About

Mark Duggan is the Wayne and Jodi Cooperman Professor of Economics at Stanford University and a Senior Fellow at the Stanford Institute for Economic Policy Research. He is also a Research Associate at the National Bureau of Economic Research. Duggan received his B.S. and M.S. degrees in Electrical Engineering from MIT in 1992 and 1994, respectively, and earned his Ph.D. in Economics from Harvard University in 1999. His academic career includes faculty positions at the University of Chicago, the University of Maryland, and the University of Pennsylvania's Wharton School before joining Stanford in 2014. His research primarily focuses on the effects of government expenditure programs such as Social Security, Medicare, and Medicaid on the behavior of individuals and firms. Recent work explores the impact of federal disability programs on the labor market and examines how changes to Medicare and Medicaid influence healthcare costs and quality. Duggan has also studied the effects of patent reforms in India on pharmaceutical prices and utilization. His research has been published in leading academic journals and featured in major media outlets. He has received notable awards including the ASHEcon Medal and the National Institute for Health Care Management's Health Care Research Award. Duggan has served as Senior Economist for Health Care Policy at the White House Council of Economic Advisers and has been an Expert Witness for the U.S. Department of Justice.

Research topics

• Meteorology
• Economics
• Marketing
• Ecology
• Biology
• Medicine
• Environmental science
• Geography
• Market economy
• Environmental health
• Demography
• Business
• Psychiatry
• Industrial organization
• Finance

Selected publications

• The impact of immunotherapy on reductions in cancer mortality: Evidence from Medicare

  Journal of Health Economics · 2026-01-23 · 1 citations

  article
  PublisherDOI

• The Impact of Immunotherapy on Reductions in Cancer Mortality: Evidence from Medicare

  National Bureau of Economic Research · 2025-10-01

  reportOpen access

  Immunotherapy is a breakthrough innovation in cancer care but is also among the most expensive treatments, with costs exceeding $150,000 per patient.We study the introduction of immune checkpoint inhibitors (ICIs), the most widely used class of immunotherapy drugs.In 2022, ICIs accounted for 44% of the $17.5 billion Medicare Part B cancer drug spending.We focus on metastatic melanoma, the first approved indication for ICIs.While overall cancer mortality rates declined since the 1990s, melanoma mortality rates increased through the early 2010s.Following the first ICI approvals in 2011 and 2014, melanoma mortality declined sharply.Using traditional Medicare claims, we estimate the impact of the introduction of ICIs on healthcare utilization, costs, and 1-year survival for patients with metastatic melanoma, relative to metastatic colorectal cancer (CRC), where ICIs were not approved until 2017.Variation in approval timing allows us to isolate the effect of ICIs from broader cancer care trends.We find that ICIs reduced 1-year mortality by 6.2%.Since about 1 in 5 metastatic melanoma patients received ICIs, this implies a 27.5% reduction among treated patients.The introduction of ICIs also reduced chemotherapy and radiation use, but increased Medicare spending by 59.3% or about 260% among ICI-treated patients.Accounting for life expectancy gains beyond one year, the benefits of ICIs for melanoma patients appear comparable, or potentially even greater, than the substantial added Medicare costs.Nonetheless, ICI use remains relatively low given large survival benefits and few alternative treatments, suggesting that costs and other barriers limit patient access.

  PublisherDOI

• Racial/ethnic disparities in time to initial treatment among patients with newly diagnosed breast cancer in a vertically integrated healthcare system.

  JCO Oncology Practice · 2025-10-01

  article

  202 Background: Previous work shows that Black patients, compared with other racial/ethnic groups, consistently experience delays in initial cancer treatment, regardless of socioeconomic status. This study examines variation in time to initial treatment (TTI) for breast cancer by race/ethnicity. Methods: We conducted a cross-sectional study using data from the KPSC Cancer Registry for patients with newly diagnosed breast cancer from 2010–2018. TTI is reported in median days. P-values are derived from Wilcoxon rank sum tests, comparing each racial/ethnic group to White patients. Results: We identified 21,955 newly diagnosed breast cancer patients from 2010–2018. When comparing TTI of Asian/PI, Black, and Hispanic patients with that of White patients, median difference in TTI ranged from 3-8 days longer for Stage I patients; 0-6 days longer for Stage II patients; 0-5 days longer for Stage III patients; and 1-5 days longer for Stage IV patients (Table 1). Compared to White patients, Black patients had TTI that was up to 7 median days longer for surgery and hormone therapy. For patients treated with chemotherapy, Asian/PI, Black, and Hispanic patients had slightly longer TTI (medians ranged 2-6 days) than White patients. Conclusions: In this vertically integrated system of care, patients with breast cancer from minoritized racial/ethnic groups had a slightly longer TTI than White patients. For example, the delay was up to 7 median days for surgery and hormonal therapy initiation among Black patients. Limitations of this work include lack of adjusting for confounding variables and other tumor characteristics. Additionally, it is unclear if these differences in TTI are clinically meaningful for informing survival. Given that this study was based in an integrated healthcare system, results may not be generalizable to other healthcare settings where delays in treatment may be even longer. Median time to initial treatment (days) for different racial/ethnic groups, based on initial treatment modality. White Asian/PI p Black p Hispanic p Other/Unk p Stage I (n=11,375) 36.0 39.0 0.002 44.0 <0.001 40.0 <0.001 36.0 0.89 Stage II (n=7473) 35.0 36.0 0.23 41.0 <0.001 35.0 0.22 34.5 0.74 Stage III (n=2200) 34.0 34.0 0.43 39.0 <0.001 35.0 0.006 33.0 0.72 Stage IV (n=907) 29.0 31.0 0.96 34.0 0.141 30.0 0.56 30.0 0.75 Chemotherapy (n=9513) 33.5 35.0 0.004 39.0 <0.001 35.0 <0.001 35.0 0.86 Hormone (n=14,226) 35.0 36.0 0.26 42.0 <0.001 37.0 <0.001 36.0 0.38 Radiation (n=9758) 33.0 35.0 0.004 38.0 <0.001 35.0 <0.001 34.0 0.54 Immunotherapy (n=1181) 34.0 37.0 0.14 39.0 0.003 36.0 0.077 33.0 0.61

