Jose J. Escarce

Photo of José Escarce
Adjunct Health Researcher
Off Site Office

Education

M.D., University of Pennsylvania School of Medicine; Ph.D., Health Care Systems, University of Pennsylvania Wharton School

Overview

Biography

Jose J. Escarce, M.D., Ph.D., is an adjunct health researcher at RAND. His research interests and expertise include health economics, managed care, physician behavior, racial and ethnic disparities in medical care, and technological change in medicine. Dr. Escarce has studied racial differences in the utilization of surgical procedures and diagnostic tests by elderly Medicare beneficiaries, and was lead investigator of a study of racial differences in medical care utilization among older persons that was based on the 1987 National Medical Expenditures Survey. Recent research for an NIH conference used the 1996-1998 Medical Expenditure Panel Survey to assess racial and ethnic differences in public and private sources of health care expenditures in the Medicare population. He was also co-investigator of a study that used interactive videodisc technology to assess the impact of patient race and gender on physician decision-making for patients with chest pain.

Dr. Escarce is currently working on several projects that address socio-demographic barriers to access in managed care organizations, and is principal investigator of a program project entitled "Health Care Markets and Vulnerable Populations," which uses the MEPS and is funded by the Agency for Healthcare Research and Quality. Among other issues, the program project addresses racial and ethnic differences in access to and quality of medical care. He was member of the Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.

Research Focus

Economics

Recent Projects

  • Effects of community uninsurance on access and quality
  • Market structure and outcomes of post-acute care
  • Effects ofneighborhoods on coronary disease in women
  • Cohort and acculturation effects on immigrant health
  • Neighborhoods and stroke incidence

Publications

Are Our Actions Aligned with Our Evidence? The Skinny on Changing the Landscape of Obesity - 2013

Food Policy Research: We Need Better Measurement, Better Study Designs, and Reasonable and Measured Actions Based on the Available Evidence - 2013

Health Status and Behavioral Risk Factors in Older Adult Mexicans and Mexican Immigrants to the United States - 2013

Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market - 2013

The Relationship Between Urban Sprawl and Coronary Heart Disease in Women - 2013

Cost Implications of ACGME's 2011 Changes to Resident Duty Hours and the Training Environment - 2012

Medicare Postacute Care Payment Reforms Have Potential To Improve Efficiency Of Care, But May Need Changes To Cut Costs - 2012

Take-up of Public Insurance and Crowd-Out of Private Insurance Under Recent CHIP Expansions to Higher Income Children - 2012

The Women's Health Initiative: The Food Environment, Neighborhood Socioeconomic Status, BMI, and Blood Pressure - 2012

Collection Of Race And Ethnicity Data By Health Plans Has Grown Substantially, But Opportunities Remain To Expand Efforts - 2011

Medicare's Bundled Payment Pilot for Acute and Postacute Care: Analysis and Recommendations on Where to Begin - 2011

Neighborhood Archetypes for Population Health Research: Is There No Place Like Home? - 2011

Preventing Obesity and Its Consequences: Highlights of RAND Health Research - 2011

Racial/ethnic Differences in US Health Behaviors: A Decomposition Analysis - 2011

Relative Affordability of Health Insurance Premiums Under CHIP Expansion Programs and the ACA - 2011

Spillover Effects of Community Uninsurance on Working-Age Adults and Seniors: An Instrumental Variables Analysis - 2011

Effects of Competition on the Cost and Quality of Inpatient Rehabilitation Care Under Prospective Payment - 2010

Estimating and Mapping Health Literacy in the State of Missouri - 2010

Medicare Spending and Outcomes After Postacute Care for Stroke and Hip Fracture - 2010

Neighbourhood Socioeconomic Status and Biological 'Wear and Tear' in a Nationally Representative Sample of US Adults - 2010

Response to McWilliams Commentary: Assessing the Health Effects of Medicare Coverage for Previously Uninsured Adults: A Matter of Life and Death? - 2010

Technical Detail and Appendices for a Study of Neighborhood Archetypes for Population Health Research - 2010

Community Demographics and Access to Health Care Among U.S. Hispanics - 2009

Cost Implications of Reduced Work Hours and Workloads for Resident Physicians - 2009

