Carole Roan Gresenz: Economist on the Run

Carole Roan Gresenz, Ph.D., is a senior economist at RAND Corporation in Arlington, Virginia. Gresenz’s research interests include: access to health care, coverage decision-making in managed care organizations, civil justice, health care markets, and the uninsured.

We talked to Carole about crowd out, discovering California, and turning somersaults.

Why did you choose Illinois, Pennsylvania and Washington as your states of focus? 

We are interested in these three states because they have all experimented with universal coverage for children. In the absence of major health care reform at the federal level, states have been important laboratories for thinking and working with incremental health care reforms.  In particular, we know that uninsured children are at risk for not having appropriate preventive care and that a healthy childhood lays the foundation for health in the future.  Because of this, insuring kids gets widespread support.

How does that square with the fact that SCHIP reauthorization has failed to pass?

Much of that debate centers on higher income children who have private health insurance coverage, but become newly eligible for public health insurance under the expansion of SCHIP.  If we offer government-sponsored insurance are we crowding out private insurance from the market?  Right now, we do not know because we’ve never tried to give this kind of health insurance eligibility to higher income children. 

What methods are you using in your research to address these questions?

The key to success for this project is integrating quantitative and qualitative methods.  On the quantitative side, we are tracking how health insurance outcomes change over time as these programs are implemented. We will use data from the Current Population Survey and data from state-conducted surveys. We will also meet with policy-makers and other stakeholders to understand the political context in which these reforms were passed and to identify threats to sustainability. Implementation varies considerably by state, so we want to identify salient differences and analyze how they affect the success of the program.  

As an economist, are you more inclined to the quantitative approach? 

I do a little bit of both.  As an economist I am definitely more comfortable on the quantitative side, but over the past few years I’ve been more involved with qualitative research.  Numbers and figures are really important, but there are issues that don’t emerge from the quantitative data. To get the whole picture, you have to talk to community residents, providers, and others.

 How did you find your way into health services research?

I got my Ph.D. in economics from Brown, where I trained as a labor economist.  When I came to RAND in 1996, there were a lot of opportunities in health research, and I dove in.  I started with mental health care issues.  I liked the process of learning about the institutions of health.  I think of economics as a toolkit that you can use for a variety of issues – for instance, I have also done work looking at housing choices among U.S. military service members.  I like to keep a broad research agenda and work on a lot of different topics. 

Did you enjoy Providence during your time at Brown?

I did not like the weather in Providence – it was usually cold and grey.  Grad school is tough; I spent most of my time in the library.  I applied for a summer internship at RAND after my second year of graduate school and basically never left.  After a summer in Santa Monica, California, I stayed as a half-time research assistant and devoted the rest of my time to my dissertation.  I’m still with RAND, but now I’m back on the east coast. 

If you weren’t a health services researcher at RAND, what would you be doing? 

When I was little I dreamt of being a gymnast. We had a sixth grade gymnastics team called the “Olympians” and I was on it—but that is about as far as I got. I did a lot of somersaults in my front yard. Right now if I weren’t working, I would certainly spend more time running. Each year I try to do a half marathon and a 10-mile race. RAND generously has a locker room right at the office, so I’m able to run every day. I have to run every day or I can’t think. The other day, someone stopped me and asked whether I had an athletic scholarship here at RAND.  I thought that was really funny.