Hao Yu, beyond the CV

Welcome to our spotlight series, where we look beyond the CV and learn more about our investigators. Meet Hao Yu, PhD, a new faculty member who joined our department in 2019. He has 25 years of experience studying health care reforms in both the U.S. and China. His research focuses on how financial and organizational factors affect health care and health outcomes for vulnerable populations, such as children with special health care needs, the mentally ill, and those who live in medically underserved areas. Prior to coming to DPM, Dr. Yu was a senior health policy researcher at RAND Corporation. Let’s dive in!

Q: You recently moved to Boston from Pittsburgh. Have you had time to explore Boston and New England?

A: Yes. For example, my son and I went kayaking in Nashua River in Groton, MA, on Columbus Day last month. We also had opportunities to receive two groups of visitors during the past three months. My family now lives in the Boston city, which has a very different living environment, compared with suburban Pittsburgh, where we built a house and lived in it for 13 years. While my son misses our Pittsburgh house, we do find many things in Boston that are not available in Pittsburgh. For example, my son was accepted to a rock band last month. For my wife, the subway system in Boston reminded her of the trolleybus with an overhead wire that she used to take in Shanghai when she was a child. While the trolleybus has long gone from the streets in Shanghai, we were amazed that the Boston subway system is still in operation more than 100 years after its establishment in 1897. We also found that Boston is very walkable and somewhat bikeable.

Q: What kind of research are you doing and why do you think it’s important?

A: I have been involved in evaluating health care reforms in both China and the U.S. for the past 20 years. Such evaluations are important because the reforms are affecting the lives of millions in each county. We all know that scientists need to conduct intensive studies to develop new drugs to save lives. Similarly, health care reforms must be rigorously evaluated because of their profound effects on people’s lives. While new drug discoveries have been made in scientific laboratories, health care reforms are currently implemented across many countries, each of which represents an interesting “laboratory” of policy design and implementation. Findings from those “policy laboratories” can facilitate different countries learning from each other about effective policies to promote universal health care coverage, improve health care quality, and control health care costs. That is why health policy research is a fast-growing field of study, and I firmly believe that rigorous policy analyses will help build up an evidence base that is vital to inform health care policies across the world.

Q: What sparked your interest in studying health care financing and delivery reforms?

A:  My interest in those topics grew when I was studying for a master’s degree in health economics in Shanghai, China, in the early 1990s. At that time, China’s health insurance system collapsed in the context of market-oriented economic reform. Rural residents were hit the hardest. My master thesis supervisor, Professor Xingyuan Gu, spearheaded the efforts to rebuild the health insurance system in rural China (By the way, when I talked to Professor Bill Hsiao of Harvard Chan School of Public Health last month, he considered Prof. Gu as a “pioneer in China’s health services research and policy”.). I participated in Prof. Gu’s social experiment study in the mid-1990s, which aimed to set up and evaluate two prepaid health plans in poor rural areas. The participation was an eye-opener to me, letting me gain first-hand experience in working in the disadvantaged communities in remote areas. The experience also taught me a lesson about health cost control as I found that it was not hard to organize health plans, but it was really difficult to control health care costs once people obtained insurance coverage. Local health care providers, especially physicians, had strong financial incentives to provide more services to insured patients, resulting in higher health care costs. As Prof. Gu succinctly summarized, a daunting challenge facing a health plan was “How can we control the physician’s pen?”, a question that depicted the difficulty influencing physician behavior due to the physician’s “power of pen”. To seek an answer to that question, I decided to come to the U.S. to pursue a Ph.D. in health economics and policy in 2000, and I kept working on health insurance studies after I got my Ph.D. in 2004. Nowadays, I am still pondering Prof. Gu’s question. I guess that I will keep looking for an answer in the coming years since controlling health care costs is a world-class problem.

Q: Some of your past research has also evaluated health insurance reform in China. How does this overlap with your domestic research?

A: Health care reforms across the world share some common goals, such as expanding health insurance coverage and controlling health care costs. For example, China has successfully achieved universal health insurance coverage since 2011. China’s success demonstrated again the important role that governments have to play in extending insurance coverage to vulnerable populations, such as rural residents and the unemployed. It also offers a lesson to the U.S., where the government role in health care remains a hotly debated topic. On the other hand, Chinese leaders, who are concerned with health cost control after reaching universal insurance coverage, may find the U.S. experience interesting. In fact, China has just launched a nation-wide implementation of the DRG (diagnosis-related group) system, which was developed in the U.S. in the 1970s to pay for inpatient care. New delivery models in the U.S., such as medical homes and integrated physical and mental health care (two topics I have studied), are also of interest to China given its efforts to strengthen its primary care system.

Q: Tell us a little more about some of your current research projects.

A: Two of my projects are related to health care workforce with one focusing on how the insurance expansion under the Affordable Care Act (also known as the Obamacare) affects physician practice location choices, and the other examining the impact of mental health workforce on children with autism. My interest in workforce policies also stems from my experience in studying health insurance in rural China in the 1990s as described above. As the largest developing country in the world, China had a rural population of over 800 million in the 1990s, of whom a large proportion lived in underserved areas with an acute shortage of physicians. I was a little surprised to find out that a similar problem had long existed in the U.S. when I conducted a study as a summer intern at the Blue Cross Blue Shield for the Great Rochester Areas in upstate New York. Since then, I have led several projects on physician workforce, and I hope that my studies can contribute to the ongoing efforts to address the persistent problems of physician shortage and maldistribution in the U.S.

Q: What do you like to do in your free time?

A: Two of my favorite hobbies are playing tennis and reading books, especially history books and books on ancient Chinese poems.