About

Joseph P. Newhouse is the John D. MacArthur Research Professor of Health Policy and Management at Harvard University. He is a member of the faculties of the Harvard Kennedy School, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Faculty of Arts and Sciences, as well as a Research Associate of the National Bureau of Economic Research. Dr. Newhouse holds B.A. and Ph.D. degrees in Economics from Harvard University and has received an honorary doctoral degree from the Pardee RAND Graduate School. His early academic pursuits included being a Fulbright Scholar in Germany. He spent the first twenty years of his career at RAND, where he designed and directed the RAND Health Insurance Experiment and served as Head of the RAND Economics Department. He was also the founding editor of the Journal of Health Economics, which he edited for 30 years. His research and contributions focus on health policy, health economics, and health services research, with numerous leadership roles in professional organizations and advisory committees, including election to the National Academy of Medicine and the American Academy of Arts and Sciences.

Research topics

• Medicine
• Family medicine
• Computer Science
• Computer Security
• Actuarial science
• Finance
• Marketing
• Nursing
• Internal medicine
• Business
• Environmental health

Selected publications

• Post-Discharge Anti-Seizure Medication Use Improves Post-Stroke Survival: <i>An Emulated Target Trial in Older Adults</i>

  medRxiv · 2026-04-20

  articleOpen access

  Objective: Levetiracetam is commonly prescribed for seizure prophylaxis after acute ischemic stroke (AIS) and often continued beyond discharge. While its short-term effectiveness for preventing post-stroke seizures is established, it is unclear whether prolonged use improves survival, particularly in older adults. We estimated the effect of continued levetiracetam use on 90-day mortality among Medicare beneficiaries after AIS. Methods: Using Traditional Medicare claims data (2008-2021), we identified beneficiaries aged ≥66 years hospitalized for AIS who initiated outpatient levetiracetam within 90 days of discharge. After one month of continued post-stroke use of levetiracetam (start of follow-up), we compared 90-day mortality between patients with a new levetiracetam dispensation within a 14-day grace period post-follow up and those without one. We performed cloning, censoring and weighting to address immortal time bias and estimated standardized mortality risks, risk differences, and 95% confidence intervals (CI). Results: Among 3,212 eligible beneficiaries, 1,779 (55.4%) received a new levetiracetam dispensation within the 14-day grace period. Median age was 76 years (IQR 70-83); 57.8% were female. After adjustment for demographics, hospitalization characteristics, timing of initiation, and comorbidities, continued use was associated with lower 90-day mortality than discontinuation (53 vs 62 deaths per 1,000; risk difference -9 per 1,000; 95% CI: (-12,-5)). The reduction was observed primarily among patients aged ≥75 years. Significance: Among older Medicare beneficiaries who initiated levetiracetam after AIS, continued outpatient use was associated with modestly lower 90-day mortality, particularly in those aged ≥75 years. These findings suggest potential benefits of levetiracetam continuation beyond the immediate post-stroke period.

  PublisherDOI

• Benzodiazepine Initiation and the Risk of Falls or Fall-Related Injuries in Older Adults Following Acute Ischemic Stroke

  Neurology Clinical Practice · 2025-03-20 · 2 citations

  article

  Background and Objectives: Benzodiazepine (BZD) use in older adults after acute ischemic stroke (AIS) is common. We aimed to assess the risk of falls or fall-related injuries (FRIs) in older adults after the use of BZDs during the acute poststroke recovery period. Methods: We emulated a hypothetical randomized trial of BZD use during the acute poststroke recovery period using linked data from the Get With the Guidelines Stroke Registry and Mass General Brigham's electronic health records. Our cohort included patients aged 65 years and older with an AIS admission between 2014 and 2021, no documented previous stroke, and no BZD prescriptions in the 3 months before admission. The potential for immortal time and confounding bias was addressed separately using inverse probability weighting. Results: 4) AIS and 32 events per 1,000 (95% CI 10-58) for those with moderate-to-severe AIS. Discussion: Initiating BZDs within 3 days of an AIS is associated with an elevated ten-day risk of falls or FRIs, particularly for patients aged 65-74 years and for those with mild stroke. This underscores the need for caution when initiating BZDs, especially among individuals likely to be ambulatory during the acute and subacute poststroke period.

