Michal Horný (April 2018)

Michal Horný graduated from the IES in 2010 with a Bachelor's degree. In addition to the IES, he also completed a Bachelor's degree in Financial Mathematics at the Faculty of Mathematics and Physics at Charles University, a Master's degree at​ ​VU University Amsterdam, and in 2017 he received a Doctoral degree from Boston University.

Currently, he is Assistant Professor at Emory University in the USA. He started this position in 2017 after finishing his Ph.D. at Boston University. During his doctoral studies in Boston, he taught cost-effectiveness analysis, and before that, he had been a Teaching Assistant for several courses at Boston University School of Public Health. He also worked shortly as a Data Analyst at the Boston Medical Center and worked for one semester as a Research Assistant at Boston University Questrom School of Business. While studying in the Czech Republic, he gained experience as an Analyst in Deloitte or UniCredit Bank. In his research, he focuses on healthcare and related issues.

Michal is also a co-founder of Doc Odds, a web application helping medical students match into a U.S. based residency training specialty of their choice. In his spare time, Michal likes bouldering, hiking, and skiing.

 

Michal, you studied in Prague, Amsterdam, and Boston. Could you find one important thing that each of the studies gave you?

After graduating from high school, I started studying mathematics at Charles University School of Mathematics and Physics. My first encounter with formal academic mathematics was a shock. But those few years of agony taught me to be persistent and humble. Math has always been a useful tool rather than an object of interest to me, and so a year later, I also enrolled in the undergraduate program at IES. The most important takeaway from IES was introducing me to several role models who inspired me and helped me figure out what I’d like to do with my life. I had been very clueless about which direction to take up until that point.

I spent only one year at VU Amsterdam, and that was a really short time. During those studies, however, many fragmented pieces of my then-knowledge finally clicked together and started to make sense. In contrast, I spent five years working on my doctorate at Boston University (that is the amount of time it usually takes to earn a Ph.D. in the United States), and I learned a lot during that time. I was incredibly lucky to have James (Jim) Burgess, Jr. as my primary academic advisor and my dissertation committee chair. Jim was not only one of the most accomplished experts in health economics but also an uncommonly kind person and an amazing teacher. Unfortunately, he lost his battle to cancer a month before my thesis defense. I also met my life partner thanks to the studies in Boston.

You focus on the topic of health economics. When did it happen that you started to concentrate on this quite unusual field?

Health economics is a remarkable field. Many standard economic models can be applied to various areas of human activity, but they fall short in healthcare. Moreover, health is very personal to every human being. Even though this will sound like a cliché, health likely is the most valuable thing we have. I suspect I became subconsciously interested in healthcare due to my parents. They are both physicians, and we often used to chat about various oddities of the healthcare system, such as the different physician reimbursement schemes. Now when I think about it, one of the first essays I wrote at IES (as part of the course requirements in Prof. Kouba’s class) was about hospital financing. Though I had no clue back then that my professional life would soon take off in this direction. I think the sudden realization occurred toward the end of my undergraduate studies.

You also experienced a non-academic career; you worked at Deloitte and UniCredit Bank. Which were the advantages/disadvantages in comparison to your current position in academia?

Simply put, U.S. universities offer two types of positions. One is called a “hard money” position which means that the university pays for your salary and in return expects you to teach about two classes per semester and publish a few research papers per year. If you happen to receive a grant, certainly no one will hold it against you, but it is not required. You can use the money from a grant to “buy yourself out” of teaching duties to have enough time to finish the funded research. Such positions are common in humanities, social sciences, and business schools. Thanks to my focus, I landed a position at a medical school, where “soft money” positions are a lot more common. For that type of position, it is expected that you’ll support a significant portion of your salary from external grants. To receive a grant, however, a strong publication record in the given field is usually required, and so it may get a little stressful. Unlike in “hard money” positions, there is usually little to no teaching requirement in “soft money” positions.