Cost Sharing and the Initiation of Drug Therapy for the Chronically Ill - 2009

Developing Predictive Models of Health Literacy - 2009

Do Patients Bypass Rural Hospitals? Determinants of Inpatient Hospital Choice in Rural California - 2009

Effects of Payment Changes on Trends in Post-Acute Care - 2009

Employer-sponsored Insurance, Health Care Cost Growth, and the Economic Performance of U.S. Industries - 2009

Health Care Cost Growth and the Economic Performance of U.S. Industries - 2009

Immigrants and Health Care Access, Quality, and Cost. - 2009

Prescription Drug Cost Sharing: A Powerful Policy Lever to Use with Care - 2009

Rural Hospitals Struggle to Attract Patients and Remain Viable - 2009

The Health Effects of Medicare for the Near-Elderly Uninsured - 2009

The Health Value and Cost of Care for Major Depression - 2009

When Drug Cost-Sharing Increases, Patients Newly Diagnosed with a Chronic Illness Delay Starting Medication - 2009

Do Neighborhood Economic Conditions Influence the Consumption of Fruits and Vegetables? - 2008

Does How Much and How You Pay Matter? Evidence from the Inpatient Rehabilitation Care Prospective Payment System - 2008

Does Place Explain Racial Health Disparities? Quantifying the Contribution of Residential Context to the Black/white Health Gap in the United States - 2008

Immigrants and Health Care: A Complex Picture - 2008

Neighborhood Socioeconomic Status and Fruit and Vegetable Intake Among Whites, Blacks, and Mexican Americans in the United States - 2008

Obtaining Utility Estimates of the Health Value of Commonly Prescribed Treatments for Asthma and Depression - 2008

Did the Medicare Inpatient Rehabilitation Facility Prospective Payment System Result in Changes in Relative Patient Severity and Relative Resource Use? - 2007

Does Quality of Care for Cardiovascular Disease and Diabetes Differ By Gender for Enrollees in Managed Care Plans? - 2007

Family Structure and the Treatment of Childhood Asthma - 2007

Hospital Competition, Managed Care, and Mortality After Hospitalization for Medical Conditions in California - 2007

Immigrants and Health Care: Sources of Vulnerability - 2007

Individual's Use of Care While Uninsured: Effects of Time Since Episode Inception and Episode Length - 2007

Language Access Services for Latinos with Limited English Proficiency: Lessons Learned from Hablamos Juntos - 2007

Social Networks and Access to Health Care Among Mexican-Americans - 2007

Socioeconomic and Racial/Ethnic Differences in the Discussion of Cancer Screening: "Between-" versus "Within-" Physician Differences - 2007

The Role of Product Design in Consumers' Choices in the Individual Insurance Market - 2007

Changes in Patient Severity Following Implementation of the Inpatient Rehabilitation Facility Prospective Payment System - 2006

Consumer Decision Making in the Individual Health Insurance Market - 2006

Consumer Decisionmaking in the Insurance Market - 2006

Hospital Competition, Managed Care and Mortality After Hospitalization for Medical Conditions: Evidence from Three States - 2006

Hospital Competition, Managed Care, and Mortality After Hospitalization for Medical Conditions: Evidence from Three States - 2006

Impact of Instructional Practices on Student Satisfaction with Attendings' Teaching in the Inpatient Component of Internal Medicine Clerkships - 2006

Comparison of Medicare Spending and Outcomes for Beneficiaries with Lower Extremity Joint Replacements - 2005

Demographic and Socioeconomic Factors Associated with Blood Lead Levels Among Mexican-American Children and Adolescents in the United States - 2005

Effects of Payment Changes on Trends in Access to Post-Acute Care - 2005

Health Care Markets, the Safety Net and Access to Care Among the Uninsured - 2005

How Cost Sharing Affects Use of Drugs by the Chronically Ill - 2005

How Does Race Matter, Anyway? - 2005

How Much Is Postacute Care Use Affected By Its Availability? - 2005

Is the Individual Market More Than a Bridge Market? An Analysis of Disenrollment Decisions - 2005

Predictors of Surgery Resident Satisfaction with Teaching By Attendings: A National Survey - 2005

Prospects for Change in the Individual Health Insurance Market - 2005

Residency Work-Hours Reform: A Cost Analysis Including Preventable Adverse Events - 2005

