Stanford Health Policy is a joint effort of the Freeman Spogli Institute for International Studies and the Stanford School of Medicine
FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.
FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.
Objective To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India of a large-scale, social franchising and telemedicine programme– the World Health Partners’ Sky Program.
Methods We investigated changes associated with the Sky Program in the knowledge and performance of health-care providers by assessing a representative sample of 810 providers in areas where the Program was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after Program implementation in 2011 and 2014, respectively. Differences in providers’ performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models.
Findings The Sky Program did not significantly improve health-care providers’ knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. The large gap between knowledge of appropriate care and the care actually delivered persisted.
Conclusion Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.
We study how agents respond to performance incentives according to key personality traits (conscientiousness and neuroticism) through a field experiment offering financial incentives for improving maternal and neonatal health outcomes to rural Indian doctors. More conscientious providers performed better – but improved less – under performance incentives. The effect of the performance incentives was also smaller for providers with higher levels of neuroticism. Our results contribute to a growing body of empirical research on heterogeneous responses to incentives and have implications for worker selection.
The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes under 138% of the federal poverty level, leading to substantial reductions in uninsured rates among low-income adults. Despite large gains in coverage, studies suggest that Latinos may be less likely than other racial/ethnic groups to apply and enroll in health insurance, and they remain the group with the highest uninsured rate in the United States. We explore two potential factors related to racial/ethnic differences in ACA enrollment—awareness of the law and receipt of application assistance such as navigator services. Using a survey of nearly 3000 low-income U.S. citizens (aged 19-64) in 3 states in late 2014, we find that Latinos had significantly lower levels of awareness of the ACA relative to other groups, even after adjusting for demographic covariates. Higher education was the strongest positive predictor of ACA awareness. In contrast, Latinos were much more likely to receive assistance from navigators or social workers when applying, relative to other racial/ethnic groups. Taken together, these results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations, two groups that are overrepresented in the Latino population, to close existing disparities in coverage.
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Dr. Hernandez-Boussard is an Associate Professor in Medicine (Biomedical Informatics), Surgery, and Biomedical Data Science at the Stanford University School of Medicine. Dr. Hernandez-Boussard's background and expertise is in the field of computational biology, with concentration on accountability measures, population health, and health policy. A key focus of her research is the application of novel methods and tools to large clinical datasets for hypothesis generation, comparative effectiveness research, and the evaluation of quality healthcare delivery.
If there is such a person as a universally respected and universally loved scholar, Professor Arrow was such a man. I have been trying to think of what I might write to pay tribute to him that somebody else could not say better. I will give it a shot, though I am not qualified to do this task full justice.
Prof. Arrow was a great genius whose work will be spoken about for as long as economics remains a subject of interest. But I am sure that other economists, even someone who did not know him personally, could do an excellent job of recounting his genius. At the very least, Prof. Arrow’s impossibility theorem and his groundbreaking work on general equilibrium models will be part of the standard curriculum of economics, I believe forever. He had an incredibly wide-ranging curiosity, which led him to work that has revolutionized many empirical fields, including my field of health economics.
Let me focus instead on Prof. Arrow’s reputation for being a kind and humble man, about which I can give some specifics. The main thing I have to say about this is that his reputation was well deserved. There are many stories I could tell, but I’ll just tell one here.
In 1989, during the fall of my senior year in college, Prof. Arrow offered a class on economic inequality for undergraduate economics majors. To my surprise, the class was not oversubscribed, and so I signed up. Prof. Arrow was quietly brilliant the whole quarter. In his hands, the economics of inequality touched on an astonishing array of topics, and to this day, I cannot think about the subject except with the framework he presented there.
He was not an outstanding speaker – there was nothing flashy about his style, but there was nothing false either. His aim as a teacher was to focus his students on the material, not himself. Even when he presented his impossibility theorem, I do not remember him saying that it was his theorem.
The next part is embarrassing. The impossibility theorem says, very roughly, that in a society where there is broad disagreement about social policy, democratic processes can produce incoherent social outcomes. When Prof. Arrow taught it in the class, however, I misunderstood and thought the theorem said that democratic processes always lead to incoherent social outcomes. That evening, I found an easy – too easy! – counter-example to the incorrectly understood theorem. So I scheduled a time to go meet with Prof. Arrow to see where I had gone astray.
When we met, Prof. Arrow was very kind as he explained my error. He even apologized for being unclear in his explanation, even though I am sure most of the rest of the class had it right.
He spent the bulk of the time that day trying to find out what I wanted to do with my life. When I told him I wanted to be a doctor and not an economist, he seemed disappointed (this genuinely surprised me) and he encouraged me to think some more about it. That meeting led me for the first time to think really seriously about a career as an economist. That brief meeting with Prof. Arrow changed my life.
It is easy to be sad when someone of Prof. Arrow’s character and genius dies. I am grateful that I had the opportunity to get to know him. I will always count his touch on my life a blessing from God and I will miss him.