  PublisherDOI

• Patterns of Anti-Seizure Medication Non-adherence in Post-Stroke Prophylaxis Among Older Adults

  2025-04-29

  preprintOpen access

  Purpose: Anti-seizure medications (ASMs) are commonly prescribed for post-stroke seizures. Yet long-term use and non-adherence lack clear clinical guidance. We examined patterns of medication non-adherence among older adults who initiated Levetiracetam–the most frequently prescribed ASM–within 30 days after an acute ischemic stroke (AIS) discharge. Methods : We analyzed a national 20% random sample of U.S. Medicare beneficiaries aged 65 and over, who were hospitalized for a first AIS between 2009-2021 and initiated Levetiracetam within 30 days of discharge. We used an adjusted proportion of days covered (PDC) measure, accounting for prescription overlap, hospital readmissions, and non-persistency, to analyze medication non-adherence patterns during the first year after initiation. Latent class mixed models on PDC trajectories were applied to characterize patterns of non-adherence and factors associated with non-adherence. Results : In our sample of 1,697 Levetiracetam initiators, the mean age was 77.4 years, with 58% female. The latent class mixed model on PDC trajectories identified three distinct non-adherence pattern groups: (i) 907 patients (53%) were non-adherent after two months, (ii) 99 patients (6%) were non-adherent after ten months, and (iii) 692 patients (41%) remained adherent. Non-white patients and males were more likely to be non-adherent to the medication. Conclusions: The adjusted PDC method and latent class model incorporate hospital readmission and adjust for relevant covariates. Approximately 60% older adults were non-adherent to Levetiracetam within a year after outpatient initiation, with race and gender significantly associated with non-adherence patterns. This study offers both methodological innovation and clinical meaningful insights into ASM non-adherence following AIS.

  PublisherOA PDFDOI

• Pain Treatment Strategy and Readmission Rates for Medicare Beneficiaries Post-Acute Ischemic Stroke

  medRxiv · 2025-09-27 · 1 citations

  preprintOpen access

  Purpose: Stroke is highly prevalent and commonly presents with pain. Primary care providers generally manage follow-up care, although ideal pain management strategies remain unclear. Treatment options include gabapentinoids, tricyclic antidepressants, and various antiseizure medications. We aim to analyze differences in hospital readmissions, a quality metric, for those initiating gabapentin in contrast to other medicines for post-stroke pain in older adults. Methods: In this matched cohort study, we analyzed a 20% sample of U.S. Medicare beneficiaries aged 65 and over hospitalized for acute ischemic stroke (AIS) between December 31, 2016, and December 31, 2021, who were discharged home. Individuals met insurance coverage criteria and did not take pain medications before hospitalization. We matched individuals on days from discharge to medication initiation. Individuals who initiated Gabapentin within 90 days of discharge (N = 1,546) were matched to individuals who initiated first-line pharmacological treatments for nerve pain other than Gabapentin within 90 days of discharge (N = 285). We investigated the time to re-admissions using a semi-competing risk framework. Results: The matched cohort of 1,831 initiators had a median age of 76 (IQR 11) and was 57.2% female and 81.3% Non-Hispanic White. Using the semi-competing risk framework, the hazard of readmissions, given that death had not occurred, was not different for Gabapentin initiators, compared to if they had initiated other medications, hazard ratio 0.871 (95% CI: 0.517, 1.466). Conclusion: We found no significant difference in hospital readmission rates between gabapentin and other post-stroke pain treatment strategies. Our findings contribute to the pharmacosurveillance of gabapentin in real-world Medicare beneficiaries.

  PublisherOA PDFDOI

• Gabapentinoid Use among Medicare Beneficiaries during the Post-Stroke Recovery Period

  medRxiv · 2025-08-11

  preprintOpen access

  Background: Most studies of gabapentinoid prescribing trends have focused on younger, commercially insured populations. Patterns among vulnerable groups, including older stroke survivors, remain poorly characterized. We described patterns of gabapentinoid initiation among Medicare beneficiaries following acute ischemic stroke (AIS). Methods: We analyzed claims data from a 20% sample of U.S. Medicare beneficiaries aged ≥ 65 years hospitalized for AIS between 2009 and 2022. We included individuals enrolled in traditional Medicare for ≥ 12 months before hospitalization, without prior stroke during this interval, and discharged home or to an inpatient destination for ≤30 days. After excluding those with gabapentinoid use before stroke, we analyzed outpatient gabapentin prescriptions six months after stroke discharge by demographic and clinical characteristics. We calculated the percentage of gabapentinoid initiators by year and U.S. census division, standardized by age, discharge destination, and modified Rankin Score (mRS). Results: Among 153,728 Medicare stroke survivors who had not previously been prescribed a gabapentinoid in the 6 months before hospitalization, 4.9% received new prescriptions within 6 months after discharge. The median age was 78 years (Quartile Range: 72 - 84), 55% were female, and 81% were Non-Hispanic White. The crude percentage of gabapentinoid initiators increased from 3.6% in 2009 to 5.8% in 2022. The standardized percentages were 3.8% in 2009 and 5.9% in 2022. We reported a 2.1 percentage point difference in gabapentinoid initiation between U.S. census divisions, with the lowest percentage in the New England Division (3.9%) and the highest in the West South Central Division (6.0%). After standardization, the percentage point difference was 1.9% between the highest and lowest U.S. division. Conclusion: The percentage of U.S. Medicare stroke survivors initiating gabapentinoid increased from 2009 to 2022. We also identified geographic variation, with the highest initiation percentage in the West South Central and the lowest in the New England U.S. Division.

