In August, Yale researchers led by Alison Galvani published an analysis (https://www.medrxiv.org/content/10.64898/2026.07.22.26358689v1) estimating that a Medicare-for-All-style system would cut national health spending by $1.04 trillion a year — about 20% — while covering everyone. It's a preprint, not peer-reviewed, and the savings lean on three big assumptions stacked together (drug pricing, provider rates, one billing system). Stress-test those down to something more conservative and the number shrinks a lot. It doesn't disappear, though — some real savings survive almost any reasonable version of the model, which ended up mattering more to me than the headline figure.

That's basically what the Congressional Budget Office found (https://www.cbo.gov/publication/57637) too, back in 2022, modeling five illustrative single-payer designs: results ranged from a $700B decrease to a $300B increase in national spending, depending almost entirely on how providers get paid. The financing label doesn't determine the outcome. The rules inside it do.

So which rules actually work? Maryland's been testing one answer since 2014 — every hospital paid under the same regulated rates, on a global budget instead of fee-for-service. Hospital expenditure growth has run 8.74 points below the national average, saving Medicare an estimated [$1.6B](https://www.mathematica.org/publications/evaluation-of-the-maryland-total-cost-of-care-model-progress-report), and a 2025 Health Affairs study, (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2025.01324) found utilization dropped 11 points more than in comparable states. Nobody had to abolish private insurance. CMS liked it enough to build its new AHEAD model (https://www.cms.gov/priorities/innovation/innovation-models/ahead) directly on Maryland's template.

Put those together and I don't think the honest answer is "pass 'Medicare for All' in one vote and hope." I believe it's a sequence: fix provider prices and hospital incentives first (the biggest, best-tested levers), negotiate drug prices without betting the whole plan on it, standardize the paperwork, then build a public option that covers the people the current system already fails — and only let it expand as far as the results justify. Nobody's employer coverage gets ripped up overnight, and nobody has to win an argument about the size of government first.

I laid the whole thing out step by step, with sources: [A Step-by-Step Path to Medicare for All (https://brokenpromiseshealthcare.org/step-by-step-path-to-medicare-for-all)

A phased in approach seems better to me than betting everything on Day One. I am sure a lot of you disagree with me. I would like to hear your ideas.

Heads up for anyone interested in health economics: the HEPARD Online Research Seminar Series kicks off its first season on September 18 with Adriana Lleras-Muney from UCLA. Her research looks at how education and income shape health and mortality outcomes, so should be a good one for anyone working on health/labor econ.

Details:

• September 18, 3:00pm CET (Fridays, 15:00-16:30 CET)
• Fully online, free to join
• Registration link gets you the Zoom link plus updates for the rest of the season

Full lineup for 2026/27 also includes Holger Strulik, Owen O'Donnell, Anupam Jena, Davide Dragone, Manasvini Singh, Sonia Bhalotra, and Mariacristina de Nardi, running through April.

Registration: https://goek.wiwi.uni-due.de/en/research/hepard/

Hi everyone,

I’m currently studying health economics in Germany and I’m interested in building my career in the pharmaceutical industry, particularly Market Access.

I’d really appreciate some honest perspectives from people who are already working in pharma, especially in Market Access, HEOR, Pricing & Reimbursement, or related roles.

A few things I’m trying to understand:

How do you see the future of Market Access over the next 5–10 years?

Is Market Access still a strong career path for someone entering the industry now?

How difficult is it to get the first Market Access job in Germany/Europe?

Which skills are actually valuable when starting out — HEOR, health economics, data analysis, HTA, pricing, reimbursement, RWE, market research, etc.?

How important is German language proficiency for Market Access roles in Germany? (I have B2)

Is it better to start with a pharmaceutical company, consulting, CRO, or another route?

What career progression and salary growth can someone realistically expect?

I’m particularly interested in hearing from people who actually work in the field, rather than general career advice.

If you were starting your Market Access career today, what would you focus on learning and what would you avoid wasting time on?

Thanks in advance.

I'm currently preparing for UGalway's MSc in Health Economics, and noticed that most graduates secure placements in Pharma companies (my goal!!!) after doing their dissertation there.