Well, that was a complicated set up to the comparison of positions in consulting and academia. In consulting, you have to sell projects, write project proposals, and hope that at least some of them will be successful because bringing enough revenue to the company is what ultimately matters. If you acquire a client, you can finally start working on the actual project. The situation is very similar in the “soft money” environment in academia. Instead of project proposals, you have to write grant proposals. Even though everyone agrees that the main objective of academia is the enrichment of knowledge, money still matters. The main difference, however, is in the choice of a topic. In the private sector, you usually work for a client who gives you instructions that you must follow. In contrast, there’s a lot of freedom to choose your own topic in academia. You can choose to work on something that you personally find interesting. However, that freedom has its limits because you must choose a topic that someone else also finds interesting. Otherwise, you may not be successful in securing funding. Whether this is an advantage or disadvantage depends on personal preferences.

Another considerable difference is in how the product of your work gets ultimately branded. In academia, you publish research papers with your name on them (the name of the university tends to be mentioned in small font in the footer). If you happen to make a scientific breakthrough, your name gets a lot of credit. Of course, your institution likely will take pride in having you on board, but still, the merit goes to that person. Inherently, there is a risk that if you fail remarkably, all the shame is also yours. It is often the exact opposite in the private sector. Your employer’s brand shields you from any potential public fame or shame, which may be desirable by some people and not by others.

Could you describe your current research? Can you tell us something about your newest findings?

I currently work on several projects. In one of them, my colleagues and I demonstrate the trade-off between health insurance premiums and the length of the time interval over which a deductible applies. For those unfamiliar with the U.S. healthcare system, health insurance plans often feature an annual deductible. For example, if the annual deductible amount is $3,000, a beneficiary of such a plan has to pay for the first $3,000 for health care each year out of pocket. The health insurance does not kick in until after that. The problem is that it is not unusual to receive a bill for such a high amount even for just a single health care visit, and many people do not have that much money readily available. As a result, they avoid going to the doctor even when this decision is detrimental to their health. We propose to shorten the interval over which the deductible applies and decrease its nominal amount (e.g., $400 per month instead of $3,000 per year). Such an alteration would decrease the risk of an unanticipated high expense for health plan beneficiaries, but it would consequently increase the insurance premium; although, not as much as a removal of the entire deductible. Unfortunately, there is no simple solution.

In another project, I work on the quantification of the value of imaging (e.g., ultrasound, computed tomography, magnetic resonance, but also a good old x-ray), which is information essential for effective resource allocation. Imaging has a tremendous benefit in the fact that a physician does not need to cut a patient open to see what is going on inside the patient’s body. Disadvantages of imaging include high prices, and in some cases, harmful radiation. It gets even more complicated because imaging itself does not heal patients – it only provides information. Thus, its effect on health is hard to quantify unlike many other health services. Then there’s also the subjective aspect of the value of imaging. Patients usually prefer certainty to uncertainty. And after all, there is some subjective value even for the treating physician because she does not have to wonder whether she had done everything she could for the patient. But all that does not imply we should scan every little soreness – resources are scarce.

Can you predict, for how long are you going to stay in the USA? Do you prefer living abroad, or are you still considering a possibility of moving back to the Czech Republic?

I admit that I often miss my family, friends and the Czech countryside but I do not plan to move back. I already have strong personal ties in the U.S. and a solid work environment with countless opportunities for research thanks to many federal and state funding agencies and private foundations. It is a bit odd, but the dysfunctional healthcare system in the U.S. is a reason why there is so much demand for research in health economics. The Czech healthcare system has its own flaws, but it generally works well. Moreover, many policies are based on ideology rather than research findings. Thus, it is no surprise that health economics in Czechia is a marginalized field. It is a shame. In any case, I like even the everyday life in the U.S. a little bit better – people here are nicer to each other.

What are your hobbies? How do you relax?

I try to boulder fairly regularly. That exercise is not only helpful to stretching tight muscles after sitting by a computer all day, but it is also good for mental health. One must be fully focused on a relatively simple task – not to fall like a plum. I also enjoy downhill skiing and hiking in the mountains, but I get to do that only a few times a year.
 


  

 

 

 

 

 

 

 

 

 

 


 


 

 


  

  

 

 

 

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