  PublisherDOI

• The Revenue and Distributional Impacts of Unemployment Insurance Reform: Evidence from California

  National Bureau of Economic Research · 2025-07-01

  reportOpen access1st authorCorresponding

  In the United States, unemployment insurance (UI) is funded through employer-side payroll taxes that are experience-rated based on previous UI claims.States differ significantly with respect to the financing of their programs, and a majority of state programs do not currently meet minimum UI trust fund solvency standards.A common culprit in the least solvent states is a very low tax base of earnings on which UI taxes are levied.We focus on California, the least solvent of the 50 state UI programs, with debt currently to the federal government of $21 billion, and which has the lowest base of taxable earnings at $7000 per year.We use matched employer-employee administrative data to estimate the impact of financing reforms to California's UI system.We find that raising the taxable earnings base would replenish the state's UI trust fund and would increase experience rating by reducing the number of systematically subsidized firms.While this improves vertical equity of the UI system, it would also worsen horizontal equity by imposing much larger percentage increases in tax costs on the firms with the fewest layoffs.Alternatively, matching the higher tax base with both higher maximum and lower minimum rates could improve both experience rating and horizontal equity.

  PublisherDOI

• The Revenue and Distributional Impacts of Unemployment Insurance Reform: Evidence from California

  SSRN Electronic Journal · 2025-01-01

  articleOpen access1st authorCorresponding
  PublisherDOI

• Neighborhood Disadvantage and Risk of Hospitalization in a Home‐Based Cardiac Rehabilitation Program After Acute Myocardial Infarction: A Retrospective Cohort Study

  Journal of the American Heart Association · 2025-12-17

  articleOpen access

  BACKGROUND: Cardiovascular disease outcomes are worse among individuals living in socioeconomically disadvantaged neighborhoods. Whether home-based cardiac rehabilitation can mitigate this risk following acute myocardial infarction is unknown. METHODS: We conducted a retrospective cohort study of 420 adults hospitalized for acute myocardial infarction between April 2018 and April 2019 who subsequently enrolled in an 8-week home-based cardiac rehabilitation program within an integrated health care system. Neighborhood disadvantage was measured using a standardized Neighborhood Deprivation Index assigned at the census tract level and categorized into quartiles (quartile 1, least disadvantaged; quartile 4, most disadvantaged). The primary outcome was all-cause inpatient hospitalization at 30 days, 90 days, and 12 months after home-based cardiac rehabilitation initiation. Logistic regression models estimated odds of hospitalization by Neighborhood Deprivation Index quartile, adjusted for age, sex, comorbidities, and race and ethnicity. RESULTS: The mean age was 62 years; 27.4% were women; and 45.5% were White, 30.5% Hispanic, 12.6% Asian, and 7.6% Black individuals. Overall, 48.1% of patients experienced ≥1 hospitalization within 12 months. Hospitalization rates increased with neighborhood disadvantage (eg, 12 months: 41.6% in quartile 1 versus 52.2% in quartile 4). In fully adjusted models, patients in quartile 4 had significantly higher odds of 30-day (odds ratio, 2.04 [95% CI, 1.08-3.98]) and 12-month hospitalization (odds ratio, 2.03 [95% CI, 1.08-3.81]) compared with quartile 1. Race and ethnicity were not consistently associated with hospitalization, though Black patients had lower odds at 12 months. CONCLUSIONS: Neighborhood socioeconomic disadvantage was associated with significantly higher hospitalization risk among patients in home-based cardiac rehabilitation after acute myocardial infarction. Additional interventions targeting structural inequities are needed to improve outcomes among marginalized populations.

