Frank A. Sloan
  • Frank A. Sloan

  • J. Alexander McMahon Professor of Health Policy and Management
  • Economics
  • Social Sciences, Rm. 236, Durham, NC 27708
  • Campus Box Box 90097
  • Phone: (919) 613-9358
  • Fax: (919) 681-7984
  • Homepage
  • Curriculum Vitae
  • Overview

    Professor Sloan is interested in studying the subjects of health policy and the economics of aging, hospitals, health, pharmaceuticals, and substance abuse. He has received funding from numerous research grants that he earned for studies of which he was the principal investigator. His most recent grants were awarded by the Robert Wood Johnson Foundation, the Center for Disease Control, the Pew Charitable Trust, and the National Institute on Aging. Titles of his projects include, “Why Mature Smokers Do Not Quit,” “Legal and Economic Vulnerabilities of the Master Settlement Agreement,” “Determinants and Cost of Alcohol Abuse Among the Elderly and Near-elderly,” and “Reinsurance Markets and Public Policy.” He received the Investigator Award for his work on the project, “Reoccurring Crises in Medical Malpractice.” Some of his earlier works include the studies entitled, “Policies to Attract Nurses to Underserved Areas,” “The Impact of National Economic Conditions on the Health Care of the Poor-Access,” and “Analysis of Physician Price and Output Decisions.” Professor Sloan’s latest research continues to investigate the trends and repercussions of medical malpractice, physician behavior, and hospital behavior.
  • Bio

    Frank Sloan is the J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics at Duke University since 1993. He is the former Director of the Center for Health Policy, Law and Management at Duke (CHPLM) that originated in 1998. He holds faculty appointments in five departments at Duke, with Economics being his primary appointment. He did his undergraduate work at Oberlin College and received his Ph.D. in economics from Harvard University.

    Before joining the faculty at Duke in July 1993, he was a research economist at the Rand Corporation and served on the faculties of the University of Florida and Vanderbilt University. He was Chair of the Department of Economics at Vanderbilt from 1986-89. His current research interests include alcohol use and smoking prevention, long-term care, medical malpractice, and cost-effectiveness analyses of medical technologies. He also has a long-standing interest in hospitals, including regulation of hospitals, health care financing, and health manpower.

    Frank has served on several national advisory public and private groups. He is a member of the Institute of Medicine and was formally a member of the Physician Payment Review Commission. He is the author of about 300 journal articles and book chapters and has coauthored and coedited about 20 books. Recently published books are Medical Malpractice (MIT Press, 2008, coauthored with L. Chepke) and Incentives and Choice in Health Care (MIT Press, 2008, co-edited with H. Kasper).
  • Other

    Course descriptions and syllabi

  • Specialties

    • Health Economics
    • Labor Economics / Economics of the Household
    • Behavioral Economics
  • Research Summary

    Health Policy, Physician Behavior, and Hospital Behavior
  • Education

      • Ph.D.,
      • Economics,
      • Harvard University,
      • 1969
      • A.B. (high honors in Economics),
      • Oberlin College, Oberlin, Ohio,
      • 1964
  • Awards, Honors and Distinctions

      • NIH Merit Award,
      • September 2005
      • Listed in Who's Who in America,
      • 43rd and 44th editions,
      • April 2004
      • Who's Who in South and Southwest,
      • 21st Edition,
      • April 2004
      • Researcher (NBER Family Members),
      • National Bureau of Economic Research,
      • 0 1988
      • Member,
      • Institute of Medicine of The National Academies,
      • 0 1982
      • U.S. Public Health Health Service Fellowship for Research Training in Medical Care,
      • 1966-1968
      • Harvard Fellowship,
      • 1965-1966
      • Summer Intern,
      • President's Council of Economic Advisors,
      • 1964
      • Woodrow Wilson National Fellow,
      • 1964-1965
  • Selected Publications

      • F.A. Sloan with L. Chepke.
      • (2008).
      • Medical Malpractice.
      • MIT Press.
      • F.A. Sloan, co-edited with H. Kasper.
      • (2008).
      • Incentives and Choice in Health Care.
      • MIT Press.
      • F.A. Sloan, co-edited with Hellen Gellband.
      • (2007).
      • Cancer Control Opportunities in Low- and Middle-Income Countries.
      • Washington: The National Academies Press.
      • FA Sloan and CR Hsieh.
      • (2007).
      • Pharmaceutical innovation: Incentives, competition, and cost-benefit analysis in international perspective.
      • Cambridge University Press.
      • [web]
      Publication Description

      © Cambridge University Press 2007 and Cambridge University Press 2010. The pharmaceutical industry worldwide is a rapidly burgeoning industry contributing to growth of gross domestic product and employment. Technological change in this field has been very rapid, with many new products being introduced. For this reason in part, health care budgets throughout the world have increased dramatically, eliciting growing pressures for cost containment. This book explores four important issues in pharmaceutical innovations: (1) the industry structure of pharmaceutical innovation; (2) incentives for correcting market failures in allocating resources for research and development; (3) competition and marketing; and (4) public evaluation of the benefits and costs of innovation. The lessons are applicable to countries all over the world, at all levels of economic development. By discussing existing evidence this book proposes incentive arrangements to accomplish social objectives.

