Case Studies

Most-Favored-Nation Benchmarking Versus Value-Based Contracting: Institutional Fit of Pharmaceutical Pricing Tools in the United States, Canada, and the United Kingdom

Prescription medication prices are often high, making it difficult for people to access the medicines they need. This study examines how three countries, Canada, the United Kingdom, and the United States, attempt to control prices while supporting fair access and workable implementation. We focus on two main approaches: using international price benchmarks to inform pricing (international reference pricing/MFN-type designs) and paying based on a drug’s clinical value or outcomes (value-based care/value-based contracting). We found that countries differ mainly because their health systems are organized differently. The United Kingdom’s centralized structure supports more consistent policy implementation, while the United States’ multi-payer structure creates greater legal, administrative, and data challenges. Canada shows strong price regulation and baseline access, but policies vary across provinces and outcomes-based contracting is less common. Newly assessed March 5, 2026, U.S. proposals (GENEROUS, GLOBE, GUARD) suggest continued federal interest in international benchmark-based approaches, but these are recent and do not yet have outcome evidence. We suggest a combined approach in the United States: use international benchmarks to strengthen negotiations and expand value-linked contracts only where measurement and coordination are feasible.

Medicaid Expansion and Frequent Mental Distress Among U.S. Adults: Staggered DiD Using BRFSS, 2011 to 2024

Medicaid expansion under the Affordable Care Act increased health insurance coverage for many low-income adults, which could improve mental health by reducing financial stress and improving access to care. We studied whether Medicaid expansion changed the share of adults reporting “frequent mental distress,” defined as 14 or more days of poor mental health in the past 30 days. Using BRFSS data from 2011–2024, we compared changes in frequent mental distress in states that expanded Medicaid to changes in states that had not yet expanded at the same time. Because states expanded in different years, we used an approach designed for staggered policy adoption and estimated effects separately for low-income, high-income, and all adults aged 18–64. Overall, average effects were small and not statistically distinguishable from zero, although some expansion cohorts showed statistically significant changes in certain years after expansion. These results suggest that Medicaid expansion alone may have limited population-level effects on frequent mental distress.

Evaluating U.S. Health Policy Levers Using Difference-in-Differences: Hospital Acquisitions, Global Budgets, and Income Policies

To evaluate the impact of selected U.S. health policy levers on financial and population health outcomes using quasi-experimental methods. A central theme of my doctoral research, reflected in three publishable dissertation manuscripts, is the evaluation of health policy levers and system-level reforms. This work applies quasi-experimental methods to examine how policy and organizational changes shape financial and population health outcomes, with a broader interest in whether reforms intended to improve efficiency, access, or quality produce meaningful benefits and under what conditions they may reduce or exacerbate inequities.

From crisis to recovery: Exploring the demand surge for mental health services in Alberta, Canada—A document-based policy analysis with an illustrative supply–demand simulation (2023–2024)

This study examines the sharp increase in demand for mental health services in Alberta following recent system pressures, using a document-based policy analysis combined with a supply–demand simulation. It evaluates how existing policies and system capacity respond to rising needs, identifies gaps between service demand and availability, and provides insights to support more responsive, data-informed mental health planning and resource allocation.

Income Inequality and Self-Reported Health: A Difference-in-Differences Study

This study examines the relationship between income inequality and self-reported health outcomes using a difference-in-differences analytical approach. By comparing changes across populations and time, the research evaluates how shifts in economic conditions influence perceived health status. The findings contribute to understanding the broader social determinants of health and the policy implications of economic disparities.

Remote Work, Well-Being, and Healthy Labor Force Participation Among Older Adults: A Scoping Review

This scoping review explores the relationship between remote work, well-being, and continued labor force participation among older adults. The study examines existing research on how flexible work arrangements influence health, productivity, and workforce engagement for aging populations. It highlights emerging evidence on the benefits and challenges of remote work and identifies policy and workplace strategies that can support healthy and sustainable participation in the labor force.

Systemic Racism in Canadian Healthcare: A Policy and Equity Analysis

This analysis examines how systemic racism manifests within Canadian healthcare systems and the policy structures that influence equity in care delivery. The work reviews existing policies, institutional practices, and health outcomes to identify disparities affecting racialized communities. It highlights structural gaps and proposes policy-informed approaches to improve accountability, equity, and culturally responsive care across healthcare institutions.

Interoperability and Digital Health Therapeutics: A Scoping Review of Emerging Technologies and Standards

This review examines the evolving landscape of emerging technologies and the standards shaping their adoption across health systems and digital infrastructure. It maps current innovations, identifies relevant regulatory and interoperability frameworks, and highlights gaps between technological capabilities and implementation practices. The review provides decision-makers with a structured overview of trends, opportunities, and considerations for integrating new technologies responsibly and effectively.

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