The Problem: Approximately one in six Americans lack health insurance, resulting in their reduced access to health care and poor health outcomes. Little was known, however, about the impact of uninsurance on people with insurance and on communities as a whole.
Grantee Perspective: Economist José A. Pagán, PhD, an associate professor of economics at the University of Texas-Pan American, believes the key to covering the uninsured is raising awareness that the lack of health insurance affects everyone.
“Everyone agrees that we should insure the 47 million Americans who are uninsured because it would be good for them. What many people don't realize is that having people uninsured is bad for everyone else,” said Pagán, who earned his Ph.D. from the University of New Mexico.
In Robert Wood Johnson Foundation Health & Society Scholars, Pagán had access to experts in health care systems and health insurance who could help him research the wider impact of uninsurance. He began his two-year fellowship at the University of Pennsylvania, one of six universities participating in the program, in 2003.
Results: In one project, Pagán and a health care systems professor at Penn analyzed the relationship between uninsurance and the unmet medical needs of insured and uninsured adults. They found that higher community uninsurance rates were associated with higher rates of unmet medical needs reported by people with insurance. They concluded that local health care delivery systems seem to be negatively affected by high uninsurance rates, which could affect health care access for people with health insurance (Health Services Research, 41(3, Part 1): 2006).
The two researchers also assessed the benefits for people with health insurance of reducing uninsurance (Health Affairs, 26(5): 2007). They showed that health service quality and access problems for the insured increased when the proportion of uninsured people in their communities was higher.
After completing his fellowship, Pagán returned to the University of Texas-Pan American as a professor of economics. He established the Institute for Population Health Policy, which coordinates research and provides training to students and faculty.
For example, in a $1.4-million project with Penn (funded by the U.S. Department of Defense), the institute is developing a breast cancer research program focused on Latinas. Pagán and faculty in finance and anthropology took courses at Penn to prepare for this project and Penn faculty members serve as mentors.
Pagán is also collaborating with other scholars. Under a RWJF Investigator Award in Health Policy Research, Pagán and clinical psychologist (and former Health & Society Scholar) Dominick Frosch, PhD, are studying whether television pharmaceutical ads prompt more than prescription requests. The study will include an analysis of the impact of these ads on the uninsured.
In a study funded by the National Institutes of Health (NIH), Pagán and another former Health & Society Scholar, consumer psychologist Sonya A. Grier, PhD, MBA, are studying minority access to and use of alternative medicine. This project evolved from a study Pagán conducted at Penn, which suggested that some patients use complementary and alternative medicine because it costs less than conventional health care, not as a way to better serve their needs.
“The Health & Society Scholar experience allowed me to fully develop a long-term, policy-relevant research agenda. I also made the personal connections that have made me a more effective researcher and leader,” says Pagán.
RWJF Perspective: RWJF created Health & Society Scholars in 2001 to build the field of population health. “There's been a growing recognition that there are social, behavioral, environmental and economic, as well as biological, determinants of health,” said Senior Program Officer Pamela G. Russo, MD, leader of RWJF's Public Health Team.
“The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities,” Said Russo.