The Managed Care Backlash: Did Consumers Vote with Their Feet? - 2005

Use of Geocoding in Managed Care Settings to Identify Quality Disparities - 2005

Assessing the Influence of Incentives on Physician and Medical Groups: A Comment - 2004

Changes in Racial Differences in Use of Medical Procedures and Diagnostic Tests Among Elderly Persons: 1986-1997 - 2004

Effect of Primary Care Visits on the Demand for Specialty Care in Health Maintenance Organizations - 2004

How Much is Post-Acute Care Use Affected by its Availability? - 2004

Impact of Managed Care on the Treatment, Costs, and Outcomes of Fee-for-Service Medicare Patients with Acute Myocardial Infarction - 2004

Increased Medicare Expenditures for Physicians' Services: What Are the Causes? - 2004

Pharmacy Benefits and the Use of Drugs by the Chronically Ill - 2004

Predictors for Medical Students Entering a General Surgery Residency: National Survey Results - 2004

Recent Trends and Geographic Variation in the Safety Net - 2004

Sociodemographic Differences in Use of Preventive Services By Women Enrolled in Medicare+Choice Plans - 2004

Socioeconomic Disparities in the Use of Home Health Services in a Medicare Managed Care Population - 2004

Socioeconomic Status and Medical Care Expenditures in Medicare Managed Care - 2004

Specificity and Sensitivity of Claims-Based Algorithms for Identifying Members of Medicare+choice Health Plans That Have Chronic Medical Conditions - 2004

Subsidies and the Demand for Individual Health Insurance in California - 2004

The Managed Care Backlash: Did Consumers Vote with Their Feet? - 2004

Updated Variable-Radius Measures of Hospital Competition - 2004

Updated Variable-Radius Measures of Hospital Competition: Data and Documentation - 2004

Use of Preventive Services by Men Enrolled in Medicare+Choice Plans - 2004

Determinants of Increases in Medicare Expenditure for Physicians' Services - 2003

Determinants of Increases in Medicare Expenditures for Physicians' Services - 2003

Incremental Treatment Costs in National Cancer Institute-sponsored Clinical Trials - 2003

Managing Care: Utilization Review in Action at Two Capitated Medical Groups; Prospective Denials of Coverage on Grounds of Medical Necessity Are Only a Small Part of the Overall Picture - 2003

Methods for Using Medicare Data to Compare Procedure Rates Among Asians, Black, Hispanics, Native Americans, and Whites - 2003

Participation of Patients 65 Years of Age or Older in Cancer Clinical Trials - 2003

Patterns of Care for Open-Angle Glaucoma in Managed Care - 2003

Practice Characteristics and HMO Enrollee Satisfaction and Speciality Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy - 2003

Racial and Ethnic Differences in Public and Private Medical Care Expenditures Among Aged Medicare Beneficiaries - 2003

Sampling Patients Within Physician Practices and Health Plans: Multistage Cluster Samples in Health Services Research - 2003

Sampling Patients Within and Across Health Care Providers: Multi-Stage Non-Nested Samples in Health Services Research - 2003

Trends and Variability in Individual Insurance Products in California: Despite Changes in Insurance Products Available Between 1997 and 2002, the Actuarial Value of Coverage Has Remained Nearly Constant - 2003

Characteristics of Eye Care Practices with Managed Care Contracts - 2002

Cost Sharing Cuts Employers' Drug Spending -- But Employees Don't Get the Savings - 2002

Employer Drug Benefit Plans and Spending on Prescription Drugs - 2002

Hospital Care for the Uninsured in Miami-Dade County: Hospital Finance and Patient Travel Patterns - 2002

Improving Access to Drugs for Medicare Beneficiaries: Can State Law Help? - 2002

Initial Practice Locations of International Medical Graduates - 2002

Personal Choices of Health Plans By Managed Care Experts - 2002

Socioeconomic, Cultural, and Behavioral Factors Affecting Hispanic Health Outcomes - 2002

The Determinants of HMO's Contracting with Hospitals for Bypass Surgery - 2002

Health Maintenance Organizations and the Changing Physician Workforce - 2001

Measuring the Incremental Cost of Clinical Cancer Research - 2001

Medical Care Expenditures Under Gatekeeper and Point-of-Service Arrangements - 2001

Using Hospital Tumor Registries to Identify Research Subjects - 2001

Expenditures for Physician Services Under Alternative Models of Managed Care - 2000

