William Pierskalla Interview

        William Pierskalla:    Yes?

        Male Voice:   Say your name and your title and spell your

name for us.

        William Pierskalla:    My name is William Pierskalla.   Last

name is spelled P-I-E-R-S-K-A-L-L-A.       My title is retired, but I

am a distinguished professor from the UCLA Anderson Graduate

School of Management and from the Wharton School, University of

Pennsylvania.

        Jennifer Muldoon:     So Doctor Pierskalla, why did you choose

to work in the field of health services research?

        William Pierskalla:    Well, to some extent it was an

accident.     I had a good friend whom I'd worked for, but then we

parted ways and he started a large consulting company and had a

problem in healthcare delivery and had a problem he and his

people couldn't solve, and he asked me to solve it.        So I came

in as a consultant and after studying the problem and thinking

about it a bit, we solved it in about two or three months and we

were done.     And that was interesting and I enjoyed it.

        Then I had another set of problems I was working on in

logistics and inventory management for businesses and one of the

things, we had were perishable inventories that if we didn't do

something with them, they were useless after a certain period of

time.     And then the people in the blood banking world wanted to
talk to me about how could we use these ideas on the blood

banking and getting the appropriate blood and, later, organs to

people at the right time and the right place.     So that's how I

got into it.

     Jennifer Muldoon:     In your opinion, what are some of the

most significant contributions of health services research?

     William Pierskalla:     Well, I think some really major

contributions were the development of the DRGS - Diagnosis

Related Groups - which made a fundamental change in how we pay

for healthcare in the United States from a cost-based payment

system to a perspective payment system, and that made a major

change in how care is delivered.

     Another one that we have that I think has been a

significant one is the development of managed care.     Now it's

not a new idea, but the way we were able to develop it over the

past thirty years has been new and that has made a significant

change in how we deliver healthcare.     And there are actually

quite a few more, especially ones on quality and getting

indicators for quality and starting to judge what we're paying

for and whether we really are improving the health of people.

So that among many.   Those are probably three of the big ones.

     Jennifer Muldoon:     What are the biggest opportunities for

the field?
     William Pierskalla:     Well, I think, I would say we really

need to - I was looking at the wrong one, sorry - we need to

find ways - and I think this is the big issue facing the field

because of the high growth in cost and that's not going to

decelerate in the near future      and we're going to have to make

hard decisions about allocating our resources.     Because of that,

we're going to have to think hard about how we can rationally

ration healthcare.

     We've tried it with managed care and it didn't succeed very

well because our system fought it hard - our legal system, our

people and so on.    But, at some point, all countries in the

world who have lower costs and are more effective at controlling

it, have a form of rationing of care.     We also have to quit

delivering care that's unneeded, and that, of course, will help

in the whole problem.    So those are two big issues facing us.

     Jennifer Muldoon:     Any advice for someone considering a

career in health services research?

     William Pierskalla:     I think the main advice I give to all

students considering a career is to develop a strong knowledge

of methodologies.    You need a very strong basis of how to look

at data, how to manage data, how to understand the processes

involved in delivery of whatever you're studying.     So that you

need - with those basis and methodology, and that would include

statistics and some mathematics and economics and various types
of that, and then you could broaden out and understand some

epidemiology and some behavioral sciences and probably sort of

the things that would give you a deeper appreciation of the way

people make decisions and how they make decisions and why they

make decisions and how they're affected by changes in their

system.     So I would start with the methodology.

     Jennifer Muldoon:     Now thinking back to the early days of

AHSR, why did you get involved in forming a new organization for

health services researchers?

     William Pierskalla:     [Laughter] Well, the main reason was I

was the executive director of the Leonard Davis Institute, which

is a major - was and still is      a major health services research

enterprise at the University of Pennsylvania, and we were facing

severe reductions in some grants that we already had, but

because the national center of health services research, which

is now ARC, was losing a lot of money from the government

funding.    They were being cut severely and then they had to cut

grantees.     So we said - Cliff Gaus and a bunch of us - said we

really have to join together to try to fight these cuts because

if we don't do that, not only will our centers be hurt - we all

had some centers - the whole field will be hurt and we were

trying to put some cohesion to it.     So that was the main reason

that I got involved in the beginning of the association - at

that time association.
     We also really needed a forum for people to speak and talk.

We knew that.     We would get together.   All the centers would get

together.     We'd bring our research together and talk, but we

needed a broader forum where people outside of that little

network could form a big network.     And so we had some good

reasons for doing it.

     Jennifer Muldoon:     What were the founders' original goals?

     William Pierskalla:     I think the original goal - well, they

were multi.     One original goal was we had to influence the way

decisions were being made in Congress and in agencies of the

government to improve the delivery of healthcare, and we had to

do that through health services research.      So that was one of

the reasons.     That was sort of the outreach to the political

sector.

     The other main reason was we needed a forum, as I said

before, to get together, to build networks, to start to look at

issues and get more ideas.     So that's what we did.   And we also

needed a way to raise money for these purposes, and so we

finally started the Association and we also started the

Foundation.

