Dr. Rachel Kreier
Dr. Kreier joined St. Joseph’s Department of Social Sciences in the fall of 2014. Before that, she taught in Hofstra University’s economics department and master’s of health administration program. In her varied career, she has been a health rights activist, union staff member, editor, health reporter, graduate student and health economist. As a reporter in the 1990s, she covered the changing American health care industry, focusing on the formation of hospital-based health care systems in reaction to the increasing penetration of managed care, and on the debate over health care reform. She returned to graduate school in 1999, earning a Ph.D. in economics from the University at Stony Brook in 2005. Since completing her doctorate, her research has focused on the role of socioeconomic status in health care markets. She and co-author B. Sengupta were awarded the Atlantic Economic Journal 2011 Best Article Award for their paper, “A dynamic model of health plan choice from a real options perspective.”
Why did you become a member of the International Atlantic Economic Society?
I liked the idea of being part of an organization that consciously fosters ties between Europeans and Americans, mainly because I have always felt that the Europeans offer successful models for approaching the policy issues that concern me as a health economist. I’ve also very much enjoyed being part of the Best Undergraduate Paper Award (BUPA) judging process.
What types of projects/research are you currently working on and what inspired/motivated you to pursue these interests?
I am interested in how access to care is allocated in health care markets, with particular concern for the equity and cost implications of reliance on markets to allocate health care in the presence of multiple, private and public insurers. I have come to believe that the traditional understanding of moral hazard as a demand-side problem (a la Mark Pauly’s classic paper) misses the main point. The important problem is that third party payment reduces the constraints that the patient demand curve would otherwise place on the behavior of suppliers (that is, doctors, hospitals, and other health care providers), especially their ability to raise prices. The solution to this “supply-side moral hazard” is all-payer price regulation. Of course, all the European democracies use this tool to control their costs, and they all have much lower costs than the U.S. I have published two papers during the past couple of years on this issue in World Affairs.
The good news is that there are signs that the United States is starting to realize that something has to be done about pricing if we are ever to “bend the cost curve.” Unfortunately, some prominent recent proposals would actually exacerbate the severe inequities we already have built into our multi-payer pricing system. Medicare, our public insurance program for the elderly, pays providers less than commercial health plans pay, and Medicaid, our public insurance program for the poor, pays even less than Medicare.
What advice would you give to someone who is considering entering your line of work/field of study?
If your goal is to be a GOOD economist, then you should struggle to communicate (and understand) the narrative or verbal implications of your mathematical modelling. There are too many economists (some of them quite successful professionally) who dazzle with the complexity of their mathematical analysis, while hiding the actual practical meaning of the highly unrealistic assumptions underlying their work.
Going forward, what other projects/research are you looking to or hoping to pursue?
I am currently in the early stages of a research project analyzing the equity implications of different approaches to regulating health care prices, which will include comparisons of the approaches adopted by different countries during different time periods, as well as of current proposals in the United States. Taking a careful look at the equity implications of assorted “alternative payment models” also forms part of this project, again, with particular attention to application in the US’s multi-payer system.
I have been part of a group of researchers (including Deb Dwyer and Maria Sanmartin) investigating mental health issues associated with problematic use of smartphones. We published an early paper analyzing census data on this topic in the Atlantic Economic Journal a year or so ago. I just presented a second paper at the IAES conference based on our own survey of a large, multi-institution sample of college students, which found that Asian students and female students were at elevated risk of problematic use. I am also working on a third paper looking at the rationality of smartphone use, drawing again on the data from our own survey. (I presented an early version of this work at an IAES conference a few years ago.)
What’s your favorite hobby?
Kayaking (mainly in various harbors off of Long Island Sound). I also read way more novels than I probably ought to.