by Jackie Ogburn
Kate Bundorf, a health economist who studies health care systems, joins the Sanford School of Public Policy as the S. Malcolm Gillis Distinguished Professor of Public Policy and an affiliate of the Margolis Center of Health Policy.
“One of the things I love about health policy is that it sits at the intersection of disciplines, and I enjoy interacting with people who have different approaches and different views about health care,” Bundorf said.
“The biggest goal for my work is to generate evidence that helps policy makers design a better health care system that is affordable, accessible and high quality for everyone.”
As an undergraduate, Bundorf was interested in the healthcare field, but “I didn’t want to be an MD; the blood and guts part of medicine was not for me,” she said.
Nevertheless, Bundorf spent several years working alongside medical doctors at Stanford University, as an associate professor in the Department of Health Research and Policy in the School of Medicine. She was also an associate professor in the Graduate School of Business and a Senior Fellow at The Stanford Institute for Economic and Policy Research.
While Bundorf was more immersed in healthcare delivery at Stanford, she was interested in moving into more policy-focused research. At Duke and the Sanford School of Public Policy specifically, she is excited to be working in a more interdisciplinary environment, which reflects her own training in public health, business and economics.
“Duke has a combination of assets that make it a very interesting place to do health policy research. First, I wanted to be in a policy school. I have spent most of my career in a medical school studying policy. I wanted the new perspective of being in a policy school studying health,” she said.
“I wanted to be in a place where I could learn from people passionate about policy and politics who were doing rigorous research in areas not specific to health. And Sanford is that place.”
After working for a pharmaceutical consulting firm for a couple of years, Bundorf went to UC Berkeley, earning an MBA and an MPH. She earned a PhD in managerial science and applied economics from the Wharton School at the University of Pennsylvania.
“Working with people who think about policy allows me a pivot of perspective,” Bundorf said.
“A big draw for me to come here was the Margolis Center. The folks at Margolis are really at the cutting edge of so many important health policy issues. The opportunity to be in a top-tier research institution but to also work with colleagues who have deep health policy expertise and strong ties to federal, state and local health policy communities is unparalleled,” Bundorf said.
There are a lot of areas of health policy Bundorf is interested in examining.
“A hot topic in health policy is the future of the Affordable Care Act. As a candidate, Biden spoke a lot about adding a “public option” and there are important questions about whether this is feasible or desirable,” Bundorf said. The Trump administration also made many smaller changes to the Affordable Care Act.
Another area of interest is state Medicaid programs. There have been huge changes in the structures of these programs especially since the passage of the Affordable Care Act, Bundorf explains with states taking different approaches. There is a lot of work to be done looking at how state policy has affected how programs are designed and administered and the implications for patients.
“I am interested in how design informs healthcare delivery,” she said.
The COVID-19 pandemic has also introduced changes in how healthcare is delivered and how it is paid for, she says. It has magnified some of the problems in the system, but is also spurring innovation.
“Some will stick and some won’t and some shouldn’t,” she said, highlighting the switch to greater use of telehealth as one example for further study. Insurance companies have been playing catch-up and allowing payment for telehealth instead of the usual office visits.
Even before the pandemic, Bundorf thought that the healthcare system would benefit from moving from a “fee for service” payment method toward value, perhaps on a population basis. Last spring, many physicians and hospital experienced a steep drop in demand in fees for service, for office visits, emergency room visits and elective procedures.
“Fee for service was good for providers, until there were no services,” Bundorf said. She suggests that health care providers may be more receptive to payment reform that promotes value by reducing their reliance on providing more services.
“The big picture question that ties my research agenda together is how to get more bang for our buck from the money we spend on health care. When I say ‘we,’ I am thinking broadly – patients, employees and employers, tax payers, state and federal governments. We need policies to create the right incentives to use our resources well,” she said.
Bundorf is a research fellow at the National Bureau of Economic Research and co-editor of the Journal of Health Economics and the International Journal of Health Economics and Management. She was a Fulbright scholar and a visiting professor at the Fudan University School of Public Health, Shanghai.
“I am incredibly excited to learn from and work with faculty and students at Sanford. Duke is also special in its combination of professional schools with strong programs in health including the medical school and the business school as well as Sanford,” she said.
“And, as I get to know more people, I realize that there is more. Really health is everywhere, or at least in lots of different places, at Duke.”