     Jennifer Muldoon:     How has your involvement with AHSR

influenced your career?

     William Pierskalla:     Well, that, probably not nearly as

much as many others because after we formed the AHSR, I started
to get into business school management and became the deputy

dean and Wharton, and then later the dean at UCLA in business.

And then I was the president of several international

organizations, so I sort of dropped off the scene for quite a

long time.

     Jennifer Muldoon:     Well, we're glad to have you back.

     William Pierskalla:     Okay.

     Jennifer Muldoon:     The early days of the annual meeting,

what was the original purpose of the AHSR annual research

meeting?

     William Pierskalla:     Well, that I can't speak to as well as

some of the others because that was about the time I was

dropping out.    I know one of the main reasons was to bring

researchers together and do that.

     Jennifer Muldoon:     What were some of the important health

services research and policy issues in the early days?

     William Pierskalla:     Well, many of them hinged around the

cost issues.    I mean, we were really putting in the perspective

payment [sounds like] system at that time.     We were starting to

look at how HMOs affected care delivery, not just the cost, but

also the need - could we improve the quality and the delivery of

care that people got through a more organized effort and a more

integrated effort of delivery of care.     That was probably the

biggest, I would say, the biggest two drivers at that time,
although there were many other issues that were important.

Quality was just starting to be talked about and a lot of us had

real concerns about how we could get the physician establishment

to buy into the need to really start to look at quality.

     Jennifer Muldoon:     The first meeting had three hundred

attendees.   What do you think attracted the original attendees

to the first meeting?

     William Pierskalla:     Oh, I think there was a hunger for

finding where a network was and where they could talk to people

and talk about what they were doing and hear what other people

were doing and really communicate and learn and discuss ideas

and work together.    I think it was just that hunger was out

there and everybody was interested and they wanted to do it.

And we didn't have that forum before.     All we had was the

American Public Health Association and a couple others which

were basically off on a different tangent.     So this was a very

welcome thing, I think, to many people.

     Jennifer Muldoon:     Do you have a favorite memory of the

annual meeting?

     William Pierskalla:     No, I don't, I'm afraid.

     Jennifer Muldoon:     Thinking to the next twenty-five years,

where do you see the annual meeting twenty-five years from now?

     William Pierskalla:    Well, let me put this question a

little differently.     I see significant major change happening in
the world - very significant major change happening in the

world.   In the United States alone, our demographics are going

to be very, very different.   Our pressures from the aging and

the lack of young workers to support Social Security and

Medicare and Medicaid is going to change rapidly.

     I also see major changes in our international stature.

Right now we're the most powerful nation in the world

economically, as well as militarily, and probably some other

dimensions too.   That's going to keep shifting and changing.      In

twenty-five years, we may not be the economically powerful.       The

Asian countries are going to grow rapidly.    The demand for all

kinds of resources are going to increase in the world.    We're

still going to see greater, greater demand and increasing costs

of energy, water, a lot of other resources.    This is going to

impact us in all kinds of ways that we haven't really thought

about.

     I think health services research has to think about those

issues and how that's going to impact our ability to deliver the

kind of healthcare that we all really would like to have and

want because we're not going to have the golden age we've had.

It's going to be a very different world in twenty-five years,

and I think health services researchers really need to start to

think more broadly than, what I would say, myopic vision we have

today of what we're going to be facing.
       The second part, I think, is I don't think health services

research will be much different in twenty-five years than it is

now.    The Academy Health will be very much different or the

annual meeting will be very much different unless we make some

major changes.     I think Academy Health has to make some very

fundamental changes to really attack these bigger problems,

these bigger issues that are going to be coming to bear on us.

       I think we're going to need to bring in other disciplines.

We have a very narrow set of disciplines in the Academy right

now compared to what's out there.    Very few people from the

major quantitative areas come here - people from engineering,

people from mathematics, people from all the sciences.     There

aren't that many here.     I think we have to reach out to these

kinds of people because they have a lot to offer on some of

these problems.     I think the same is true for the public health

sector and so on.    We don't get many of those, and they, I

think, have to be brought in.    We have to be much more, what I

would say, is inclusive.    And I'm not talking ethically or

racially.     I'm talking intellectually inclusive that we don't

have today.

       I also think we need to bring in groups of people that are

users - the politicians, the agencies, the hospitals and long­

term care people - people who have real problems that they're

facing on either at least a weekly or monthly or day-to-day
basis.   And I don't see many of those around here.      Those actual

users, if we converse with them, we'll find a whole host of new

things we should be working on and could be working on.

     And, finally, I think we have to be more inclusive of

ideologies.     Right now we're fairly     if I had to describe it -

this is my first meeting for a long time, and I've been

observing it - I'd have to describe it - I'd say we're fairly

liberal, mostly Democrats - and I think Bob Brook hit that - and

are not really open to the debate across ideas and ideologies,

and I think that's essential for real growth and a real

contribution.     So that's what I believe.

     Jennifer Muldoon:     Anything else you'd like to add?

     William Pierskalla:     No, I think I've just said about every

opinion I've had on this issue [laughter].

     Jennifer Muldoon:     That's great!