US health economists: who we are and what we do

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<ul><li><p>HEALTH ECONOMICSHealth Econ. 17: 535543 (2008)Published online 7 November 2007 in Wiley InterScience ( DOI: 10.1002/hec.1314</p><p>US HEALTH ECONOMISTS: WHO WE ARE AND WHAT WE DO</p><p>MICHAEL A. MORRISEYa and JOHN CAWLEYb,*aDepartment of Health Care Organization and Policy, and Lister Hill Center for Health Policy, University of Alabama at</p><p>Birmingham, Birmingham, AL, USAbDepartment of Policy Analysis and Management, and Sloan Program in Health Administration, Cornell University,</p><p>Ithaca, NY, USA</p><p>SUMMARY</p><p>This paper reports the results of a Fall 2005 survey of US health economists, the rst in over 18 years. Whereappropriate, the results are compared with the earlier ndings of Feldman and Morrisey (J. Health Politics PolicyLaw 1990; 15(3):627646). The paper describes the demographics and training of health economists. It alsodescribes how employers view the substitutability between a Ph.D. in economics and a Ph.D. in health servicesresearch, which is a key question because self-identied health economists increasingly include health servicesresearchers trained in schools of public health or medicine. This study also reports the expectations of various,employers of health economists regarding external grant and contract support. It also reports health economistsperceptions of the processes that allocate resources and recognition: promotion review, journal refereeing, andgrant review. Copyright # 2007 John Wiley &amp; Sons, Ltd.</p><p>Received 31 October 2006; Revised 12 August 2007; Accepted 28 September 2007</p><p>KEY WORDS: training of health economists; research productivity; labour issues-health economists</p><p>INTRODUCTION</p><p>Health economics is a relatively new and diverse eld of economics. It is a testament to themarketability of health economists skills that its practitioners are spread across government, the privatesector, and the academy. Moreover, within the academy health economists can be found in colleges ofarts and sciences, business schools, and schools of public health and medicine. Because of this diversity,it is difcult to observe the demographic characteristics, training, publication strategies, and satisfactionacross the eld as a whole.This paper provides that information, which was collected in a unique survey of US health</p><p>economists, the rst in over 18 years. Where appropriate, the results are compared with theearlier ndings of Feldman and Morrisey (1990), which was based on a survey of members of the HealthEconomics Committee of the American Public Health Association and/or the Canadian HealthEconomics Research Organization. This paper describes the demographics and training ofhealth economists. It also describes how employers view the substitutability between a Ph.D. ineconomics and a Ph.D. in health services research, which is a key question because self-identied healtheconomists increasingly include health services researchers trained in schools of public health ormedicine. This study also reports the expectations of various employers of health economists regardingpublications and external grant and contract support. Finally, the paper reports health economistsperceptions of the processes that allocate resources and recognition: promotion review, journalrefereeing, and grant review.</p><p>*Correspondence to: Department of Policy Analysis and Management, and Sloan Program in Health Administration, CornellUniversity, 124 MVR Hall, Ithaca, NY 14853, USA. E-mail:</p><p>Copyright # 2007 John Wiley &amp; Sons, Ltd.</p></li><li><p>DATA AND METHODS</p><p>The survey was developed by the authors with the input and feedback of an advisory committeeconsisting of Roger Feldman (chair), Sharon Arnold, Dick Arnould, Kate Bundorf, Mike Hagan, DaveKnutson, and Kristine Metter. E-mail invitations and two follow-up reminders to take the survey weresent to 1439 unduplicated US members of the International Health Economics Association (IHEA)and/or the Health Economics Interest Group of AcademyHealth.1 While there is overlap inmembership, the survey process prevented dual members from responding more than once. The onlinesurvey was open between 24 October 2005 and 21 November 2005 and was completed by 460respondents, for a response rate of 32%. Out of 460 respondents, 101 considered themselves to beneither a health economist nor an economist who works in health; they were dropped from this analysisleaving 359 self-designated health economist respondents.The relatively low response rate raises the issue of the generalizability of the ndings. The direction of</p><p>non-response bias, if any, is unclear. On the one hand, those with higher opportunity costs of time maybe less likely to respond. On the other hand, those with stronger interest in the survey topic may be morelikely to respond. Non-respondents may have disproportionately been members who considerthemselves to be neither a health economist nor an economist who works in health, and thereforewould have been dropped from the analysis.Our response rate