As we prepare for the 30th Anniversary AcademyHealth Annual Research Meeting (ARM), we've asked leaders in the field to share some of their memories of the event and perspectives on how the field has changed since our first meeting in 1983. Below is a submission from Dr. Tom Rice, UCLA Fielding School of Public Health, a former member of the AcademyHealth board of directors and previous recipient of both the AHSR Young Investigator Award (now the Alice S. Hersh New Investigator Award) and the AcademyHealth Article-of-the-Year award.
My first AcademyHealth meeting – at the time it was called the Association for Health Services Research – was in 1985, about a year after I arrived as an assistant professor at UNC’s School of Public Health. I had recently completed a dissertation that concluded that physicians induce demand for their services, a controversial topic at the time although perhaps not as much so today. The conclusions were at odds with conventional economics, which viewed the demand curve as something that could be shifted only if people’s tastes and preferences or incomes changed.
This work and subsequent research I engaged in did not fit very well into the world of academic economics at the time. But it did receive a welcome reception at the Annual Research Meetings. From the beginning of my career, I have found a home at AcademyHealth, as the field of health services research is open to diverse perspectives.
To commemorate the Annual Research Meeting’s 30th Anniversary, I have been asked to reflect on how my own field has changed. Indeed, health economics has evolved a great deal over these 30 years. It is more nuanced now. Thirty years ago we were addressing very basic questions, such as how patient cost sharing affects the demand for care; the impact of fee-for-service vs. HMOs on costs and care; and how technology (counter-intuitively) resulted in higher spending.
We’ve learned a great deal since then, so the questions that health economists address are more sophisticated now. We’ve known that cost-sharing matters, but now we are devising methods of fine-tuning it so as to encourage the use of appropriate services and discourage those that aren’t. While we are still interested in service usage, far more emphasis is placed on measuring the quality and outcomes of care. We now have a better understanding of what makes consumers (and providers) tick as exemplified by the increased use of experimental and behavioral economics in health. We know, for example, that people do not always respond to more, and more detailed, information in the ways that economic theory predicts. It’s been over 50 years since Herbert Simon coined the term, "bounded rationality"; this is finally now part of the mindset of health economists, as is the concept of "nudging."
Perhaps the greatest change is the recognition that economics isn’t always the key to explaining behavior. It wasn’t all that long ago, for example, that we would have expected that if prescription drugs were free, people would use recommended amounts. There is now increasing recognition that the social determinants of health outweigh others – the adage that your zip code matters more than all of the tools of modern medicine. We have paid lip service over the years to collaboration among the medical, social and management sciences to address such disparities in care and health. I think that the latter two fields have come to grips with this but much more progress needs to be made by medical science in recognizing what the other two fields can bring.
AcademyHealth continues to play a critical role in advancing the field – bringing scientists of all stripes together to address fundamental issues of access, quality, and costs, and advocating for sufficient funding to address these problems.
Tom Rice, PhD UCLA Fielding School of Public Health
Registration for the 2013 AcademyHealth Annual Research Meeting is now open. The ARM is the premier forum for health services research, where more than 2,400 attendees gather to discuss health policy implications, sharpen research methods, and network with colleagues from around the world. The ARM program is designed for health services researchers, providers, key decision makers, clinicians, graduate students, and research analysts.
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