HMO Growth and the Geographical Redistribution of Generalist and Specialist Physicians, 1987-1997 - 2000

HMO Penetration and the Geographic Mobility of Practicing Physicians - 2000

Race and Sex Differences in the Management of Coronary Artery Disease - 2000

The Cost of Cancer Treatment Study's Design and Methods - 2000

The Effect of HMO Penetration on Physician Retirement - 2000

Visits to Primary Care Physicians and to Specialists Under Gatekeeper and Point-of-Service Arrangements - 2000

Association of Dialyzer Reuse with Hospitalization and Survival Rates Among U.S. Hemodialysis Patients: Do Comorbidities Matter? - 1999

Cost Functions for Dialysis Facilities and the Quality of Dialysis - 1999

Equity in Managed Care for Mental Disorders - 1999

Financial Incentives and Drug Spending in Managed Care: Incentives for Both Physicians and Patients Can Interact to Help Curb Spending in This Increasingly Costly Sector - 1999

Managed Care and the Workers' Compensation Bargain - 1999

Self-reported Physician Specialties and the Primary Care Content of Medical Practice: A Study of the AMA Physician Masterfile - 1999

The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization - 1999

Diagnostic Coding and Medical Rehabilitation Length of Stay: Their Relationship - 1998

Health Maintenance Organization Penetration and the Practice Location Choices of New Physicians - 1998

Indications for and Outcomes of Cholecystectomy: A Comparison of the Pre and Postlaparoscopic Eras - 1998

Physician Opportunity Costs in Physician Practice Cost Functions - 1998

Development of Function-Related Groups Version 2.0: A Classification System for Medical Rehabilitation - 1997

How Practicing Surgeons Trained for Laparoscopic Cholycystectomy - 1997

Quality Assessment in Contracting for Tertiary Care Services By HMOs: A Case Study of Three Markets - 1997

Segmentation of Hospital Markets: Where Do HMO Enrollees Get Care? - 1997

Effect of Dialyzer Reuse on Survival of Patients Treated with Hemodialysis - 1996

Externalities in Hospitals and Physician Adoption of a New Surgical Technology: An Exploratory Analysis - 1996

Survival of Medicare Patients After Enrollment in Hospice Programs - 1996

Using Physician Practice Cost Functions in Payment Policy: The Problem of Endogeneity Bias - 1996

Diffusion of Laparoscopic Cholecystectomy Among General Surgeons in the United States - 1995

Falling Cholecystectomy Thresholds Since the Introduction of Laparoscopic Cholecystectomy - 1995

A Case-Mix Classification System for Medical Rehabilitation - 1994

Hospital Adoption of Laparoscopic Cholecystectomy - 1994

Revised Estimates of Diagnostic Test Sensitivity and Specificity in Suspected Biliary Tract Disease - 1994

Using Medicare Claims for Outcomes Research - 1994

Effects of the Relative Fee Structure on the Use of Surgical Operations - 1993

Omnibus Budget Reconciliation Act of 1987. - 1993

Omnibus Budget Reconciliation Act of 1987. - 1993

Racial Differences in the Elderly's Use of Medical Procedures and Diagnostic Tests - 1993

Would Eliminating Differences in Physician Practice Style Reduce Geographic Variations in Cataract Surgery Rates? - 1993

Assessing Physicians' Estimates of the Probability of Coronary Artery Disease: The Influence of Patient Characteristics - 1992

Explaining the Association Between Surgeon Supply and Utilization - 1992

Geographic Variation in Relative Fees Under Medicare - 1991

Impact of the Medicare Fee Schedule on an Academic Department of Medicine - 1991

Admission Source to the Medical Intensive Care Unit Predicts Hospital Death Independent of APACHE II Score - 1990

Hyporeninemic Hypoaldosteronism in a Patient with Cirrhosis and Ascites - 1986

Association of Dialyzer Reuse and Hospitalization Rates Among Hemodialysis Patients in the US -

Compliance Among Pharmacies in California with a Prescription-Drug Discount Program for Medicare Beneficiaries -

Effects of Family Structure on Children's Use of Ambulatory Visits and Prescription Medications -

Health Care Markets, the Safety Net, and Utilization of Care Among the Uninsured -

Neighborhoods and Cumulative Biological Risk Profiles by Race/Ethnicity in a National Sample of U.S. Adults: NHANES III -