Interested in health economics, or the efficiency and value in the production and use of healthcare, doctoral candidate Derek Jenkins studies how managed care plans impact the value of care in hospitals. He hypothesized that when people have low out-of-pocket costs, they’re more likely to be recommended and pay for low-value services they don’t necessarily need, such as diagnostic imaging of non-specific lower back pain and Vitamin D screening. 

“In health economics we call this moral hazard,” Jenkins says; that is, when the service costs more to produce than what it’s worth to the patient. Managed care organizations often prevent these services under their plans. 

“Managed care organizations offer plans like HMOs and PPOs and bargain with hospitals on your behalf for prices of health services,” he says, “but the tradeoff is that they may not cover procedures they see as low value and you often must choose providers within their network.” 

Jenkins’ preliminary research proves his hypothesis correct—patients with low out-of-pocket costs pay for more low-risk procedures, though they aren’t necessarily any healthier than those with managed care plans. 

He recently co-authored a study with Dr. Shooshan Danagoulian on maternal health outcomes of the Flint Water Crisis. They compared their participants with other mothers in Michigan before and after the crisis and found mothers in Flint were more likely to continue smoking while pregnant, fewer intended to breastfeed their babies, and that they gained more weight during pregnancy. 

“We interpret this as evidence that mothers were stressed out, and as a result there was an additional negative impact on maternal health not directly related to the lead in the water.” 

He finds a similar theme runs through his study on managed care plans. 

“I focus on not only the effect of managed care plans on their enrollees, but also on others using the hospital who aren’t in managed care.” 

Hospital and even doctor visits can cause anxiety over affordability, scheduling conflicts, and the general concern over what may or may not be wrong with your health. Additional procedures and visits to specialists cause added stress, and without input from managed care organizations, it’s up to the consumer to decide which are worthy of their hard-earned cash. Not to mention, overuse of services is one hefty factor contributing to the soaring healthcare costs for all Americans. 

Jenkins’ long-term hope for his research is that it will be instrumental in slowing the growth of health expenditures in the U.S. and improving the quality of care.