Economics Faculty Al Headen to Serve on NIH Advisory Council

by Anna Rzewnicki

July 07, 2008

Al Headen Brings Economist’s Perspective to Health Care Dialogue.

Racial and ethnic disparities in health care have persisted in the United States, even in the face of economic growth, says Alvin E. Headen, Jr., associate professor economics at North Carolina State University’s College of Management.

“Why do they persist, even with rises in income? What social and economic factors are contributing to this?” he asks. Such questions have helped to guide his research as an economist for more than two decades.

Most recently, Headen explored the topic with seven fellow researchers at a January 2007 session that he organized in conjunction with the National Economic Association meeting in Chicago. The title of their session was “Eliminating Racial and Ethnic Health Disparities: Twenty Years after the Initiative.”

Part of Two National Health Care Discussions

In the coming years, Headen will be part of two national health care discussions. He was recently appointed to the National Advisory Council on Minority Health and Health Disparities (NACMHD), a part of the National Institutes of Health.

He also is participating in ‘Cost-over-Care Health Delivery,’ a project that is promoting a national dialogue on the need for an outcome-focused, patient-value approach to health delivery.

The National Center on Minority Health and Health Disparities (NCMHD) was established in 2000 “topromote minority health and to lead, coordinate, support, and assess the NIH effort to reduce and ultimately eliminate health disparities,” according to the law that established the center. The NCMHD conducts and supports basic, clinical, social, and behavioral research, promotes research infrastructure and training, fosters emerging programs, disseminates information, and reaches out to minority and other health disparity communities.

The NCMHD Advisory Council provides advice, assists and consults with, and makes recommendations to the director of the center on matters relating to its activities and mission. With its expanded authority to grant awards and contracts, NCMHD continues the work begun by the former NIH Office of Research on Minority Health

“I am particularly interested in guiding additional research toward a focus on two questions,” Headen said. “First, how much progress has been made in reducing the persistent racial and ethnic disparities in health, and second what, if any, factors have contributed most to changes in health disparity?”

The NIH has typically focused on science-related research, he said. “It’s important to have an economist involved now, because health outcomes depend on both medical sciences and practice, and on patient and provider choices in response to economic incentives.” His term on the advisory council continues through February 2010.

Cost-over-Care Health Delivery

Headen’s research also is part of the ‘Cost-over-Care Health Delivery’ dialogue that is being led by Louis Sullivan, M.D., former secretary of the U.S. Department of Health and Human Services (HHS), president emeritus of the Morehouse School of Medicine in Atlanta, Ga., and a charter member of the National Advisory Council on Minority Health and Health Disparities.

The campaign is sponsored by Pfizer, Inc., and includes several health-related organizations as partners. Headen attended the campaign’s June 27 kickoff in Washington, D.C.

Both activities are well aligned with Headen’s career that has centered on the economics of health care and particularly health care for minorities. Prior to joining NC State’s College of Management, Headen held economist positions with Blue Cross/Blue Shield and the American Medical Association.

“My concern is that most of the cost containment in government programs is borne disproportionately on the most vulnerable population groups – the elderly and minorities, those receiving Medicaid and Medicare,” he said.

“The elderly present a particularly complex problem,” he said, “with economic and cultural components. For example, a lot of their care had been provided by informal caregivers, typically the women in their families, and this is still where most of the care for the elderly is provided.

“But as market conditions change,” Headen continues, “it is getting more costly for women to stay at home. This is creating complicated situations for the family and for public policy, and as more and more Baby Boomers move into this age group, there will be increasing strains on the social resources.
“The current policy that focuses primarily on the cost of care is out of balance,” he said. “We should be focusing on the value of medical care. If you ran a business and only cared about cutting costs, eventually you will lose business because of lower quality,” he said.

One of Headen’s recent research papers explores whether Medicaid’s preferred drug lists affect the use of cholesterol-reducing statin drugs for all Medicaid patients equally or if they disproportionately impact patients who are being treated by doctors prescribing in poor or minority neighborhoods. The preferred drug lists are intended to reduce health care costs. While physicians can obtain prior approval to prescribe medications that are not on the preferred lists, it appears that they don’t always do so because of the additional time cost borne by the physician, Headen said.

The researchers found that in certain states, the prescription of these medications adhered closely to Medicaid-imposed restrictions in poorer or more ethnically diverse neighborhoods. This could imply that there is a greater change in physicians’ prescribing practice, fewer patients receive the restricted medication by prior authorization, and more patients experience a disruption in their medication regime and resulting consequences, he said. The authors had shown in previous research that physicians treating a large share of Medicaid patients tend to practice in neighborhoods dominated by ethnic minorities.

Research Monograph

The full study, along with related studies by other researchers, was published in a 2006 PharmacoEconomics supplement edition on ‘Prescription for Problems: Unintended Consequences of Access Restrictions in Government Funded Healthcare.” Headen was guest editor of the publication. His role with that monograph and his prior research led to an invitation from Pfizer to participate in Sullivan’s campaign.
Pharma has been under attack for years because of the rising cost of prescription drugs, Headen said, “but they are still a small part of health care costs.”

Citing the high cost of bringing a new drug to market, Headen said, “if they don’t get the money from sales, you can expect less innovation. Those who are more sick require more innovative medicines. If you restrict those medicines, you will save money for the third party payer. But, the other side of this is, have you saved money at the cost of meaningful alternatives for the patient? This is very much a part of the discussion.”

Headen’s research paper and others are posted on Sullivan’s ‘Cost-over-Care Health Delivery’. “Pfizer wanted the research component to be included in the ‘Cost-over-Care Health Delivery’ discussion,” Headen said. “It’s exciting to see the possibility of having policy-relevant research being included directly in the policy debate,” he said.

Current Profile

Al Headen Economics

"Economist’s Perspective"

Related Profiles

• 

  Seena George

  Giving Back

  Read More

• 

  MGIM

  Global Innovation

  Read More