However, I don't know the real prospects since I only consulted to LinkedIn, and most of them are Irish (I'm an international student).

Does anyone have any insights? Comments?

Hi everyone,👋

I have a clinical background and am looking to pivot into Health Economics, HEOR, Market Access, or HTA consulting.
Uk, Australia or any other country?
A few quick questions:

1. Job Market: Which of the countries has the strongest demand for entry-level HEOR/HTA analysts who require work visas?

2. Work Visas & Residency: How realistic is the transition from a post-study work visa to long-term residency/sponsorship in this field?

3. Programs: Which specific universities do recruiters actually target for practical decision modeling and HTA skills (e.g., York, Sheffield, LSE, Dublin, Erasmus)?

Would appreciate any insights from anyone working or hiring in these regions!

Burnt out on clinical medicine's memorization grind, and health economics looks more analytical and appealing.

My (probably wrong) assumption: it's basically applied econ/stats with a health label. True or am I underestimating it?

Quick questions if you're in the field:

1.Day-to-day: more modeling, or more writing/meetings?

2.Is it actually hectic/high-pressure, or decent work-life balance?

3.Salary realistic expectations ,is it worth the pivot financially?

4.Which countries are good for this field right now (job market + quality of life)? Was looking at Australia but open to other options.

5.Clinical-background switchers ,any regrets?

Brutal honesty welcome, trying to avoid jumping into another thing I end up resenting.

I started an investigation trying to understand why Americans pay so much for prescription drugs.

At first, the obvious suspects seemed to provide the answer: drug manufacturers, pharmacy benefit managers, insurance companies, wholesalers, lobbyists and Congress. But the further I followed the evidence, the harder it became to point to any single culprit.

What I found was more complicated.

The major participants in the system can often be acting within the law. Campaign contributions are legal. Lobbying is legal. The revolving door between government and industry is legal. The rules governing how prescription drugs are purchased are legal.

That eventually forced me to change the question.

Instead of asking “Who broke the law?”, I began asking “Who wrote the rules?”

Markets don't simply happen. They operate within rules established by government. Those rules determine who can negotiate, who cannot, what incentives exist and how different participants behave.

And when those rules consistently produce outcomes that are extremely costly for patients, I think we have to look beyond individual wrongdoing and examine the system itself.

That raises an uncomfortable question:

Can a system produce what people experience as corruption even when the people participating in it are following the law?

I don't expect everyone to agree with my answer. I'm interested in the question because I think it goes beyond prescription drug prices. It gets into power, incentives, governance and the difference between what is legal and what is just.

I put my personal conclusion in this 11-minute epilogue:

None Dare Call It Corruption — The Final Finding - https://www.youtube.com/watch?v=Rp8zV4e1qvo&list=PLBqo2KcncJ8U

The evidence behind the investigation is here:

Before the Counter — Evidence - https://brokenpromiseshealthcare.org/before-the-counter#evidence

Hi! I’m a 25 year old with a BSC in Governance and Economics and an MSC in Political Economy in the Netherlands.

I have roughly 2 years of experience post-grad working as a researcher for universities in development economics. But I am now struggling to find a job in my field or any for that matter because I don’t speak Dutch fluently (although im working on it!). I am thinking of doing a second masters in Health Economics with the idea that I could work at pharmaceutical companies, or biotech companies since these sectors tend to be more international. But I also wanted to pose the question here.

How is the market looking like for entry-level positions and do you find that it is more international?

how long does pfizer take to schedule an interview with u after the recruiter call?

I'm a beginner trying to independently make a CEA comparing oral (TRF/3TC) and injectable (LEN) PrEP for HIV/AIDS.

After 3 weeks of reviewing the literatures and youtube videos, I still feel stuck in solving the following problem

1. Published analyses define their health states differently. What do you consider in defining health states? Is it country-specific (i.e., affected by policies, standard regimens, etc)?
2. How do you source transition probabilities (i.e., what is the key metrics I need to look for to compute it)?
3. There are also other metrics about the population I'm interested in (high-risk groups) that are regional instead of national, do I just use it or is there any alterations needed? I'm quite stumped since their exact number is hard to quantify.
4. How do you estimate costs for a treatment that hasn't been introduced? Is there any proper way to do it?