of 32% is lower than the response rate of 43% for a 2002 survey of health services</p><p>researchers conducted by AcademyHealth (Resneck and Luft, 2004) and 54% for a 1989 survey of USand Canadian health economists (Feldman and Morrisey, 1990). This decline in response rates by healtheconomists and health services researchers is consistent with the general downward trend in surveyresponse rates since the early 1990s (Biener et al., 2004). Studies have found no impact of the decline inresponse rates on non-response bias (Curtin et al., 2000; Keeter et al., 2000) or the representation ofpopulation subgroups (Biener et al., 2004). To a certain extent, the declining response rates could be aresult of the growth of the eld; Feldman and Morrisey (1990) identied 441 likely health economists toinvite to take their survey; we identied more than three times as many: 1439. The growth of the eld ofhealth economics may have led more people who work in multiple elds of economics or health to jointhe organizations whose members we invited to participate in the survey, and these people at the marginof the eld may have been less likely to respond.To investigate the extent to which the lower response rate affected the representativeness of our</p><p>sample, we compare the respondents to our survey to those of Feldman and Morrisey (1990), which hada 54% response rate. It is not a perfect comparison, because the two surveyed different organizations atdifferent stages in the evolution of the eld of health economics, but it remains the closest availablecomparison. Feldman and Morrisey (1990) do not report demographic characteristics of their sample,so comparisons are limited to education and employment, but on those dimensions the samples appearcomparable. The percentage with an economics (as opposed to some other) Ph.D. is 72% in the currentsample compared with 84% in the 1989 sample. This difference may be due to increased production ofdoctorates in health services research and health policy rather than to lower response. In both samples,the graduate programs in economics that produced the most respondents included: Wisconsin (#1 inboth surveys), Chicago, Michigan, Yale, Harvard, MIT, and the University of California at Berkeley.The percentage of the sample that works in an economics department is almost identical in the twosamples: 24% in the current sample and 25% in the 1989 sample. Likewise, the percentages working ingovernment are very similar: 12% in the current sample and 14% in the 1989 sample. These</p><p>1We acknowledge that certain self-identied health economists may not be members of these professional groups. For example,those in government or at teaching institutions may not have travel budgets that permit them to attend health economicsconferences and as such may be less likely to belong to IHEA or AcademyHealth. Such individuals may be underrepresented inthese data.</p><p>M. A. MORRISEY AND J. CAWLEY536</p><p>Copyright # 2007 John Wiley &amp; Sons, Ltd. Health Econ. 17: 535543 (2008)DOI: 10.1002/hec</p></li><li><p>comparisons yield no evidence that the decline in response rate from 54% in 1989 to 32% in 2005fundamentally altered which health economists responded.The survey consisted of 61 questions and was divided into eight parts. The rst asked about</p><p>demographic characteristics. Subsequent sections asked about education and training, employment,how health economists spend their professional time, publications, and their professional experience.Other sections dealt with how much economists earn, their perceptions of policy issues, and researchproductivity; these ndings are reported elsewhere (Cawley and Morrisey, 2007, Morrisey and Cawley,2006; Morrisey and Cawley, 2007).</p><p>FINDINGS</p><p>Demographics</p><p>Seventy-two percent of our nal sample was self-identied as a health economist and the remaining 28%was self-identied as an economist who works in health. Hereafter, we refer to both groups as healtheconomists. Eighty-ve percent of respondents were members of the IHEA and 61% were members ofAcademyHealth. In all, 46.5 percent of respondents were members of both IHEA and AcademyHealth,38.5% were members of IHEA but not AcademyHealth, and 14.4% were members of AcademyHealthbut not IHEA.Sixty-two percent of respondents were members of the American Economic Association. Reecting</p><p>the diverse nature of the eld, 25% were members of the American Public Health Association, 13%were members of the International Society for Pharmacoeconomics and Outcomes Research, and nearly10% were members of the Society for Medical Decision Making and the Association for Public PolicyAnalysis and Management. Over 7% were members of a medical specialty society.Over 90% of the sample was between the ages of 31 and 60 (37% aged 3140, 29% aged 4150, and</p><p>27% aged 5160). Nearly 38% of respondents were female. Eighty-eight percent of respondents werewhite and nearly 11% were Asian. African-Americans comprised only 1.3% of respondents. Regardingethnicity (distinct from race), 4.1% were Hispanic or Latino. Nearly 81% of respondents were marriedand 70% were members of dual career couples (which could be married or unmarried). Among the dualcareer couples, 27% were both academics and 10% were both economists. Nearly 59% of respondentsin a dual career couple said their partners career made it difcult to relocate.