Policy Matters: HKS Professor Uses Health Care Data to Inform Policymakers

December 6, 2011
By Frank White, Alumni Relations and Resource Development

Meet Professor of Public Policy Amitabh Chandra and hear from his students at Harvard Kennedy School. Film by Steve Atlas.

Amitabh Chandra was not altogether happy as he clutched a cup of coffee and boarded the shuttle from Boston to Washington, DC. He felt honored to have been asked to testify before the US Civil Rights Commission, but getting there would not be pleasant.

“It was a brutal day,” the professor of public policy later recalled.

“I got up at 4 a.m. and drove through the rain to get to Logan for the 6 o’clock shuttle. Driving in, you’re at the leading edge of rush hour, and I was thinking, ‘I have students to advise, dissertations to read, papers to referee, grants to finish. What am I doing going to Washington at this hour? Maybe I should have stayed behind and just done my work.’ Everyone on that 6 a.m. shuttle thinks similar thoughts.”

In spite of the difficulties, Chandra knew he could not refuse the invitation. “The most important people in the country want to hear from you, and when your plane is circling Washington, you know that the decisions made in the buildings down below will affect the lives of 300 million people. That can’t be said of many other places.”

Three basic points

As Chandra walked into the Commission’s building, he thought about the “market test” (as he called it) that lay before him. He would take an oath and speak for 10 minutes without being interrupted. The Commission, half Democrats and half Republicans, would listen to several other witnesses, after which there would be a lengthy back-and-forth examination of their testimony.

“Think of the three basic points you want to get across,” he repeated to himself as he entered the hearing room, “no ponderous answers and no academic vacillating or you’ll lose them.”

Nodding to the other witnesses, Chandra pulled out his chair and sat at the long witness table below the Commissioner’s table, positioned on a raised dais.

Actually, he was a bit surprised to have been invited to speak in the first place. He had been studying inequities in health care treatment of minorities, and his findings contradicted what a lot of people believed to be true.

Against conventional wisdom

“The conventional wisdom was that minorities, especially African Americans, were receiving inadequate health care because of racism that manifested itself in the clinical encounter between doctor and patient,” he says today. “That’s easy to assert, but very hard to prove. There are hundreds of variables that physicians treating patients observe, but that social scientists don’t necessarily see.”

Chandra discovered other correlations that were much more straightforward and easier to demonstrate.

“My colleagues and I found that where you lived seemed to be a more significant factor than simple bias. If you lived in a place lacking access to a first-class medical facility, you naturally received lower quality care than someone who did have that access. Minority patients are much more likely to live in areas where the care isn’t as good—but within those places, doctors treat white and black patients similarly.”

Feeling some trepidation at how his testimony would be perceived because he might be seen as an apologist for racially motivated bias, Chandra plunged ahead. He told the Commission, “What we have been calling prejudice in the clinical encounter is really a difference in neighborhoods, referral patterns, and the resources of providers that serve in these neighborhoods.” He cited research showing that “those providers who treat minorities are often less clinically trained and have fewer resources.”

A highly professional response

Afterward, he found that his concerns were groundless. The commissioners were highly professional and asked good questions. Their queries centered on “What do we do about this problem?” and not on “Are you sure you know what the problem is?”

“It’s exciting and terrifying,” he says, speaking of the hearing. He notes that good testimony must strike a balance between sound academic research and immediate relevance to policymaking.

According to Chandra, the hearing was different from what we see on television, where Democrats and Republicans appear to have strikingly different goals. “At least on the Civil Rights Commission, the commissioners have the same goal, which is good policy to improve outcomes for minorities,” he says. “The differences are in how to achieve that goal.”

Sharing with the students

Chandra could not linger in Washington to learn how his testimony had been received. He had to hurry back to Cambridge to meet with students, who always enjoyed hearing about interactions with policymakers like this one.

“The executive education students especially like to know about these encounters: they’re a tough crowd in the classroom,” he says. “Of course, many are policymakers themselves, and teaching them is like working out in the gym; it’s where we train to make sure our work is relevant.”

Flying home, he reflected on how he might have done a better job. “The data was precise and convincing, and ‘data is the plural of anecdote,’” he thought, “but it might have been more persuasive if I had told a story to illustrate my findings. Something like, ‘Let me tell you about Mr. Smith, who is treated in City Hospital.’”

“We’re all drawn to the power of stories over statistics, but the truth is really in the statistics,” he decided as his flight banked over Cambridge, Massachusetts.

Policy matters.

Amitabh Chandra

Amitabh Chandra, professor of public policy

“If you lived in a place lacking access to a first-class medical facility, you naturally received lower quality care than someone who did have that access," Chandra testified.

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