About

Guy David is the Alan B. Miller Professor of Health Care Management and a Professor of Medical Ethics and Health Policy at the Perelman School of Medicine. He serves as the Chair of the Health Care Management Department. His research interests encompass applied microeconomics, health economics, industrial organization, and regulation within the healthcare sector, with particular focus on emergency medical services, post-acute care, primary care, nonprofit organizations, and the impact of regulation and competition on healthcare delivery. He has held academic positions at Wharton since 2004 and is a Senior Fellow at the Leonard Davis Institute of Health Economics, as well as a Research Associate at the National Bureau of Economic Research's Health Care Program. His work involves analyzing the economic features of healthcare markets, evaluating policy instruments such as antitrust laws and regulation, and understanding the behavior of healthcare providers and payors. Dr. David's contributions include examining the effects of hospital mergers, pharmaceutical advertising, and the impact of policy changes on healthcare utilization and quality.

Research topics

• Medicine
• Political Science
• Internal medicine
• Computer Science
• Environmental health
• Obstetrics
• Medical emergency
• Pathology
• Emergency medicine
• Data science
• Family medicine
• Social psychology
• Psychology
• Nursing

Selected publications

• Inpatient to Outpatient Shifts in Surgical Care: Persistence of COVID-19 Era Changes and Socioeconomic Variations

  Medical Care Research and Review · 2025-12-06 · 1 citations

  articleOpen access

  The COVID-19 pandemic disrupted surgical care delivery, yet the extent to which shifts from inpatient to outpatient settings have persisted remains unclear. Using medical claims data from Independence Blue Cross (2018-2022), we examined changes in surgery settings across 102 procedures before the pandemic and during the 2 years following the suspension of elective surgeries. After 2 years, inpatient volumes decreased for 9 of the 20 most common pre-pandemic inpatient procedures, with corresponding increases in outpatient utilization. Hip and knee replacements experienced the most pronounced shifts, with inpatient shares falling by more than 40 percentage points. Patients from lower-income census tracts saw greater declines in overall procedure volumes (-6.0%) compared to those from higher-income areas (+5.2%). Total allowed amounts decreased for procedures with outpatient migration, while out-of-pocket costs remained stable. These findings suggest durable, post-pandemic shifts in surgical care delivery patterns, with potential implications for access, costs, and equity.

  PublisherDOI

• No-Transcatheter Aortic Valve Replacement (TAVR) Zones and Their Effect on Access to Care for Medicare Beneficiaries with Aortic Stenosis

  Advances in Therapy · 2025-02-13 · 4 citations

  articleOpen access1st author

  INTRODUCTION: This study investigates the impact of geographic and socioeconomic barriers on access to transcatheter aortic valve replacement (TAVR). METHODS: Utilizing Medicare data from the US Centers for Medicare and Medicaid Services, this study analyzed TAVR and surgical aortic valve replacement (SAVR) procedures among beneficiaries from 2017 to 2022. Geographic units were defined by 5-digit zip codes, categorized on the basis of TAVR/SAVR volume into four categories: (1) no TAVR or SAVR, (2) no-TAVR zone (SAVR present, no TAVR), (3) low-TAVR zone (TAVR/SAVR ratio ≤ 0.5), and (4) TAVR accessible (TAVR/SAVR ratio > 0.5). The differential distance index (DDI) was developed to measure travel hurdles, calculated as the difference in miles from a patient's zip code center to the treatment hospital (TAVR versus SAVR, CABG (coronary artery bypass grafting), and PCI (percutaneous coronary intervention) comparators). This study maintained a continuous access variable to model outcomes such as the ratio or volume of TAVR/SAVR and the percentage share of TAVR/AVR within each zip code over biennial periods (2017-2018, 2019-2020, 2021-2022). Covariates in the model included population density, area deprivation index (ADI), and calendar time, with an exploration of the interaction between DDI and ADI. RESULTS: The analysis revealed significant geographic disparities in TAVR access across the USA, with no-TAVR zone and low-TAVR zone areas often featuring lower population densities, higher ADIs, and more rural settings. Increased travel distance (DDI) significantly correlated with lower TAVR utilization, emphasizing distance as a critical barrier. Furthermore, both ADI and DDI emerged as significant predictors of TAVR volume and share, underlining the compound effect of socioeconomic status and geographic distance on healthcare access. CONCLUSIONS: This study highlights the critical role of geographic and socioeconomic barriers in accessing advanced medical treatments like TAVR. Addressing these barriers may ensure equitable healthcare distribution, guiding policymakers and providers towards more accessible healthcare solutions for all populations.