</p><p>Education and training</p><p>The vast majority of health economists are doctorally trained; 93% had a Ph.D. and another 3% hadanother academic doctorate (e.g. Sc.D.). Small percentages had, in addition to their doctorate, an MD(2.6%), an RN (1%) or a JD degree 51%: Two percent had a professional degree only and 3% hadonly a masters degree. The number of individuals in the sample with these degrees is very small so ourestimates should be interpreted with caution.Among those with a Ph.D., nearly 72% have their doctorate in economics. In contrast, Feldman and</p><p>Morrisey (1990) found that 84% of doctorates were in economics in 1989. The economics departmentsthat trained the most members of our sample are: Wisconsin (16 respondents), Chicago (11), Michiganand Yale (9 each), Harvard, MIT, and the University of Washington (8 each), Maryland and the CityUniversity of New York (7 each), Stanford and the University of California at Berkeley (6 each), andBoston University and Washington University of St Louis (5 each). Collectively, these economicsdepartments trained 48% of the respondents with an economics Ph.D.Eighteen percent of our sample with a doctorate received it in health services research, health policy,</p><p>or health systems. Health economists with such training represent an increasing share of the eld. Ofhealth economists who received their doctorate before 1995, 81.8% earned it in economics and only</p><p>US HEALTH ECONOMISTS: WHO WE ARE AND WHAT WE DO 537</p><p>Copyright # 2007 John Wiley &amp; Sons, Ltd. Health Econ. 17: 535543 (2008)DOI: 10.1002/hec</p></li><li><p>8.4% earned it in health services research. Among those who received their doctorates in 1995 or after,60.1% earned it in economics and 27.3% earned it in health services research. When health servicesdoctorates are included with those in economics Harvard is tied for rst withWisconsin and the Universityof North Carolina Chapel Hill joins the list of universities training the most health economists.Regardless of their type of doctoral degree, 76% of health economists wrote a health-related</p><p>dissertation but two-thirds of respondents said their graduate program lacked a formal eld in healtheconomics when they were studying for their doctorate.We asked what types of training are acceptable for new health economist hires in the respondents</p><p>organization. Specically, the survey asked: Suppose your department-agency-rm had advertised foran assistant professor or similar professional position in health economics. How likely is your group toconsider the following candidates acceptable? Ten different degrees or areas of specialization werelisted and respondents were asked to rate each on a seven-point scale from denitely acceptable todenitely unacceptable. Table I presents the responses for ve of the key degrees/specializations byemployment setting of the respondent.It is clear that a Ph.D. in economics with a specialization in health economics continues to be the</p><p>most acceptable training for health economists across all types of employers; 88100% of respondentssaid that such training would be considered acceptable at their place of employment. However, theacceptability of a health services research degree varies dramatically across employer types. In a schoolof arts and sciences (A&amp;S) only one-third of respondents would nd someone with such a degree to belikely acceptable. This was a lower acceptability rating than even a Ph.D. in economics with noexperience in health.In contrast, respondents in schools of public health and in the private sector reported that a health</p><p>services research degree was more acceptable than any degree except a Ph.D. in economics with a healthspecialization. Moreover, a candidate with a Ph.D. in health services research was more acceptable thana candidate with a Ph.D. in economics, but with no past experience in health in every employmentsetting except a college of A&amp;S.</p><p>Employment</p><p>Nearly two-thirds (64%) of health economists worked in academia in 2005. Government (the federalgovernment almost exclusively) employed 12%. Nonprot organizations employed 15% and the for-prot sector employed 9%.</p><p>Table I. Acceptable training for a newly hired health economist</p><p>Type of employer</p><p>Type of candidateArts andsciences</p><p>Businessschools</p><p>Schoolsof publichealth</p><p>Schoolsof medicine Government</p><p>Privatesector</p><p>Ph.D. in economics, specialization in health economics 88% 97% 96% 94% 100% 94%Ph.D. in economics, interest in health economics 88 86 63 74 91 77Ph.D. in economics, no past experience in health 46 14 8 14 31 28Ph.D. in public policy, health policy,health services research</p><p>33 52 82 69 66 85</p><p>MD, no other doctoral degree 0 10 10 24 10 43Number responding 33 30 50 35 35 67</p><p>Notes: (1) This table presents answers to the...</p></li></ul>