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
Abstract: This paper considers a relatively new form of financing for social services, the “social impact bond (SIB).” Proponents of SIBs argue that they present a solution to several problems in funding social services, including performance incentives and risk allocation. Using a simple model, we first demonstrate that, despite their apparent novelty, SIBs in concept need not produce any difference in outcome from standard financing arrangements with private nonprofit firms. We then argue that SIBs will lead to greater program success if investors’ effort responds to incentives and can positively influence outcomes, either directly (e.g., effort exerted in production) or indirectly (e.g., effort devoted to screening), but are unlikely to do so otherwise. We conclude that, as in the more general theoretical literature, the value of this particular application in terms of funding innovation will be strongly context-dependent.
Description: with Mark Pauly and Adam Leive
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.
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 Senior Vice President and Chief Healthcare Marketing Development officer at Walgreen Co, 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.
The objective of this course is to provide students with a rigorous understanding of the health care system in the United States. The course will focus on the historical development of the current health care system; challenges of health care costs, quality, and access; the relationship between market failure and the passage of the Affordable Care Act (ACA); the impact to date of recent health reforms on the organization, structure, delivery and outcomes of the health care system, and future reforms and responses of the health care system. This class will consist of 4 interconnected segments. The first segment will provide an in-depth analysis of the U.S. health care system prior to the passage of the ACA and the factors underlying the failure of this market. The second segment of the course will review the history of attempts to reform the US health care system, the politics of reform, and the story of how the ACA ultimately passed through Congress. The third segment will focus on the effects of the ACA subsequent health reforms, such as the Medicare Access and CHIP Reauthorization Act, over the last 8 years on cost, access, and quality. This will include perspectives from a diverse set of stakeholders, includiing insurers, health care systems, physicians, private sector entrepreneurs, and others. ,The final segment of the course will consider the possible long-term outlook for health reform in the United States, including recent pushes for national single payer, or "Medicare for All."
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.
900-001 Proseminar in Health Econometrics: This course will cover empirical methods used in economics research with an emphasis on applications in health care and public economics. The methods covered include linear regression, matching, panel data models, instrumental variables, regression discontinuity, bunching,qualitative and limited dependent variable models, count data, quantile regressions, and duration models. The discussion will be a mix of theory and application, with emphasis on the latter. The readings consist of a blend of classic and recent methodological and empirical papers in economics . Course requirements include several problem sets, paper presentations, an econometric analysis project and a final exam. The course is open to doctoral students from departments other than Health Care Management with permission from the instructor. ,900-002 Proseminar in Health Economics: Models and Methods: This course is intended to provide entering doctoral students with information on the variety of health economics models, methods, topics, and publication outlets valued and used by faculty in the HCMG doctoral program and outside of it. The course has two main parts: the first, to acquaint students with theoretical modeling tools used frequently by health economists. This part of the course involves a number of lectures coupled with students presentations of class projects in a workshop environment. The second part of the course will offer presentations from the health economics, management and operations research community at Penn on a research method or strategy they have found helpful and they think is important for all doctoral students to know.
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.
A lawsuit that wants to dismantle the Affordable Care Act in its entirety could create outcomes that are worse than the problems it aims to fix.Knowledge @ Wharton - 2018/06/19