I've watched Mirko Von Hein and surfed online, any detailed resource (esp. course slides) anyone is willing to share would be so so helpful.

Thnak you.

I support pharmaceutical, biotech, and healthcare organizations in turning evidence into reimbursement, market access, and value-based healthcare decisions.

My consulting expertise spans:

• HEOR & HTA strategy
• Cost-effectiveness, cost-utility & budget impact modelling
• Pricing & reimbursement strategy
• Market access & payer strategy
• Real-world evidence & evidence generation
• Economic model development, adaptation & localization
• Saudi Arabia & GCC HTA and reimbursement requirements
• Scientific writing, publications & evidence synthesis

My focus is not simply on producing analyses — it is on developing decision-relevant evidence that supports pricing, reimbursement, product positioning, healthcare decision-making, and patient access.

I am currently open to freelance consulting engagements, HEOR/HTA projects, research collaborations, and strategic advisory assignments with pharmaceutical, biotech, healthcare, and consulting organizations.

📍 Saudi Arabia | GCC & MENA

Let’s connect

📱 WhatsApp: +966 54 076 3394
📧 Email: [Hammam.omarcra@gmail.com](mailto:Hammam.omarcra@gmail.com)
🔗 LinkedIn: Hammam Omar – LinkedIn Profile

If you have an upcoming HEOR, HTA, market access, pricing, reimbursement, or economic modelling project, feel free to contact me to discuss how I can support your objectives.

#HEOR #MarketAccess #HTA #HealthEconomics #Pricing #Reimbursement #Pharma #LifeSciences #SaudiArabia #GCC #ValueBasedHealthcare #EconomicModelling #RealWorldEvidence #HealthcareConsulting

Hey all,

I recently completed a placement in market access/insights and have regulatory affairs coursework under my belt, so I've been trying to break into HEOR/Health Economics & Market Access roles at medical device and pharma companies.

I've been doing a lot of networking on LinkedIn, reaching out to people in roles I'm interested in, trying to get warm intros through people who supervised my placement

It's been a mix of some traction (warm intros, people forwarding my info to hiring managers) and a lot of waiting/silence otherwise.

Has anyone else been down this road, trying to get into HEOR, market access, or health economics roles as a recent grad? How long did it take you? Did networking/cold outreach actually move the needle for you, or was it more about the applications themselves? Any advice on what actually worked would be hugely appreciated.

Thanks!

So I'm increasingly annoyed by how terrible the current US healthcare system is, and also how poor the general proposed alternatives are in terms of laying out HOW their plan would work. (looking at you Medicare for All...)

So I've spent some time (with the help of LLMs to consolidate and word my thoughts) devising my own framework.

I'm just a layman though. So there's a lot I still probably don't understand enough about how the system currently works. You can see my proposal on the linked Substack.

It's quite long, but I'd really appreciate any criticism about any poor thinking I have. Any things I'm missing. There are a lot of questions I still don't have answers for, but I figure I have to start somewhere, if only for my own satisfaction or having my own basis on which to judge future proposals. I'm particularly interested in any economic points I'm missing, like perverse incentives I'm not accounting for, or any that the proposal is unintentionally creating.

This is not intended to be self-promotion. It's on Substack because it would be too long to post in the body of a Reddit post.

Let me know your thoughts if you have any.

https://commonwealthanalyst.substack.com/p/american-health-security

I’m trying to decide between the MSc Health Economics at Erasmus University Rotterdam and the MSc Health Economics at University of Galway, and I keep going back and forth.

My long-term goal is HEOR / HTA / market access, with the possibility of eventually moving into life sciences strategy consulting. My background is in neuroscience, clinical research, and medical writing (specifically competitive intelligence, not promo), so I’m looking to build the economics, modeling, and reimbursement side of my skill set.

The main reason I’m drawn to Erasmus is honestly pretty simple: I think it's a better school. Plus I’d rather live in Rotterdam and its way cheaper! I've lived in the Netherlands before, I like the city, the location in Europe, and the lifestyle. Erasmus also seems to have the stronger reputation academically, particularly for economics, and I think I’d enjoy that environment.