      • FA Sloan and LM Chepke.
      • (2007).
      • The law and economics of public health.
      • Now Publishers.
      • [web]
      Publication Description

      The fundamental question addressed by this paper is whether or not and the extent to which imposing tort liability on potential injurers improves the public's health. Conceptually, imposing the threat of litigation on potential injurers gives them an incentive to exercise more care than they would absent the threat. While the conclusion might seem to be obvious at first glance, in reality, the conclusion is far from obvious. For one, insurance coverage may blunt incentives to take care. Also, the tort system may operate far less perfectly than the theory would have it. In the end, the question must be answered on the basis of empirical evidence. © 2007 F. A. Sloan and L. M. Chepke.

      • F.A. Sloan with J. Ostermann, G. Picone, C. Conover, and D.H. Taylor, Jr..
      • (2004).
      • The Price of Smoking.
      • MIT Press.
      • F.A. Sloan with V.K. Smith and D.H. Taylor, Jr..
      • (2003).
      • The Smoking Puzzle: Information, Risk Perception, and Choice.
      • Harvard University Press.
      • (Awarded Honorable Mention, Research Communication Award, July 2004 by the American Agricultural Economics Association)
      • F.A. Sloan with Stout, E., Whetten-Goldstein, K., and Liang, L..
      • (2000).
      • Drinkers, Drivers, and Bartenders: Balancing Private Choices and Public Accountability.
      • University of Chicago Press.
      • (1995).
      • Valuing Health Care: Costs, Benefits, and Effectiveness of Pharmaceuticals and Other Medical Technologies.
      • Cambridge: New York and Melbourne: Cambridge University Press.
      • A Khwaja, F Sloan and Y Wang.
      • (February, 2009).
      • Do smokers value their health and longevity less?.
      • Journal of Law and Economics
      • ,
      • 52
      • (1)
      • ,
      • 171-196.
      • [web]
      Publication Description

      One reason why individuals consume harmful addictive goods is that the "full" price of such goods is low. Using data on adults specifically collected for this study, we examine the internal cost of one such good by estimating the value that smokers and nonsmokers place on loss of health and longevity from a major lung disease, chronic obstructive pulmonary disease (COPD). Differences in the nonpecuniary internal cost of getting COPD between current smokers and people who have never smoked range from $80,000 to $260,000, implying that one reason people continue to smoke is that they face a lower full price of smoking. Our results suggest that although taxation and regulation of cigarettes may be justified for externality reasons, the principle of consumer sovereignty implies that the case is much weaker for interventions based on helping smokers internalize costs they impose on themselves.

      • FA Sloan and JH Shadle.
      • (March, 2009).
      • Is there empirical evidence for "Defensive Medicine"? A reassessment..
      • J Health Econ
      • ,
      • 28
      • (2)
      • ,
      • 481-491.
      • [web]
      Publication Description

      Proponents of tort reform applied to medical malpractice argue for change partly on the premise that the threat of lawsuits has made medical care more costly. Using U.S. longitudinal data from the National Long-Term Care Survey merged with Medicare claims and other data for 1985-2000, this study assesses whether tort reforms have reduced Medicare payments made on behalf of beneficiaries and the survival probability following an index event. Direct reforms (caps on damages, abolition of punitive damages, eliminating mandatory prejudgment interest, and collateral source offset) did not significantly reduce payments for Medicare-covered services in any specification. Indirect reforms (limitations on contingency fees, mandatory periodic payments, joint-and-several liability reform, and patient compensation funds) significantly reduced Medicare payments only in a specification based on any hospitalization, but not in analysis of hospitalization for each of four common chronic conditions. Neither direct nor indirect reforms had a significant effect on the health outcomes, with one exception. The overall conclusion is that tort reforms do not significantly affect medical decisions, nor do they have a systematic effect on patient outcomes.

      • FA Sloan, A Khwaja, D Silverman and Y Wang.
      • (March, 2009).
      • Are Smokers Misinformed?.
      • Journal of Health Economics
      • ,
      • 28
      • (2)
      • ,
      • 385-397.
      • [web]
      Publication Description

      While there are many reasons to continue to smoke in spite of its consequences for health, the concern that many smoke because they misperceive the risks of smoking remains a focus of public discussion and motivates tobacco control policies and litigation. In this paper we investigate the relative accuracy of mature smokers' risk perceptions about future survival, and a range of morbidities and disabilities. Using data from the survey on smoking (SOS) conducted for this research, we compare subjective beliefs elicited from the SOS with corresponding individual-specific objective probabilities estimated from the health and retirement study. Overall, consumers in the age group studied, 50-70, are not overly optimistic in their perceptions of health risk. If anything, smokers tend to be relatively pessimistic about these risks. The finding that smokers are either well informed or pessimistic regarding a broad range of health risks suggests that these beliefs are not pivotal in the decision to continue smoking. Although statements by the tobacco companies may have been misleading and thus encouraged some to start smoking, we find no evidence that systematic misinformation about the health consequences of smoking inhibits quitting.

