Mario Macis

Professor of Economics and Management, Johns Hopkins Carey Business School
Research Associate, National Bureau of Economic Research

Tell us a little bit about your research. How does it contribute to the overall goal of HBHI?

I am an applied economist and much of my work centers on how economic incentives interact with psychological factors and social norms to drive people’s behavior and policy-relevant outcomes, focusing on health-related behaviors and markets. I studied the markets for blood, plasma, bone marrow, and organs for transplantation. I focused on how donors respond to information and incentives and how the public perceives the tradeoff between morality and efficiency when considering economic incentives for the supply of organs for transplantation. I also studied the role of incentives, behavioral interventions, and social networks in addressing the under-detection of infectious diseases, particularly tuberculosis and HIV, and more recently, the adoption of preventive behaviors against COVID-19. Another strand of my research considers the drivers and the effects of management practices in health care organizations.

What would you say most motivates you to do what you do? What are the goals you most want to accomplish in your work?

Currently, my main goal is to understand the determinants of societal support for market-based solutions to social problems, focusing on health-related decisions and contexts. This is important because for markets to work well, they must enjoy the support and trust of the public. The “business of health” is no exception. Understanding whether and why specific market-based solutions are socially acceptable (or not) is a critical input for policymakers, regulators, and leaders of health care organizations.

Tell us about a current project you are working on and what potential impacts do the findings have? What makes you excited about it?

In an ongoing study, I conduct randomized survey experiments to study how people reason about the pricing of health-related products during emergencies. During the COVID-19 pandemic, the demand for many products (including masks, hand sanitizer, toilet paper, etc.) surged, causing prices to increase substantially. Price increases are often considered unethical, cause public outrage, and prompt authorities to introduce price controls and other “anti-gouging” regulations. However, changes in relative prices convey important signals to buyers and sellers. For instance, higher prices can motivate more entry and greater supply of goods in high demand, can induce sellers to build inventories, can promote innovation, and make the allocation of goods across geographical areas more efficient. These efficiency-morality dilemmas characterize many market-design and regulation choices in the health care sector and beyond. The goal of this study is to analyze how people perceive and reason about tradeoffs between competing values and goals in their support for market-driven price surges versus price controls. We consider goods such as pharmaceutical drugs, treadmills for home use, hand sanitizer, and hand moisturizer.

In a pilot funded by an HBHI pilot grant, my coauthors and I find that U.S. and Canadian residents show strong opposition to price surges, particularly for health-related products such as pharmaceutical drugs and hand sanitizer. The nature of the opposition appears to be rooted in moral values, particularly fairness and equity concerns. However, the support for prices being determined by market forces (with no government intervention) increases when possible tradeoffs are made salient (e.g., higher prices for pharmaceutical drugs today may incentivize pharmaceutical companies to produce more and better drugs tomorrow), and when the increase in price was caused by supply-chain bottlenecks. The full-scale study will be conducted on representative samples and will collect a richer set of variables, including the respondents’ moral and political views and their overall opinions about the role of markets in the economy in general and in the healthcare sector in particular.

Tell us about a project you are working on with other HBHI colleagues.

In joint work with Seema Kacker (PhD, MS-IV and HBHI Affiliate Trainee), we are exploring why patients often do not take advantage of free health services. In a study recently accepted for publication in Health Economics, we find that low-income patients' willingness to use follow-up eye services (to which they are already entitled for free), increases substantially when the patients are given paper vouchers, especially when the vouchers include information about the retail dollar value of those services. We are currently planning follow-up studies to understand better the barriers to and motivation for taking-up free medical services. In particular, we are interested in studying how patients perceive free health services and why, with the goal of designing more effective outreach strategies targeting marginalized populations in Baltimore and other U.S. localities.

What have you learned so far from being a part of HBHI?

Being part of HBHI reinforced my belief that to get to the root of a problem and to find effective strategies and solutions; it is crucial to collaborate and build bridges between different disciplines and approaches. Specialized studies are essential, but interdisciplinary collaborations are just as important.

Scholars must make an effort to communicate with scholars from other disciplines and be open to suggestions and criticism.

It is also essential for scientists and researchers to effectively communicate their findings and results to policymakers and the public.

In your opinion, where are the greatest opportunities to improving the American health care system? How can HBHI contribute?

There are many wasteful inefficiencies and intolerable inequities in the American health care system. HBHI contributes by fostering in-depth work that addresses specific problems faced by patients and health care organizations, as well as by enabling big-picture, system-wide thinking and discussion that inform state-level and national policy.

For fun: If you could travel anywhere in the world, where would you go and why?

As a native of Sardinia, I am fascinated by islands. Luckily, I had the opportunity to travel to some special ones, for example, Easter Island, Santorini, and the Lofoten islands. The Galapagos, Pitcairn, and Flores are on my wish list.