  PublisherOA PDFDOI

• Inequities in Access to Tricuspid Valve Treatments

  JACC Advances · 2024-10-18 · 3 citations

  articleOpen accessSenior author

  Background: Opportunities to minimize inequities in accessing treatments for tricuspid regurgitation disease should be considered. Objective: The objective of this study was to explore how access to new tricuspid regurgitation technologies change when heart centers are restricted by payer coverage requirements. Methods: This case series study identified U.S. hospitals with a record of performing transcatheter aortic valve replacement, transcatheter edge-to-edge repair, and tricuspid and mitral valve procedures for the calendar year 2021. Population 65+ years of age and Area Deprivation Index (ADI), were identified by zip code. We created 10 scenarios based on low, medium, and high hospital volumes for combinations of transcatheter aortic valve replacement, transcatheter edge-to-edge repair, tricuspid and mitral valve procedures. Distance from a zip code to scenario eligible hospitals was determined; the closest hospital to a zip code was identified as the distance someone with tricuspid regurgitation would have to travel for care. Each scenario was modeled with the dependent variable as the distance to the nearest scenario eligible hospital by ADI, controlling for population size 65+ years of age. Results: A total of 929 U.S. hospitals met our study inclusion. ADI was statistically significant in every scenario-when ADI goes up (more deprivation), distance to the nearest hospital increases. Patients in zip codes with low ADI travel an average of 15 to 52 miles, medium ADI 31 to 67 miles, and high ADI 47 to 95 miles. Conclusions: Patients in higher socioeconomic deprivation areas travel longer distances to hospitals meeting procedure volume requirements. Policymakers and patient advocacy groups should consider this to ensure equitable access to potentially life-saving technologies.

  PublisherDOI

• Limited Access to Aortic Valve Procedures in Socioeconomically Disadvantaged Areas

  Journal of the American Heart Association · 2024-01-13 · 10 citations

  articleOpen access1st authorCorresponding

  Background To explore how differences in local socioeconomic deprivation impact access to aortic valve procedures and the treatment of aortic valve disease, in comparison to other open and minimally invasive surgical procedures. Methods and Results Procedure volume data were obtained from the Healthcare Cost and Utilization Project from 18 states from 2016 to 2019 and merged with area deprivation index data, an index of zip code‐level socioeconomic distress. We estimate the relationship between local deprivation ranking and differences in volumes of aortic valve replacement, which include transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), versus coronary artery bypass graft surgery and laparoscopic colectomy (LC). All regressions control for state and year fixed effects and an array of zip code‐level characteristics. TAVR procedures have increased over time across all zip codes. The rate of increase is negatively correlated with deprivation ranking, regardless of the higher share of hospitalizations per population in high deprivation areas. Distributional analysis further supports these findings, showing that lower area deprivation index areas account for a disproportionately large share of SAVR, TAVR, and LC procedures in our sample relative to their share of all hospitalizations in our sample. By comparison, the cumulative distribution of coronary artery bypass graft procedures was nearly identical to that of total hospitalizations, suggesting that this procedure is equitably distributed. Regressions show high area deprivation index areas have lower prevalence of SAVR ( β =−15.1%, [95% CI, −26.8 to −3.5]), TAVR ( β =−9.1%, [95% CI, −18.0 to −0.2]), and LC ( β =−19.9%, [95% CI, −35.4 to −4.4]), with no statistical difference in the prevalence of coronary artery bypass graft ( β =−2.5%, [95% CI, −12.7 to 7.6]), a widespread and commonly performed procedure. In the population aged ≥80 years, results show high area deprivation index areas have a lower prevalence of TAVR ( β =−11.9%, [95% CI, −18.7 to −5.2]) but not SAVR ( β =−0.8%, [95% CI, 8.1 to 6.3]), LC ( β =−3.5%, [95% CI, −13.4 to −6.4]), or coronary artery bypass graft ( β =5.2%, [95% CI, −1.1 to 1.1]). Conclusions People living in high deprivation areas have less access to life‐saving technologies, such as SAVR, and even moreso to device‐intensive minimally invasive procedures such as TAVR and LC.

