Hugh Waters

Associate Professor
Health Economics and Financing


The University of North Carolina at Chapel Hill
School of Nursing
Carrington Hall, CB #7460
Chapel Hill, NC 27599-7460

Office: 405

Hugh Waters is a health economist and Associate Professor in the UNC School of Nursing, with an adjunct appointment in the School of Public Health.  He has 23 years of experience working with public health programs, both in the U.S. and internationally.  His areas of expertise are: (1) health insurance and health financing reforms; (2) evaluation of the effects of health financing mechanisms on access, equity, and quality; and (3) economic evaluation of health programs.

He has significant experience in measuring performance, for both healthcare providers and health systems.  He has published research in the peer-reviewed literature on international comparisons of quality-based purchasing arrangements, and the costs and benefits of quality improvement initiatives.  He has worked with a wide variety of data sources focused on health care cost, access, and quality.  In the U.S., these include the Hospital Consumer Assessment of Healthcare Providers Survey (HCAHPS); the Hospital Inpatient Quality Reporting (IQR); the Quality Improvement Organization (QIO) Clinical Warehouse; Healthcare Cost and Utilization Project (HCUP); the Healthcare Cost Reporting Information System (HCRIS); the Medicare Provider Analysis and Review File (MEDPAR); and Hospital COMPARE.  Internationally, he has worked closely with data from the Living Standards Measurement Surveys (LSMS), the Demographic and Health Surveys (DHS), and several additional nationally-representative household surveys.

Dr. Waters has worked closely with private health insurers and Medicaid programs in North Carolina, Michigan, Minnesota, Maryland, and Virginia.  He is a co-editor of the book Good Practices in Health Financing published in 2008 by the World Bank, and the author of several chapters in this book, which contains a series of case studies of health insurance programs in ten countries.  He has successfully carried out economic evaluations and has applied Activity-Based Costing (ABC) in a wide variety of healthcare settings.  For example, he led an economic analysis of the Keystone Quality Improvement program in Michigan, focusing on the economic implications of a patient safety program aimed at reducing hospital-acquired infections – showing that this type of quality improvement program can also financially benefit hospitals and health insurers.  The Keystone Project averted 29.9 catheter-related blood stream infections, and 18.0 cases of ventilator-associated pneumonia, per hospital per year.  The economic analysis found an average cost of $3,375 per infection averted – substantially less than estimates of the additional healthcare costs associated with these infections – which range from $12,208 to $56,167 per infection episode.

Dr. Waters speaks French and Spanish fluently, and has worked in over 30 countries.  He holds a Ph.D. in Public Health Economics from the Bloomberg School of Public Health, and a M.S. in International Economics from Georgetown University.  He currently teaches courses on Health Economics and Comparative Health Systems.