The big appeal of Galway is the internship.

The MSc has an optional (obviously I'll do it), 8–12 week summer work placement, with recent placement partners including IQVIA, Novartis, AbbVie, NCPE, HIQA, etc. Placements can involve cost-effectiveness analysis, modeling, HTA, market access/pricing, and policy.

The cohort is also tiny (~20 full-time students), and most placements are paid, although payment isn't guaranteed.

That is really appealing to me because I care a lot about getting actual industry experience. Part of me thinks its more valuable to spend my summer learning HEOR/market access in an office than have a better known degree and graduate without relevant experience.

The downside is that Galway is about triple the cost, I don't think the ranking is that great (big for me, right? since I'm pivoting heavily from clinical research and a neuroscience undergrad). I'd also probably have to commute 30+ minutes to school because of the housing crisis they are facing.

I also recently spoke to someone who did Economics & Business at Erasmus for his bachelor's and then the MSc Health Economics at Galway. He's now a Senior Associate in Health Economics, Market Access & Reimbursement at J&J. He said that academically he'd choose Erasmus, but he chose Galway because the industrial placement gave him confidence and essentially provided his entry into the industry (he was econ undergrad whereas I have clinical trials experience)

That made me take the placement much more seriously.

With Erasmus, I'd have to put much more effort into finding an internship myself. I'm a hustler and I know I'll do whatever I can to get one, but I'm also aware that I'd be trying to break into a strongly quant based, relatively niche field, and I only have basic Dutch language proficiency.

So I'm trying to figure out how much that structured internship is actually worth compared with living somewhere I'd prefer and having the academic/location/network advantages of Erasmus.

What would you choose?

I'm particularly interested in hearing from people who actually work in HEOR, HTA, market access, pricing/reimbursement, life sciences consulting, or pharma.

If you had these two options, would you prioritize:

A) Erasmus + living in Rotterdam + stronger economics reputation + access to the broader European/Benelux ecosystem, while taking responsibility for finding your own internship

or

B) Galway + a small cohort + a structured industry placement + potentially graduating with direct HEOR/market access experience, despite the higher cost and the fact that I don't particularly want to live there?

And if you've attended either program, I'd especially love to hear:

• How strong is the actual quantitative/modeling training?
• How difficult is it to get an internship?
• What kinds of jobs do graduates actually get?
• Does the university's reputation matter much when applying for HEOR/market access roles?
• How valuable is having an internship built into the MSc?
• Would you choose differently knowing what you know now?

Thanks!

Summary — Pros, cons & caveats

University of Galway

Pros:

• Structured, credit-bearing industry placement (IQVIA, Novartis, NCPE, etc.)
• Very small cohort → close faculty support + networking
• Higher chance of graduating with direct industry experience
• Some placements are paid and can act as a pipeline into pharma/consulting
• Could be cute

Cons:

• More expensive overall for me (housing + cost of living + tuition)
• Housing crisis → likely long commute / limited accommodation options
• Less strong academic reputation in economics compared to Erasmus
• More geographically limited network than the major European pharma/consulting hubs
• I might go stir crazy

Caveat:

• The placement is optional and competitive, so specific roles aren't guaranteed
• International/UK placements may be possible, but this isn't formally assured

Erasmus University Rotterdam

Pros:

• Strong academic reputation in economics/health economics, with a strong quantitative foundation
• Located in Rotterdam → access to the broader Benelux/European pharma, consulting, and health policy ecosystem
• Stronger international brand recognition in economics/quantitative fields
• Larger ecosystem of relevant companies nearby
• I would genuinely enjoy living there more (I've lived in the Netherlands before and know it's a better lifestyle fit for me)
• Cheaper for me

Cons:

• No structured, built-in industry placement → I would be responsible for securing relevant experience myself
• I'd need to be proactive early to secure an internship in a relatively niche field
• Likely more competitive to break into HEOR/market access without prior direct experience
• Dutch language can be a soft barrier for some local roles (I only have basic Dutch)
• Potentially less direct exposure to UK-style HTA systems such as NICE

Caveat:

• Erasmus has a very strong academic reputation in economics/health economics, but it is more theory- and research-oriented than industry-structured, so I'd need to be proactive about translating the degree into relevant HEOR/market access experience through internships and networking.

