Vivian Ho: Examining economies of health care

By Ross Tomlin

Vivian Ho may have a Dr. in front of her name and spend an inordinate amount of time worrying about patients. She is, however, not a physician.

Instead, Ho, who has a Ph.D. in economics, crunches the stories of patients into equations. Such is the surreal life of an economist trying to fix a broken health care system.

"Economic analysis incorporates many different variables and can get very complicated, because we're trying to model how consumers and health care providers react to multiple policy levers," said Ho, who holds joint appointments as both an associate professor of medicine at Baylor College of Medicine and as the James A Baker III Institute Chair in health economics at Rice University. "I spend a lot of time punching away at the computer."

Ample supply of data sets

With her close connections in the Texas Medical Center, Ho doesn't have to look very far to find an ample supply of data sets on patient populations, nor does she lack an impetus for doing what she does. Expertise in health care economics is in particular demand at a time when more than 46 million Americans lack health insurance for an entire year and the infrastructure of health care is threatened by dwindling payments from the federal government and private insurers.

Fortunately for Ho, her line of work is not restricted to statistics and computer programs. In June, she published a paper in Annals of Surgical Oncology showing that in recent years, patients' outcomes had generally improved in surgical procedures for six different cancers, a study requiring extensive collaboration with clinicians at institutions across the country.

She is currently working with Laura Petersen, M.D., associate professor of medicine at BCM, on the potential benefits of making heart bypass and balloon angioplasty procedures that restore blood flow to the heart available in central, high-volume institutions that could perform them better and more cost-effectively.

On the other hand – which economists are wont to consider – one possible tradeoff of concentrating services in one place is higher prices, which would defeat part of the purpose. Finding the proper balance between safer health care provision and economic feasibility is where Ho's credentials come into play.

Health economics 101

As a Ph.D. economics student at Stanford University, Ho stumbled on the then-nascent field of health economics "almost by accident."

"I was kind of swimming around looking for a topic, and someone suggested health policy, which at that time was not something an economist or a Ph.D. student would see or think of normally," said Ho. "Economics tends to be quite abstract, and the nice thing about doing health economics is it gets you much more in touch with the real world."

Her first job after getting her Ph.D. was at Canada's McGill University, where she observed firsthand the pros and cons of that country's universal health care system. Although Canadians have widespread access to health services in the same vein as the European system, Ho doesn't believe their model is sustainable indefinitely.

"Up until now, it's had some very good outcomes, and I think it's great for low-income people. But it's starting to show cracks," said Ho. "Unfortunately, in the long run health care costs are increasing at the same rate in Canada and the U.S., so Canada isn't likely to be able to sustain the same level of health care for much longer."

Despite these flaws, Ho believes the United States would benefit to an extent from emulating the Canadian system. Any national policy that allows some individuals to "opt out" of health insurance coverage, as is the case in the U.S., creates problems when the cost of their treatment is shouldered by public health care facilities or passed on to the insured.

"However, we should not strive for universal insurance by following the Canadians' model," said Ho, who favors more market-based reforms such as pay-for-performance, provider quality reports, and realignment of reimbursement rates more closely with provider costs. "If we combine these reforms with subsidies, which allow the uninsured to purchase insurance through private markets, we have a better chance at controlling health care costs and eventually achieving universal access."

All in a day's work

After pursuing her research at McGill, Washington University in St. Louis, and the University of Alabama at Birmingham, Ho was recruited jointly by both BCM and Rice University in 2004 because, Ho said, the two institutions realized the importance of economic issues facing the health care system, especially in Houston's medical center, which struggles daily to support a large and growing uninsured population.

"We've got rising health care costs and a growing number of people who are uninsured, partly because they can't afford to pay for the rising cost of health insurance," said Ho. "We're trying to figure out ways to make the system work more efficiently and distribute resources in a way that everyone can get access to health care."

Currently, Ho spends most of her time doing grant-funded research on how economic incentives and government regulations can improve the quality of health care while keeping costs under control. For example, she is now analyzing cardiac Certificate of Need (a regulatory review process that requires application to the Department of Public Health in some states prior to offering or developing a new or changed institutional health service). She hopes to determine whether these kinds of government regulations improve access to cardiac care, how it affects the outcomes of advanced procedures for patients with heart disease, and what influence the regulations have on the cost of health care.

It goes without saying that solving the problems of the U.S. health care system is no small task. For Ho, the prospect of "improving society and providing objective information to policymakers to hopefully make the health care system better" supplies all the demand she needs to synthesize the abstract and the real.