been unfamiliar to students prior to taking the course. We will make extensive use of outside speakers, many of whom will be true industry leaders within different sectors of the health care services industry. Speakers will address the current management issues they face in running their businesses as well as discuss the career decisions and leadership styles that enables them to reach the top of their profession. Students will be asked to develop a plan to both buyout and manage a specific health care services business of their choosing and will present their final plans to a panel of leading Health Care Private Equity investors who will evaluate their analysis. Prerequisites: HCMG 841. Health Care Management MBA majors only Senior healthcare executives and policy leaders will be engaged as guest speakers.
This seminar will explore empirical methods in health care research with an emphasis on applications in health care economics and finance. The methods covered include estimation with panel data, program evaluation models, qualitative and limited dependent variable models, stochastic frontier models, estimation with count data, and duration models. The readings consist of a blend of classic and recent empirical studies, including articles on the demand for health care and health insurance, tests for moral hazard and adverse selection, and estimation of provider cost functions. Students are required to conduct an econometric analysis of some issue within the health care field. With the permission of the instructor, the seminar is open to doctoral students from departments other than Health Care Systems.
The purpose of this doctoral level course is to investigate the theory and practice of cost-benefit and cost-effectiveness analysis as applied to health care. The three techniques to be examined are cost-effectiveness analysis with single dimensional outcomes, cost effectiveness analysis with multiple attributes (especially in the form of Quality Adjusted Life Years), and economic cost-benefit analysis. Valuation of mortality and morbidity relative to other goods will be emphasized. Students will be expected to develop written critiques of articles in the literature, and to design a new application of one of the techniques as a term project.
The three heavyweights announced last week that they are joining forces to reduce health care costs for their employees. Will the new model shake up the health care industry?Knowledge @ Wharton - 2018/02/6