Hi everyone,
I’m currently pursuing an MSc in International Health Economics & Pharmacoeconomics in Germany, after completing a PharmD in India.
I’m looking for a Werkstudent/internship in areas like Health Economics, HEOR, HTA, Market Access, Pricing & Reimbursement, or Pharmacoeconomics.
I’d love some honest advice from people working in this field in Germany:
How difficult is it for an international graduate to get the first relevant internship/Werkstudent role?
How important is German? Is B1/B2 enough, or is C1 usually expected?
Which skills should I prioritize — Excel, R, cost-effectiveness modelling, Markov models, systematic reviews, IQWiG/G-BA/AMNOG?
Which companies/organisations are worth targeting?
What does the career progression and salary realistically look like after graduation?
I’m particularly interested in hearing from people who started their Health Economics/HTA/Market Access career in Germany as international graduates.
Thanks!

Hello everyone,

For ages, I have been worried about my quantitative skillset, specifically the ability for me to learn about relationships between variables. I majored in analytics at a decent state school, but many analytics programs are light on actual statistics, including this one. I managed to get a role in Regulatory due diligence at company that typically hires graduates from top schools because the case was not that quantitative and my interviewing skills are very good (I am a good communicator relative to what I perceive the benchmark to be, I can structure information effectively, and deliver a story and display some fundamental domain knowledge from interning in the past at healthcare companies).

The reason for this worry is not necessarily because I will be performing super complex calculations during my career, taking integrals, etc. It is because of two reasons (all relative to other employees):

1. The literal use of mathematical operations to arrive at solutions. Machines take care of the actual formulas, but not the judgement and the knowledge of what is happening when I manipulate numbers to come up with a solution.
2. General "learning rate" -- the rate at which i consume, process, understand, and then apply new information, controlled for all other variables and assuming it is the same information, relative to a fellow employee. Think of this as turning information into knowledge that I can pull for future applications. I fear that someone from a top quality quantitative background will have a higher learning rate regardless of subject, assuming variables like motivation, need, etc are held equal to mine.

Much of this concern has been because I do not care much for absolute progress in learning something, because I tell myself if i do not learn it fast enough, or if x person learns y subject quicker than me, or if x person knows y subject while I never learned it, then I feel a gap that I cannot fill. This may or may not hamper my learning; I have a feeling it does, so this becomes a constant cycle of always feeling stressed learning a new quantitative subject, then saying I shouldn't be stressed, and that if I am stressed, I am learning at a poorer rate, all to arrive at the same beginning.

I can't even be happy when I accomplish something, because I am constantly auditing and benchmarking my own ability to an ideal.

What do I do here?

I was thinking and curious what will be the future for countries currently in stage 5 of the DTM model and what is likely to happen if more countries enter it? Will populations drop? Also from an economical point of view what would happen, lets Say Japan, currently in Stage 5 or around it?

Four out of five patients at a primary health care center could benefit from counseling but only one out of five is referred. Of those referred 20 percent cancel their appointment or just do not show up. In that group 80 percent manages as good on their own and the other 20 percent need counseling the most. Of those who come to counseling 80 percent needs help to understand and cope with their current situation whereas 20 percent are in the need of a broader approach. In the group that needs a broader approach 80 percent is best treated in the primary care with an eclectic stance while the other 20 percent for the best is referred to secondary psychiatric care.

The group that is accepted for RCT (randomized controlled trial) studies is found among the 80 percent of the patients with the need of a broader approach of the 20 percent of the patients in counseling. In that population 80 percent is not accessible for the scientists (due to life et cetera). The other 20 percent is subject to research. Approximately 20 percent of this group of 20 percent are the very patients that are part of the RCT studies (they have accepted to be randomized for CBT (cognitive behavioral therapy) or TAU (treatment as usual), they have allocated time for all tests, they have showed up for all sessions and done their homework, and they have taken part of the follow ups. Lately it has been shown that internet based CBT and group based CBT is as god as CBT with physical sessions. This research is based on the group of 20 percent of the population that accept and endure physical sessions CBT.

