In the spring of 2023, Professor Jacqueline Fox was one of just 22 professionals from across the country awarded a Fulbright Global Scholarship, designed to foster international understanding and cooperation as recipients teach, conduct research and carry out professional projects throughout the world.  

This year, Fox – a renowned national expert in health law and health care financing, regulation and reform – began research for her Fulbright-awarded project: “The True Cost of Health Care,” the first of its kind to compare and critique the English, Australian and U.S. processes for determining total national health care expenditures. 

“Health care accounting as we know it started in the 1960s, but a lot has changed in terms of philosophy, bioethics, legal theories, medical theories, our social norms, policy research,” Fox says. "My research is about modernizing how countries calculate total national health care expenditures and explaining some of the harms caused by the current accounting systems.” 

Fox is familiar with the potential harms complex health care financing and insurance processes can cause patients, personally as well as professionally, and for roughly three decades her passion for identifying these problems and seeking solutions has placed her at the forefront of evaluating systemic policy. 

Her path to national expert in health care tax law began her senior year of college, working on what she describes “the coolest project ever” with the American Civil Liberties Union, where she read every single state’s constitution and ranked them based on whether they could be used to call for better public education funding.  

“They followed that list for years,” she says with pride. “And I realized if this is my idea of fun – sitting in this room in the New York Bar researching state constitution’s – I'll go to law school.”  

At Georgetown University, she discovered a love for the complexity of large-scale financing systems while taking tax law from nationally known tax law expert, Martin Ginsburg – husband of U.S. Supreme Court Justice Ruth Bader Ginsburg – which inspired her to join a big law firm handling tax and securities after graduating. It was during this time a close family member experienced a health crisis.  

Everything turned out well, but it wasn't until Fox threatened to sue the insurance company that they agreed to cover the cost of a necessary surgery. News of Fox’s success spread throughout the firm, prompting staff to request her advocacy for their own issues with health care coverage. She quickly discovered a knack for this work and left the firm to establish her own national practice helping clients across the country.  

As one of the few attorneys in the country working for patients seeking access to care, Fox was highly sought after. Because her clients frequently faced issues related to public policy, she became an expert in the field. Upon realizing how much she enjoyed that aspect of her work, she returned to academe, earning consecutive fellowships at Johns Hopkins University and Yale University.  

Though her scholarship in bioethics and systemic policy is highly technical and sizeable in scope, it’s her compassion that guides her. 

“Patients and caretakers are dealing with life and death, with very painful resource allocation decisions,” Fox says. “I think if you're deeply respectful of people and their capacity to be moral actors who deserve to be treated with dignity, it really informs the structure of the system.” 

Fox acknowledges that defining what counts as a health care cost and how it is counted in the health care system are important; her scholarship interrogates the impact of where those lines are drawn. Her research on “The True Cost of Health Care” will offer a window to better understand how bridging gaps in health care access and coverage may provide significant savings in the long run. 

“If I invest in diagnostic tests that allow me to catch a disease early, there is a chance of a net savings because the disease won't manifest. But what if I have an early intervention of physical therapy for manual laborers before their backs give out? That will be experienced broadly with, for example, savings in Social Security disability payments later on, but may not be experienced as a savings in actual health care,” Fox says. “Even though it will impact people's health, the cost savings may not be accounted for in the health care accounting methods, and so we may be incorrectly putting pressure on people to constrain costs that are actually super effective for achieving the end goals of society.” 

When it’s finished, Fox wants her research to provide countries with new approaches to health care accounting processes and suggestions for better resource allocation decisions. Her scholarship underscores her altruism: to hold health care systems accountable in service of the people.