  • Advising, Mentoring and Teaching Recognition Award (AMTRA), JHSPH,
  • Delta Omega Honor Society, Johns Hopkins University School of Hygiene and Public Health,
  • Dissertation grant received from the Agency for Health Care Policy and Research, 1997–
  • Graduated with distinction, Georgetown University,
  • Nabisco Brands Scholarship for Interest and Promise in the Field of International Public Affairs, Georgetown University,
  • Phi Beta Kappa Honor Society, College of William and Mary,
  • Koenig-Nimmo Foreign Service Scholarship, College of William and Mary,
  1. Morgan, R., Ensor, T., and Waters (2015). Private Health Sector Performance: Factors Affecting Quality, Equity, and Efficiency. Forthcoming in The Lancet.
  2. Jha, K., Larizgoitia, I., Audera‐Lopez, C., Waters, H.R., Bates, D.W. (2013). The Global Burden of Unsafe Medical Care: An Estimate of Harm. British Medical Journal (BMJ), Vol. 22, No. (10), pp. 809‐15.
  3. Lefevre, , Shillcutt, S.D., Waters, H.R., Haider, Sabbir, El‐Arifeen, Shams, Mannan, Ishtiaq, Shah, Seraji, Darmstadt, G.L., Wall, Steve N., Williams, Emma K., Black, R., Santosham, M., and Baqui,A. (2013). Economic Evaluation of Neonatal Care Packages in a Cluster‐Randomized Controlled Trial in Sylhet, Bangladesh. WHO Bulletin, 91, 736‐745.
  4. Waters, H., Korn, , Colantuoni, E., Berenholtz, S., Goeschel, C., Needham, D., Pham, J.C., Lipitz‐Snyderman, A., Watson, S.R., Posa, P., and Pronovost, P.J. (2011). The Business Case for Quality: Economic Analysis of the Michigan Keystone Patient Safety Program in ICUs. American Journal of Medical Quality, 26(5), 333–339.
  5. Donaldson, A., Waters, H. R., Arora, M., Varghese, B., Dave, P., and Modi, B. (2011). A Cost‐Effectiveness Analysis of India’s 2008 Prohibition of Smoking in Public Places in Gujarat. International Journal of Environmental Research and Public Health, 8(5), 1271–1286.
  6. Plescia, , Wansink, D., Waters, H. R., and Herndon, S. (2011). Medical costs of secondhand‐smoke exposure in North Carolina. North Carolina Medical Journal, 72(1), 7–12.
  7. Guerrero‐Lopez, M., Ruiz, J. A., Shigematsu, L. M., and Waters, H. R. (2011). The economic impact of Mexico City’s smoke‐free law. Tobacco Control, 20(4), 273–278.
  8. Bós, M., Howard, B. V., Beresford, S. A., Urban, N., Hutchinson, F., Tinker, L. F., Waters H., Bós A., Chlebowski R., Ennis J. (2011). Cost‐effectiveness analysis of a low‐fat diet in the prevention of breast and ovarian cancer. The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. Journal of the American Dietetic Association, 111(1), 56–66.
  9. Sáenz de‐Miera, , Thrasher, J. F., Chaloupka, F. J., Waters, H. R., Hernandez‐Avila, M., and Fong, G. T. (2010). Self‐reported Price of Cigarettes, Consumption and Compensatory Behaviours in a Cohort of Mexican Smokers before and after a Cigarette Tax Increase. Tobacco Control, 19(6),481–487.
  10. Faden, R., Chalkidou, K., Appleby, J., Waters, H. R., and Leider, J. P. (2009). Expensive Cancer Drugs: A Comparison between the United States and the United Kingdom. Milbank Quarterly, 87(4),789–819.
  11. Rao, K. D., Waters, H., Steinhardt, L., Alam, S., Hansen, P., and Naeem, A. J. (2009). An Experiment with Community Health Funds in Afghanistan. Health Policy and Planning, 24(4), 301–311.
  12. Steinhardt, C., Waters, H., Rao, K. D., Naeem, A. J., Hansen, P., and Peters, D. H. (2009). The Effect of Wealth Status on Care Seeking and Health Expenditures in Afghanistan. Health Policy and Planning, 24(1),1–17.
  13. Waters, H. R., Foldes, S., Alesci, N. L., and Samet, J. (2009). The Economic Impact of Exposure to Secondhand Smoke in Minnesota. American Journal of Public Health, 99(4), 754–759.
  14. Bós, , and Waters, H. (2008). Determinants of Catastrophic Health Expenditures in Brazil: The Impact of the Public System and Private Insurance. CEPAL Review, No. 95. Also in Spanish as Bós, A. y Waters, H. Efectos de protección financiera del sistema de salud pública y del seguro privado en Brasil. Revista de la CEPAL (95), 125–139. Available here.