  PublisherOA PDFDOI

• Abstract WP217: Risks and Benefits of Lecanemab and Anticoagulants: Results from a Simulation Model

  Stroke · 2025-01-30

  article

  Background: In CLARITY-AD, lecanemab slowed cognitive decline but increased intracranial hemorrhages (ICHs), particularly with concurrent anticoagulant use. The Alzheimer’s Association’s expert guidance is to avoid co-prescribing; however, CMS and FDA do not restrict or warn against it. We used a microsimulation model to quantify the potential benefits and harms of co-prescribing lecanemab and apixaban in people with atrial fibrillation (AF) experiencing mild cognitive impairment or early Alzheimer’s. Methods: We developed a microsimulation model to estimate the health and cognition-related quality of life among persons 65-90 years with AF and cognitive impairment. We compared 4 strategies over 18 months in a cohort of 100,000 people: apixaban alone, lecanemab and apixaban, lecanemab alone, and neither. The model was populated with the Health and Retirement Study-AF cohort. Monthly model outcomes included ICH, ischemic stroke, cognitive impairment, quality-adjusted life months (QALMs), and survival. Increased ICH risk was a key input: a trial-reported 2.02-fold increase for lecanemab alone, a 1.84-fold increase for apixaban alone (anticoagulant literature), and a trial-reported 9.92-fold increase for lecanemab and anticoagulants together. We assigned quality-of-life estimates and mortality rates for people with cognitive impairment, stroke, and ICH. Background mortality rates increased with cognitive decline and following a stroke or ICH event. Results: For ages 65-74, apixaban alone and lecanemab added to apixaban produced a similar net benefit (13.2 QALM each, Table ). Over 100,000 simulated persons aged 65-74 years, adding lecanemab to apixaban would result in greater ICH events (2000 vs. 400) and all-cause deaths (5860 vs. 5180) and slower cognitive decline (mean change in CDR-SB 1.11 vs. 1.53). One-way sensitivity analyses show that the net benefit for people aged 65-74 years is sensitive to the determinants of ICH—lecanemab/anticoagulant interaction, lecanemab effect on ICH, apixaban effect on ICH, baseline ICH risk—and lecanemab effect on CDR-SB ( Figure ). Apixaban alone was preferred for people 75 years and older. Conclusion: The model-based results suggest equipoise between apixaban alone and lecanemab with apixaban for people with cognitive impairment and AF aged 65-74 years. Improving lecanemab efficacy or reducing its effect on ICH could produce a net benefit for this age group. For people 75 and older, apixaban alone would be preferred.

  PublisherDOI

• A Claims-based Machine Learning Model to Classify Modified Rankin Scale at Stroke Discharge (P6-14.012)

  Neurology · 2025-04-07 · 2 citations

  article

  We validated a Medicare claims-based classifier to assess stroke severity, as measured by the Modified Rankin Scale (mRS) at discharge, among Medicare beneficiaries hospitalized for acute ischemic stroke (AIS).

  PublisherDOI

• Claims‐Based Machine Learning Classifier of Modified Rankin Scale in Acute Ischemic Stroke

  Journal of the American Heart Association · 2025-10-14 · 3 citations

  articleOpen access

  BACKGROUND: We developed a classifier to infer acute ischemic stroke severity from Medicare claims using the modified Rankin Scale at discharge. The classifier can be used to improve stroke outcomes research and support the development of national surveillance tools. METHODS: This multistate study included all participating centers in the Paul Coverdell National Acute Stroke Program database from 9 US states. This database was linked to Medicare data sets for patients hospitalized with acute ischemic stroke, employing demographics, admission details, and diagnosis codes to create unique patient matches. We included Medicare beneficiaries aged 65 and older who were hospitalized for an initial acute ischemic stroke from January 2018 to December 2020. Using Lasso-penalized logistic regression, we developed and validated a binary classifier for modified Rankin Scale outcomes and as a secondary analysis we used ordinal regression to model the full modified Rankin Scale. Performance was evaluated on held-out test data using area under the receiver operator characteristic curve, receiver operator characteristic precision-recall, sensitivity, and specificity. RESULTS: We analyzed data from 68 636 eligible patients. The mean age was 79.5 years old. Seventy-seven and a half percent of beneficiaries were White, 14% were Black, 2.6% were Asian, and 2% were Hispanic. The classifier achieved an area under the receiver operator characteristic curve score of 0.86 (95% CI, 0.85-0.86), sensitivity of 0.81 (95% CI, 0.80-0.81), specificity of 0.73 (95% CI, 0.72-0.74), and precision-recall area under the curve of 0.90 (95% CI, 0.90-0.91) on the test set. CONCLUSIONS: Among Medicare beneficiaries hospitalized for acute ischemic stroke, the claims-based classifier demonstrated excellent performance in area under the receiver operator characteristic curve, precision-recall area under the curve, sensitivity, and acceptable specificity for modified Rankin Scale classification.