      • FA Sloan and Y Wang.
      • (November, 2008).
      • Economic theory and evidence on smoking behavior of adults..
      • Addiction
      • ,
      • 103
      • (11)
      • ,
      • 1777-1785.
      • [web]
      Publication Description

      AIMS: To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework. METHODS: A systematic review and appraisal of important theoretical and empirical economic studies on smoking. RESULTS: There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking. CONCLUSIONS: Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

      • F Sloan and L Chepke.
      • (Spring 2008).
      • From medical malpractice to quality assurance.
      • Issues in Science and Technology
      • ,
      • 24
      • (3)
      • ,
      • 63-70.
      Publication Description

      Health care service providers in the US need to implementing a proper a medical malpractice system that focuses on compensating patients for medical errors and finding ways to prevent these errors from occurring. The service providers need to eliminate misconceptions about the problems associated with the medical malpractice system, as a first step toward solving real problems of medical errors and low level of quality assurance. Steps can be taken, to reconstruct the system aimed at improving the quality of medical care, by giving medical professionals better incentives, to deliver the services that people need. A number of options exist, to reform the medical malpractice system, such as enterprise insurance that has the potential to provide the initiative for systematic change.

      • FA Sloan, A Khwaja and S Chung.
      • (October, 2007).
      • Individual Expectations and Behaviors: Evidence of the Relationships between Mortality Expectations and Smoking Decisions.
      • Journal of Risk and Uncertainty
      • ,
      • 35
      • (2)
      • ,
      • 179-201.
      • [web]
      Publication Description

      Using data from the Health and Retirement Study, we assess the accuracy of subjective beliefs about mortality and objectively estimated probabilities for individuals in the same sample. Overall, subjective beliefs and objective probabilities are very close. However, there are differences conditional on behaviors, with current smokers being relatively optimistic and never smokers relatively pessimistic in their assessments. In the aggregate, individuals accurately predict longevity, but at the individual level, subjective beliefs provide information in addition to the estimated objective probabilities in predicting actual events, which may arise from the effect of past or anticipated decisions on these beliefs. © 2007 Springer Science+Business Media, LLC.

      • A Khwaja, D Silverman and F Sloan.
      • (September, 2007).
      • Time preference, time discounting, and smoking decisions.
      • Journal of Health Economics
      • ,
      • 26
      • (5)
      • ,
      • 927-949.
      • [web]
      Publication Description

      This study examines the relationship between time discounting, other sources of time preference, and choices about smoking. Using a survey fielded for our analysis, we elicit rates of time discount from choices in financial and health domains. We also examine the relationship between other determinants of time preference and smoking status. We find very high rates of time discount in the financial realm for a horizon of 1 year, irrespective of smoking status. In the health domain, the implied rates of time discount decline with the length of the time delay (hyperbolic discounting) and the sign of the payoff (the sign effect). We use a series of questions about the willingness to undergo a colonoscopy to elicit short- and long-run rates of discount in a quasi-hyperbolic discounting framework, finding no evidence that short-run and long-run rates of discount differ by smoking status. Using more general measures of time preference, i.e., impulsivity and length of financial planning horizon, smokers are more impatient. However, neither of these measures is significantly correlated with the measures of time discounting. Our results indicate that subjective rates of time discount revealed through committed choice scenarios are not related to differences in smoking behavior. Rather, a combination of more general measures of time preference and self-control, i.e., impulsivity and financial planning, are more closely related to the smoking decision. © 2007 Elsevier B.V. All rights reserved.

      • P Arcidiacono, H Sieg and F Sloan.
      • (February, 2007).
      • Living rationally under the volcano? An empirical analysis of heavy drinking and smoking.
      • International Economic Review
      • ,
      • 48
      • (1)
      • ,
      • 37-65.
      • [web]
      Publication Description

      This study investigates whether models of forward-looking behavior explain the observed patterns of heavy drinking and smoking of men in late middle age in the Health and Retirement Study better than myopic models. We develop and estimate a sequence of nested models that differ by their degree of forward-looking behavior. Our empirical findings suggest that forward looking models fit the data better than myopic models. These models also dominate other behavioral models based on out-of-sample predictions using data of men aged 70 and over. Myopic models predict rates of smoking for old individuals, which are significantly larger than those found in the data on elderly men. © 2007 by the Economics Department Of The University Of Pennsylvania And Osaka University Institute Of Social And Economic Research Association.

      • A Khwaja, D Silverman, F Sloan and Y Wang.
      • (January, 2007).
      • Smoking, wealth accumulation and the propensity to plan.
      • Economics Letters
      • ,
      • 94
      • (1)
      • ,
      • 96-103.
      • [web]
      Publication Description

      We investigate the relationship between wealth, smoking, and individual propensities to plan. Planning propensity affects wealth but not smoking, suggesting that planning is not an all-purpose skill. Financial planning may draw on different abilities than those that facilitate smoking cessation. © 2006 Elsevier B.V. All rights reserved.

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  • Teaching

    • ECON 690.03
      • Perkins 071
      • TuTh 03:05 PM-04:20 PM
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