  15. Dao, T., Waters, H., and Le, Q. V. (2008). User Fees and Health Service Utilization in Vietnam: How to Protect the Poor? Public Health, 122(10), 1068–1078.
  16. Hussain, , Waters, H., Khan, A. J., Omer, S. B., and Halsey, N. A. (2008). Economic Analysis of Childhood Pneumonia in Northern Pakistan. Health Policy Planning, 23(6), 438–442.
  17. Jiménez‐Ruiz, A., Sáenz de Miera, B., Reynales‐Shigematsu, L. M., Waters, H. R., and Hernandez‐Avila, M. (2008). The Impact of Taxation on Tobacco Consumption in Mexico. Tobacco Control, 17(2), 105–110.
  18. Waters, H. R., Hatt, E., and Black, R. E. (2008). The Role of Private Providers in Treating Child Diarrhea in Latin America. Health Economics, 17(1), 21–29.
  19. Waters, H. R., Hobart, , Forrest, C. B., Siemens, K. K., Pittman, P. M., Murthy, A., et al. (2008). Health Insurance Coverage in Central and Eastern Europe: Trends and Challenges. Health Affairs (Millwood), 27(2), 478–486.
  20. Weiner, P., Famadas, J. C., Waters, H. R., and Gikic, D. (2008). Managed Care and Private Health Insurance in a Global Context. Journal of Health Politics, Policy and Law, 33(6), 1107–1131.
  21. Waters, H., Steinhardt, , Oliver, T. R., Burton, A., and Milner, S. (2007). The Costs of Non‐Insurance in Maryland. Journal of Health Care for the Poor and Underserved, 18(1), 139–151.
  22. Hyder, A., Waters, H., Phillips, T., and Rehwinkel, J. (2007). Exploring the Economics of Motorcycle Helmet Laws – Implications for Low and Middle‐Income Countries. Asia‐Pacific Journal of Public Health, 19(2), 16–22.
  23. Devgan, , Waters, H., Pronovost, P.J., and M.A. Makary. (2007). A Cost Analysis of Intra‐Operative X‐Ray Screening for Retained Surgical Foreign Bodies. Journal of Surgical Research, 137(2), 186. Available here.
  24. Hatt, and Waters, H. (2006). Determinants of Child Morbidity in Latin America: A Pooled Analysis of the Interactions between Parental Education and Economic Status. Social Science and Medicine, 62(2), pp. 375–386.
  25. Hussain, , Waters, H., Omer, S. B., Khan, A., Baig, I. Y., Mistry, R., et al. (2006). The Cost of Treatment for Child Pneumonias and Meningitis in the Northern Areas of Pakistan. International Journal of Health Planning and Management, 21(3), 229-238.
  26. Waters, H. R., Penny, E., Creed‐Kanashiro, H. M., Robert, R. C., Narro, R., Willis, J., et al. (2006). The Cost‐Effectiveness of Child Nutrition Education Programme in Peru. Health Policy and Planning, 21(4), 257–264.
  27. Anderson, F., Hussey, P. S., Frogner, B. K., and Waters, H. R. (2005). Health Spending in the United States and the Rest of the Industrialized World. Health Affairs (Millwood), 24(4), 903–914. *This was the 4th most frequently viewed article on Health Affairs’ website in 2005.
  28. Bishai, , Kumar, K. C. S., Waters, H., Koenig, M., Katz, J., Khatry, S. K., et al. (2005). The Impact of Vitamin A Supplementation on Mortality Inequalities among Children in Nepal. Health Policy and Planning, 20(1), 60–66.
  29. Waters, H. R., Hyder, A., Rajkotia, Y., Basu, S., and Butchart, A. (2005). The Costs of Interpersonal Violence – An International Review. Health Policy, 73(3), 303–315.
  30. Pavlovich, Waters, H., Weller, W., and Bass, E. (2004). Systematic Review of Literature on the Cost‐Effectiveness of Nutrition Services. Journal of the American Dietetic Association, 104(2), 226–232.
  31. Pronovost, J., Needham, D. M., Waters, H., Birkmeyer, C. M., Calinawan, J. R., Birkmeyer, J. D., et al. (2004). Intensive Care Unit Physician Staffing: Financial Modeling of the Leapfrog Standard. Critical Care Medicine, 32(6), 1247–1253.
  32. Waters, H. R., Anderson, F., and Mays, J. (2004). Measuring Financial Protection in Health in the United States. Health Policy, 69(3), 339–349.
  33. Waters, H. R., Dougherty, L., Tegang, P., Tran, N., Wiysonge, C. S., Long, K., et al. (2004). Coverage and Costs of Childhood Immunizations in Cameroon. Bulletin of the World Health Organization, 82(9), 668–675.
  34. Waters, H. R., and Hussey, (2004). Pricing Health Services for Purchasers – A Review of Methods and Experiences. Health Policy, 70(2), 175–184.