  PublisherDOI

• Postpandemic Cardiac Mortality Rates

  JAMA Network Open · 2025-05-30 · 3 citations

  articleOpen access

  This cohort study describes the monthly and annual population-based cardiac mortality rates during and after the COVID-19 pandemic.

  PublisherOA PDFDOI

• Choice of Epilepsy Anti-Seizure Medications and Associated Outcomes in Medicare Beneficiaries

  medRxiv · 2025-03-20

  preprintOpen access

  Background: The lack of specific guidelines for seizure treatment after acute ischemic stroke (AIS), makes the choice of an appropriate anti-seizure medication choice a challenge for providers because each drug may have different adverse effects and outcomes. Methods: In this retrospective matched cohort study, we analyzed a 20% sample of U.S. Medicare beneficiaries aged 65 and over hospitalized for a first acute ischemic stroke (AIS) between 2009-2021 who were discharged home. We included individuals who were enrolled in Medicare hospital, medical and prescription drug insurance for 12 months prior to hospitalization and were not taking epilepsy-specific anti-seizure medication (ESM) prior to hospitalization. We matched individuals on days from discharge to ESM initiation. Individuals who initiated ESMs other than Levetiracetam, i.e. Lamotrigine, Carbamazepine, Oxcarbazepine within 30 days of discharge (N = 229) were matched to Levetiracetam initiators (N =687). We investigated the time to seizure-like events, emergency department (ED) visits, and re-hospitalizations with a follow-up of 180 days after initiation using a semi-competing risk framework. We estimated the average treatment effect among the treated i.e. those who received other ESMs. Results: The matched cohort of 916 ESM initiators had a median age of 74 (IQR 69, 82) and was 57% female and 71% Non-Hispanic White. Using the semi-competing risk framework, those who received other ESM had a 37% lower hazard of seizure-like events compared to receiving LEV, given that death had not occurred, hazard ratio 0.63 (95% CI: 0.43, 0.91). Among those who initiated ESMs other than Levetiracetam, the hazard of ED visits and hospitalizations, given that death had not occurred, did not different significantly from initiating Levetiracetam; hazard ratios 1.00 (95% CI: 0.80, 1.25) and 0.98 (95% CI: 0.75, 1.28), respectively. Conclusion: In a sample of Medicare beneficiaries hospitalized for acute ischemic stroke and discharged home, initiating Levetiracetam in the outpatient setting was associated with a higher risk of seizure-like events compared to other ESMs. However, no significant differences were observed in the incidence of ED visits or hospitalizations, suggesting comparable safety profiles in these broader clinical outcomes.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01HS006414

  NIH · $226k · 1991

• Medicare at a Crossroads

  NIH · $60.5M · 2009–2030

• NIH Grant P01HS010803

  NIH · $7.9M · 2006

• Health Policy Training Program: Promoting Outcomes, Quality, and Diffusion of Advances

  NIH · $7.7M · 1993–2029

Frequent coauthors

• John Hsu

  Massachusetts General Hospital

  235 shared

• Vicki Fung

  Harvard University

  104 shared

• Sharon‐Lise T. Normand

  Harvard University

  85 shared

• Mary Price

  Massachusetts General Hospital

  77 shared

• Robert H. Brook

  60 shared

• Alan M. Zaslavsky

  Harvard University

  60 shared

• Lidia M.V.R. Moura

  Harvard University

  58 shared

• Harry P. Selker

  52 shared

Education

• Ph.D., Economics

  Harvard University

  1969

• B.A., Economics

  Harvard College

  1963

Awards & honors

• David N. Kershaw Award and Prize of the Association for Publ…
• Baxter Health Services Research Prize (1988)
• AHSR’s Distinguished Investigator Award (1992)
• Swiss’ Hans Sigrist Foundation Prize (1995)
• American Risk and Insurance Association’s Elizur Wright Awar…