Derek S. Brown, assistant professor, Brown School, is a health economist who uses innovative methods to quantify health, health care, and behaviors. He applies econometric models to large administrative and survey data sets to study health impacts, costs, and outcomes. We recently checked in with Dr. Brown to see what he’s currently working on and what thoughts he has as a new administration takes office later this week.
Q: Are you currently working on any public health research? What are you hoping to work on in 2017?
I’m working in several areas, but the core projects include:
- Analyses of how Medicaid physician payment rates vary across states, and how this affects access to care
- An analysis of the intersection of housing, child welfare (child abuse & neglect), medical care, and social services (multiple studies with Professor Patrick Fowler)
- Additional analyses of the economic impacts of child maltreatment (multiple studies)
- An analysis of preferences for cancer screening and how those vary by cancer risk
- An analysis of access to care among those utilizing health care exchanges
- An analysis of preferences and policies around long-term care insurance
- An analysis of Medicaid-funded medication-assisted therapy for substance abuse, including opioid addiction (with Professor David Patterson)
- An analysis of geographic disparities in sickle cell disease (SCD) care funded by Medicaid (with Dr. Allison King)
Q: What were your some of your work highlights/favorite projects from 2016?
This is hard to say. My total scientific output was a little slower, but I laid the groundwork for a lot of new studies in 2017 and beyond by getting some seed grants funded and access to some new data sources near the end of the year. I wrote several proposals and am trying to start up some new work. I think I would say it was developing some new collaborations, relationships, and partnerships for long-term research.
Q: You spend a lot of time studying Medicaid. The new Missouri state legislative session and US Congressional session started recently. What challenges and opportunities do you anticipate the Medicaid program facing in the coming years?
Medicaid faces a lot of challenges. Financing is a perennial issue. Medicaid is a substantial share of state budgets, and a frequent target for cuts.
At the national level, I see two big threats. One is the potential repeal of the Affordable Care Act. If that happens, and we lose funding for the Medicaid expansions (in states that participated), that will immediately increase the number of uninsured by a huge number and return us to problems of high uninsurance and lack of access to health care. Second, even if coverage provisions are left intact, the discussion of Medicaid block grants is concerning. Because funding under block grants is fixed (set to grow at usually low levels), it does not change proportionately with the number of beneficiaries as now; thus, fiscal pressures on the states will increase leading to cuts and worse coverage within the existing program. Additionally, the block grants may be implemented in a way that states have increased latitude for cutting coverage and using these funds in other ways besides health care, or in adding restrictions (like employment requirements) that weaken access to care in Medicaid.
At the state level, I think the concerns are more likely in two areas. One is maintaining access and quality of care while making changes. For example, many states are introducing small copayments for drugs or health care services. A dollar or two or five might not sound like much, but it can be huge for those on Medicaid, and really impact access to care. Second is managed care. The quality of managed care (vs. traditional fee for service) can be excellent, but rapid expansion of Medicaid managed care is an implementation challenge, particularly in rural areas. In Missouri, we are supposed to have 100% managed care by mid-2017. We’ll see if we get there!
Q: Has any of your recent work involved collaboration with other faculty scholars or community partners from other areas of expertise? If so, how has this multi-disciplinary approach impacted your process/findings?
Yes, in fact, much of it involves collaboration with other scholars. This enhances my ability to provide relevance to other fields, professional communities, and the public. As a health economist and being involved in health services research, I have experience and tools to analyze data, but I’m an additional step further removed from the practice of health care or the interaction with clients and patients. Working with other clinicians, physicians, social workers, and experts helps ground my work and give it greater relevance.
As mentioned above, some partnerships include:
- An analysis of Medicaid-funded medication-assisted therapy for substance abuse, including opioid addiction with Professor David Patterson.
- An analysis of geographic disparities in sickle cell disease (SCD) care funded by Medicaid with Dr. Allison King.
- Additional collaborations (still somewhat formative) with Dr. Chris Dy around Medicaid orthopedic surgery.