  35. Waters, H. R., Hyder, A., and Phillips, T. L. (2004). Economic Evaluation of Interventions to Reduce Road Traffic Injuries – A Review of the Literature with Applications to Low and Middle‐Income Countries. Asia‐Pacific Journal of Public Health, 16(1), 23–31.
  36. Waters, H., Morlock, , and Hatt, L. (2004). How Healthcare Purchasers can Influence Quality – A Conceptual Framework and Comparative Analysis of Contextual Factors. International Journal of Health Planning and Management, 19(4), 365–381.
  37. Waters, H. R., Rehwinkel, A., and Burnham, G. (2004). Economic Evaluation of Mectizan Distribution. Tropical Medicine and International Health, 9(4), A16–25.
  38. Waters, H., Saadah, , Surbakti, S., and Heywood, P. (2004). Weight‐for‐Age Malnutrition in Indonesian Children, 1992‐1999. International Journal of Epidemiology, 33(3), 589–595.
  39. Waters, H., Hatt, , and Peters, D. (2003). Working with the Private Sector for Child Health. Health Policy Planning, 18(2), 127–137.
  40. Waters, H., Saadah, , and Pradhan, M. (2003). The Impact of the 1997–98 East Asian Economic Crisis on Health and Health Care in Indonesia. Health Policy Planning, 18(2), 172–181.
  41. Pronovost, J., Waters, H., and Dorman, T. (2001). Impact of Critical Care Physician Workforce for Intensive Care Unit Physician Staffing. Current Opinion in Critical Care, 7(6), 456–459.
  42. Waters, H., Abdallah, H., and Santillán, D. (2001). Application of Activity‐Based Costing (ABC) for a Peruvian NGO Healthcare Provider. International Journal of Health Planning and Management, 16(1), 3–18.
  43. Makinen, , Waters, H., Rauch, M., Almagambetova, N., Bitrán, R., Gilson, L., et al. (2000). Inequalities in Health Care Use and Expenditures: Empirical Data from Eight Developing Countries and Countries in transition. Bulletin of the World Health Organization, 78(1), 55–65.
  44. Waters, H. R. (2000). Measuring Equity in Access to Health Social Science and Medicine, 51(4), 599–612.
  45. Waters, H. R. (1999). Measuring the Impact of Health Insurance with a Correction for Selection Bias – A Case Study of Health Economics, 8(5), 473–483.
  • 05/15 to present – Shaping Systems: Shaping Systems to Promote Desired Outcomes: Interprofessional Collaborative Practice in Rural NC Emergency Departments.  Health Resources and Services Administration (HRSA).
  • 04/14-07/14    Assessing the impact of alcohol tax increases in U.S. states on alcohol consumption, health conditions, and revenue. National Institute for Alcohol Abuse and Alcoholism ($80K).
  • 04/14-08/14    Preparing an analysis summarizing key aspects of the Affordable Care Act (ACA) for insurers and employers.  GLG Research ($25K).
  • 10/13-03/14    Designing an Impact Evaluation for the U.S. Agency for International Development (USAID) Feed the Future Project in Haiti.  University of North Carolina Population Center ($35K).
  • 09/13-12/13    Developing a Health Financing Strategic Plan for the Country of Rwanda. Management Sciences for Health ($45K).
  • 06/12-07/13    Evaluation of the CMS Hospital Value-Based Purchasing (HBVP) Program.  Center for Medicare and Medicaid Services ($350K).
  • 03/12-04/13    Coordination and Management of Shared Savings Program (SSP) Application Process for Accountable Care Organizations (ACOs). Center for Medicare and Medicaid Services ($180K).
  • 03/12-04/13    Evaluation of the Center for Medicare and Medicaid (CMS) Gainsharing Initiative Center for Medicare and Medicaid Services ($150K).
  • 11/11-07/12    Review of Quality Measurement Initiatives for Inclusion in Provider Performance Assessment Center for Medicare and Medicaid Services ($120K).
  • 10/11-04/12    Economic Assessment of Preventable Readmissions. Center for Medicare and Medicaid Services ($75K).
  • 11/11-07/12    Identification of Healthcare Spending Drivers, using Patient Claims, Abu Dhabi. Intramural Funding, Research Triangle Institute ($40K).
  • 11/11-07/12    Understanding Pittsburgh’s Provider and Insurance Markets. Mellon Foundation ($40K).
  • 08/11-07/12    Hospital-Acquired Conditions-Present on Admission (HAC-POA) Project. Center for Medicare and Medicaid Services ($300K).