February 23, 2013
Since his years as an undergraduate at MIT, Anupam “Bapu” Jena has investigated the intersection of health and economics. He has published extensively during and after his training in medicine and economics at the University of Chicago. Dr. Jena has established an uncommon expertise in the application of economic theory to clinical practice. Three years after receiving his medical degree, Dr. Jena is considered among the leading health policy researchers and health economists in the U.S. In July 2012, Harvard Medical School welcomed him as an Assistant Professor of Health Care Policy.
Dr. McNeil MD, PhD, Head of the Department of Health Care Policy, notes that Dr. Jena, “has used his joint training in medicine and economics to his advantage and to the advantage of those interested in health policy and its impact on patients and doctors.” Dr. Jena focuses on topics at the center of current debates in health care—malpractice risk as it varies by specialties, the determinants and consequences of the development of new medical technologies, and the association between the cost of care and mortality—and his analyses are already influencing the national dialogue about health care policy.
In each area, Dr. Jena’s contributions have been distinguished by novel approaches and illuminating insights that challenge our assumptions. His dual training and creativity in study design are demonstrated in his research in the question of cost-effectiveness in patient care. To overcome the inherent uncertainties in conventional analyses based on “quality-adjusted life year” (QUALY) measurements, Dr. Jena instead applied methods from economics around “willingness to pay” (WTP) to find measurements based on actual patient decisions facing out-of-pocket prices for drugs and technology. The insights derived from this approach have broad consequences to a diverse set of treatment technologies, particularly on treatment for cancer. Dr. Jena explores these possibilities in a series of papers recognized as the state-of-the-art evaluations of a controversial set of therapies.
Dr. Jena’s most influential work to date, however, may be an enlightening exploration of the actual cost and impact of malpractice published in the New England Journal of Medicine. Dr. Jena and his colleagues analyzed a large data set from a private insurer to measure the risk of malpractice claims faced by physicians in various specialties. In an elegant analysis, they determined the lifetime risk per specialty of being sued for malpractice, and found substantially higher risks than expected. Their finding suggests that malpractice risk may be a bigger driver of health care costs than had been previously believed. Dr. Jena says of this investigation, “We are using unique data on 40,000 physicians to try and understand malpractice from a physician perspective. We are exploring how malpractice plays out over a physician’s lifetime: How much of a physician’s career is spent under a claim? What are unique features of each specialty? How does malpractice affect a physician’s behavior in their practice?”
Linking his research to health care reform, Dr. Jena and his colleagues are also revisiting the role of malpractice in driving health care costs. “Historically, the cost of defensive medicine has not been believed to be a large contributor to overall health care spending, but we are starting to question that paradigm. It may play a larger role than we previously understood. Regardless of its impact on costs, malpractice is clearly a lightning-rod issue for physicians; it is something they are very concerned about. As we enter this new era in health care reform—as physicians become even more accountable for high quality care at lower cost—it is important have physician buy-in for all parts of reform. Addressing their concerns about malpractice may make them more likely to buy into all aspects of health care reform.”
In addition to his research activities, Dr. Jena has significant experience as a teacher, including serving as a lecturer in economics at the University of Chicago and supervising and teaching residents at Massachusetts General Hospital, as well as presenting at conferences nationally. He serves as a reviewer for many journals, including Annals of Internal Medicine, Journal of the American Medical Association, and Journal of Health Economics. In 2007, he and his co-author, Tomas J. Philipson, were awarded the Eugene Garfield Award from Research! America for the best paper in economics on the economic impact of medical research for “Who Benefits from New Medical Technologies? Estimates of Consumer and Producers Surpluses for the New HIV/AIDS Drugs,” published in BE Forum for Health Economics and Policy. Other papers have been finalists for the National Institute for Health Care Management Foundation Annual Research Award and the Annals of Internal Medicine Young Investigator Award.
Dr. Jena is delighted to return to Boston after his time in Chicago, and particularly to the Harvard Department of Health Care Policy. He says, “The Department has a history and role in fostering both clinical and economic research and is at the intersection of both fields. It’s enriching to be able to receive feedback from clinicians, economists, and statisticians. Ideas must be clinically and economically relevant to pass muster with every expertise within the Department. As a clinician and an economist, there was no better place for me.”