  PublisherDOI

• Evaluation of Socioeconomic and Racial/Ethnic Disparities in All-Cause Mortality in Adolescents and Young Adults With Cancer

  Journal of the National Comprehensive Cancer Network · 2024-09-01 · 5 citations

  article

  BACKGROUND: Adolescent and young adult (AYA) patients with cancer have historically been understudied. Few studies have examined survival disparities associated with racial/ethnic and socioeconomic status (SES) and do not account for the influence of insurance status and access to care. We evaluated the association of SES and race/ethnicity with overall mortality for AYA patients who were members of an integrated health system with relatively equal access to care. METHODS: AYA patients diagnosed with the 15 most common cancer types during 2010 through 2018 at Kaiser Permanente Southern California were included. Neighborhood Deprivation Index (NDI) quartile (Q1: least deprived; Q4: most deprived) was used as a measure of SES. Mortality rate per 1,000 person-years was calculated for each racial/ethnic and NDI subgroup. Multivariable Cox model was used to estimate hazard ratios (HRs) for all-cause mortality adjusting for sex, age and stage at diagnosis, cancer type, race/ethnicity, and NDI. RESULTS: Data for 6,379 patients were tracked for a maximum of 10 years. Crude mortality rates were higher among non-White racial/ethnic patients compared with non-Hispanic (NH)-White patients. In the Cox model, Hispanic (HR, 1.31; P=.004) and NH-Black (HR, 1.34; P=.05) patients experienced significantly higher all-cause mortality risk compared with NH-White patients. Patients from more deprived neighborhoods had higher mortality risk. In the Cox model, there was no significant difference in all-cause mortality between Q1 and Q2 through Q4 (Q2: HR, 0.88; P=.26, Q3: HR, 0.94; P=.56, and Q4: HR, 0.95; P=.70). CONCLUSIONS: For AYAs with cancer with similar access to care, Hispanic and NH-Black patients have higher risk of all-cause mortality than NH-White patients, whereas no significant SES-associated survival disparities were observed. These findings warrant further investigation, awareness, and intervention to address inequities in cancer care among vulnerable populations.

  PublisherDOI

• EPR24-119: Development of Heart Failure Following Anthracycline Exposure in Survivors of Adolescent and Young Adult Cancer in an Integrated Healthcare System

  Journal of the National Comprehensive Cancer Network · 2024-04-05

  article
  PublisherDOI

• Experience Rating as an Automatic Stabilizer

  Tax Policy and the Economy · 2023-07-01 · 2 citations

  article1st authorCorresponding

  Unemployment-insurance taxes are experience rated, penalizing firms that dismiss workers. We examine whether experience rating serves as an automatic stabilizer in the labor market. Taking advantage of the variation in layoff penalties across states, we utilize detailed data on state tax schedules and assess whether firms are less responsive to labor-demand shocks when facing higher layoff penalties. Our findings show that average layoff penalties from UI reduce firm adjustments to negative shocks by 11%. This indicates that experience rating contributes to labor market stabilization. For example, during the Great Recession, experience rating preserved nearly a million jobs.

  PublisherDOI

• Why Does the Inflation Reduction Act Exclude Expensive Cancer Treatments in Price Negotiations?

  JCO Oncology Practice · 2023-12-07 · 3 citations

  articleSenior author

  PURPOSE: The Inflation Reduction Act (IRA) includes provisions for price negotiations of certain high-spending drugs in Medicare Parts B and D. This provision received considerable attention from those interested in the costs of cancer care since Medicare covers most patients with cancer and many cancer drugs are expensive. We simulate how many cancer drugs may be eligible for IRA price negotiations and examine the reasons that many are likely to be excluded from negotiation. METHODS: This study uses 2021 Medicare Fee-for-Service Part B and Part D prescription drugs expenditure data. Cancer drugs were identified using the SEER Program list of cancer medications. Our measures included total spending, beneficiary users, and spending-per-beneficiary for all cancer drugs covered under Medicare. Each drug was evaluated for eligibility on the basis of IRA negotiation provisions, including estimated loss of patent exclusivity, current competitors, and orphan drug designation. RESULTS: We found that very few cancer drugs will meet the IRA eligibility thresholds to be included in negotiations. We estimate that only 2.2% of beneficiaries with cancer will see lower costs because of the IRA negotiations. The main reason for this is that although novel cancer drug treatments are priced high, they generally treat relatively few beneficiaries and thus do not meet negotiation eligibility criteria, which are primarily based on a ranking of total spending. CONCLUSION: The IRA negotiation provisions will have limited impact on cancer drug prices and will likely leave most patients with cancer exposed to high drug costs.

  PublisherDOI

Frequent coauthors

• William A Woolston

  68 shared

• Ilyana Kuziemko

  National Bureau of Economic Research

  68 shared

• J. David Brown

  67 shared

• David Autor

  47 shared

• William N. Evans

  University of Notre Dame

  41 shared

• Perry Singleton

  33 shared

• Jae Song

  United States Social Security Administration

  29 shared

• Craig Garthwaite

  Kellogg's (Canada)

  24 shared

Education

• B.S., Electrical Engineering

  M.I.T.

  1992

• M.S., Electrical Engineering

  M.I.T.

  1994

• Ph.D., Economics

  Harvard University

  1999

Awards & honors

• 2010 ASHEcon Medal