  PublisherOA PDFDOI

• Measuring hospital inpatient Procedure Access Inequality in the United States

  Health Affairs Scholar · 2024-10-29 · 2 citations

  articleOpen access

  Geographic disparities in access to inpatient procedures are a significant issue within the US healthcare system. This study introduces the Procedure Access Inequality (PAI) index, a standardized metric to quantify these disparities while adjusting for disease prevalence. Using data from the Healthcare Cost and Utilization Project State Inpatient Databases, we analyzed inpatient procedure data from 18 states between 2016 and 2019. The PAI index reveals notable variability in access inequality across different procedures, with minimally invasive and newer procedures exhibiting higher inequality. Key findings indicate that procedures such as skin grafts and minimally invasive gastrectomy have the highest PAI scores, while cesarean sections and percutaneous coronary interventions have the lowest. The study highlights that higher inequality is associated with greater market concentration and in particular, fewer hospitals offering these procedures. These findings emphasize the need for targeted policy interventions to address procedural access disparities to promote more equitable healthcare delivery across the United States.

  PublisherDOI

• Revenues, costs, and contribution margins of major inpatient cardiovascular procedures within the Medicare population

  American Heart Journal · 2024-12-03 · 3 citations

  articleOpen access
  PublisherOA PDFDOI

• The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health

  Journal of the American Medical Directors Association · 2023-08-24 · 4 citations

  articleOpen access
  PublisherOA PDFDOI

• Hospital ownership and admission rates from the emergency department, evidence from Florida

  Health Services Research · 2023-10-24 · 5 citations

  articleOpen accessSenior author

  OBJECTIVE: In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department. DATA SOURCES: We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019. STUDY DESIGN: We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for-profit hospital as an instrument. DATA COLLECTION/EXTRACTION METHODS: Our main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults. PRINCIPAL FINDINGS: Adjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1-9.1) higher at for-profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009. CONCLUSION: Our results are consistent with allegations that for-profit hospitals maintain lower admission thresholds to increase occupancy levels.

  PublisherOA PDFDOI

• Authors’ Response

  The Journal of the American Dental Association · 2023-06-29 · 1 citations

  letterSenior author
  PublisherDOI

• The Effect of Performance Pay Incentives on Market Frictions: Evidence from Medicare

  SSRN Electronic Journal · 2023-01-01

  articleOpen access
  PublisherDOI

Frequent coauthors

• Candace Gunnarsson

  25 shared

• Sara Markowitz

  24 shared

• Brendan G. Carr

  Icahn School of Medicine at Mount Sinai

  23 shared

• Michael E. Abboud

  University of Pennsylvania

  22 shared

• Michael T. Mullen

  Temple University

  21 shared

• Roger A. Band

  Thomas Jefferson University

  21 shared

• William Pajerowski

  21 shared

• Judy Jia

  Stroke Association

  21 shared

Labs

• Health Care ManagementPI

Education

• PhD, School of Business

  University of Chicago

  2004

Awards & honors

• National Bureau of Economic Research Dissertation Fellowship…
• University of Pennsylvania Research Foundation Award 2006 an…
• Leonard Davis Institute of Health Economics Pilot Project Pr…
• Center for Health Management Research Grant Award, 2008
• National Institute of Health Grant Award 2008