Shaping health policy

Jeffrey Harman, Ph.D.

Health care economist Jeffrey Harman, Ph.D., is researching ways to contain health care costs, improve quality and remove barriers to care at a time when affordable health care may be slipping out of reach for many Americans.

“I look at patient-level factors; provider-level factors, like physicians and hospitals; and system-level factors that might be resulting in barriers to care with the idea that we can use this information to design interventions or health policies that can better target the problems,” said Harman, an associate professor in the department of health services research, management and policy, and director of the Ph.D. program in health services research.

Harman’s research findings often raise important questions about the best ways to control health care costs without sacrificing access or quality of care. He is part of a team led by Paul Duncan, Ph.D., chair of the department, that is evaluating Florida’s Medicaid reform demonstration project, currently being conducted in five Florida counties. Harman has examined the fiscal outcomes of the reform, which places enrollees in Medicaid in private health plans that resemble a managed care model. He tracked spending before and after reform implementation in the participating counties, and compared those costs to expenditures in two control counties. He found significant cost savings under the reform plan, particularly among people who qualify for Medicaid through the Supplemental Security Income (SSI) program, usually people with low income who have a disability.

“Expenditures went down by about $11 per month, per person in the reform counties,” Harman said. “But when I looked at what happened to expenditures in the counties that didn’t implement this reform, those expenditures went up by $194. So the state is saving over $200 per member, per month for the people who are on the Medicaid SSI program in reform counties.”

There is an important caveat with this information, Harman said, that will require further analysis when new data become available.

“We still don’t know how the health plans are reducing expenditures. We don’t know if it’s because these plans are providing care more efficiently, which is what we hope they’re doing, or that they’re saving money because they’re restricting access to needed care.”

In another study, Harman and fellow department faculty member Christopher Harle, Ph.D., an assistant professor, and Robert Cook, M.D., M.P.H., an associate professor in the department of epidemiology, investigated the impact of electronic medical records on depression treatment. The team focused on patients diagnosed with depression seen at primary care practices. The results were surprising — patients with depression seen at practices with electronic medical record systems were about half as likely to be offered depression treatment than patients at practices that did not have electronic medical records. Their next step is to conduct more research to examine why the disparity exists, Harman said. The research team hypothesizes that a lack of prompts in electronic medical record systems for depression treatment information and guidelines, as well as decreased patient interaction, may play a role.

“Some previous studies have shown that the amount of psychosocial interaction between patients and physicians is lower in practices that have electronic medical records so there is some evidence that typing notes into the computer is actually reducing the amount of time that providers and patients are talking to each other during visits,” Harman said.

Harman’s interest in access to mental health care began early in his career. After graduating from college and finding few jobs related to his economics major, he took a position as a mental health counselor at a halfway house for people with schizophrenia and drug addiction problems who had been discharged from a state psychiatric hospital.

“As I was doing that job I started seeing all of these barriers that made it really difficult to get the sort of care they needed and be able to live independently,” Harman said. “So when I went to grad school I decided I wanted to find something where I could combine my interest in mental health care with my economics background and so that’s why I ended up in health economics and health policy.”