Pareto’s law is an empirically based statement that identifies a 80/20 relation in various situations. At a primary health care center, for example, 20 percent of the patients stands for 80 percent of all the appointments.

When the healthcare is under pressure from stakeholders to produce more and more evidence based appointments there is a risk that Pareto’s law collapses into what I call Pareto’s curse. In this particular case evidence based practice translates into CBT which translates into good practice. CBT is good. But without individually customized CBT and without more than one line of treatment only 20 percent of 20 percent of 80 percent of 20 percent of those who come for counseling will benefit from the treatment. That is 0,64 percent or one patient out of 156 patients needing counseling.

To understand why this threatens healthcare systems we have to look at Goodhart’s law. Goodhart’s law can be formulated as "When a measure becomes a target, it ceases to be a good measure." The evidence based practice movement initially wanted to give research its natural place next to clinical experience and the patients preferences. This measure then became the target.

To overcome Pareto’s Curse we must return to Pareto’s Law and do what is best in each situation.

(A counselor the other day went with her daughter to a primary healthcare clinic for teenagers for a first meeting with a psychologist. The daughter spent 80 percent of the session filling in forms and talked with the psychologist for 20 percent of the session. The daughter decided to not return.)

(Note, this is only a problem in 80 percent of 20 percent of the world’s countries.)

Are there any good courses on creating a budget impact model?

Four out of five patients at a primary health care center could benefit from counseling but only one out of five is referred. Of those referred 20 percent cancel their appointment or just do not show up. In that group 80 percent manages as good on their own and the other 20 percent need counseling the most. Of those who come to counseling 80 percent needs help to understand and cope with their current situation whereas 20 percent are in the need of a broader approach. In the group that needs a broader approach 80 percent is best treated in the primary care with an eclectic stance while the other 20 percent for the best is referred to secondary psychiatric care.

The group that is accepted for RCT (randomized controlled trial) studies is found among the 80 percent of the patients with the need of a broader approach of the 20 percent of the patients in counseling. In that population 80 percent is not accessible for the scientists (due to life et cetera). The other 20 percent is subject to research. Approximately 20 percent of this group of 20 percent are the very patients that are part of the RCT studies (they have accepted to be randomized for CBT (cognitive behavioral therapy) or TAU (treatment as usual), they have allocated time for all tests, they have showed up for all sessions and done their homework, and they have taken part of the follow ups. Lately it has been shown that internet based CBT and group based CBT is as god as CBT with physical sessions. This research is based on the group of 20 percent of the population that accept and endure physical sessions CBT.

Pareto’s law is an empirically based statement that identifies a 80/20 relation in various situations. At a primary health care center, for example, 20 percent of the patients stands for 80 percent of all the appointments.

When the healthcare is under pressure from stakeholders to produce more and more evidence based appointments there is a risk that Pareto’s law collapses into what I call Pareto’s curse. In this particular case evidence based practice translates into CBT which translates into good practice. CBT is good. But without individually customized CBT and without more than one line of treatment only 20 percent of 20 percent of 80 percent of 20 percent of those who come for counseling will benefit from the treatment. That is 0,64 percent or one patient out of 156 patients needing counseling.

To understand why this threatens healthcare systems we have to look at Goodhart’s law. Goodhart’s law can be formulated as "When a measure becomes a target, it ceases to be a good measure." The evidence based practice movement initially wanted to give research its natural place next to clinical experience and the patients preferences. This measure then became the target.

To overcome Pareto’s Curse we must return to Pareto’s Law and do what is best in each situation.

(A counselor the other day went with her daughter to a primary healthcare clinic for teenagers for a first meeting with a psychologist. The daughter spent 80 percent of the session filling in forms and talked with the psychologist for 20 percent of the session. The daughter decided to not return.)

(Note, this is only a problem in 80 percent of 20 percent of the world’s countries.)