About

Sean Y. Sylvia, PhD, is an Associate Professor in the Department of Health Policy and Management at UNC’s Gillings School of Global Public Health. As a health and development economist, his work employs experimental and quasi-experimental methods to study innovative approaches aimed at improving the delivery of health services in underserved communities worldwide. His research has been published in leading public health and economics journals such as the BMJ, PLOS Medicine, Health Services Research, the Journal of Health Economics, World Development, and the Economic Journal. Dr. Sylvia currently leads the Digital Health Economics and Policy (DHEP) Lab, which brings together interdisciplinary teams to integrate insights from behavioral, data, and computer sciences into transformative health policy research suited for the digital age. His academic background includes a PhD in Agricultural and Resource Economics with a concentration in Development Economics from the University of Maryland at College Park. Prior to his position at UNC, he held academic and research roles at Renmin University of China, Stanford University, and the World Bank.

Research topics

• Medicine
• Sociology
• Geography
• Psychology
• Environmental health
• Economics
• Demography
• Pathology
• Economic growth
• Political Science
• Developmental psychology
• Family medicine
• Socioeconomics
• Surgery
• Nursing
• Psychiatry
• Intensive care medicine
• Gerontology

Selected publications

• Big Data on Little People: Towards Early Skill Assessment at Scale in Resource-poor Field Settings 

  SSRN Electronic Journal · 2026-01-01

  preprintOpen accessSenior author
  PublisherDOI

• Early life grandmother caregiving trajectories and child development: A longitudinal study

  International Journal of Behavioral Development · 2025-11-13

  articleOpen access

  Grandmothers are influential caregivers for young children, yet their contributions to child development remains understudied. This study characterized trajectories of grandmother caregiving from infancy to two years and examined their associations with child development. Data came from a longitudinal birth cohort study in rural Pakistan (n=959). Grandmother caregiving behaviors were maternally reported at three months, one, and two years postpartum using a 24-hour recall. Child development (cognitive skills, socioemotional development, and mental health) outcomes were assessed at six years. We found four distinct grandmother caregiving trajectories during infancy: (1) Low (34.9%), (2) Unstable Medium (9.3%), (3) Stable Medium (40.8%), and (4) High (14.9%). Early life grandmother caregiving trajectories longitudinally predicted specific developmental domains in middle childhood. Children with grandmothers in the High trajectory group had higher inhibitory control, and children with grandmothers in the Unstable Medium group had greater socioemotional problems. No meaningful differences with verbal comprehension, working memory, or anxiety scores were observed. Future research should characterize key family members' caregiving patterns throughout childhood to capture the dynamic nature of caregiving. In addition to parents, interventions that engage grandmothers may help create a cohesive caregiving environment and improve child development.

  PublisherDOI

• Telehealth payment parity and outpatient service utilization: evidence from privately insured workers

  Health Affairs Scholar · 2025-03-29 · 5 citations

  articleOpen accessSenior author

  Telehealth was catalyzed by the COVID-19 pandemic and has become a new norm in healthcare. In response to the pandemic, some states passed telehealth payment parity legislation, mandating equal payment rates for telehealth and in-person services. We evaluated the relationship between telehealth payment parity and health service utilization, focusing on insured workers in commercial insurance plans. Using the Merative Commercial Claims and Encounters database from 2019 to 2021, we leverage variation in the timing of policy changes across states using a difference-in-difference approach. Payment parity was significantly associated with increased telehealth visits and total outpatient visits but without a notable rise in in-person visits. Furthermore, payment parity was pronounced in increasing telehealth utilization within self-funded large employer plans, while not significantly associated with telehealth visits among fully insured small employer plans. Our findings underscore the important role of payment parity in increasing telehealth service utilization by incentivizing providers. Future policies should support the sustainable integration of telehealth services, shifting from solely focusing on equal payment rates to adopting value-based reimbursement models that improve equitable healthcare access for all employees in commercial insurance.

  PublisherDOI

• Off the COVID-19 Epicentre: The Impact of Quarantine Controls on Employment, Education and Health in China's Rural Communities

  UNC Libraries · 2025-04-18

  articleOpen access

  This study documents the COVID-19 disease-control measures enacted in rural China and examines the economic and social impacts of these measures. We conducted two rounds of surveys with 726 randomly selected village informants across seven provinces. Strict disease-control measures have been universally enforced and appear to have been successful in limiting disease transmission in rural communities. The infection rate in our sample was 0.001 per cent, a rate that is near the national average outside of Hubei province. None of the villages reported any COVID-19-related deaths. For a full month during the quarantine, the rate of employment of rural workers was essentially zero. Even after the quarantine measures were lifted, nearly 70 per cent of the villagers still were unable to work owing to workplace closures. Although action has been taken to mitigate the potential negative effects, these disease-control measures might have accelerated the inequality between rural and urban households in China.

  PublisherDOI

• The Role of Telehealth Payment Parity on Recommended Care and Emergency Department Service Utilization Among Workers With Chronic Conditions

  Medical Care · 2025-07-07 · 2 citations

  articleSenior authorCorresponding

  BACKGROUND AND OBJECTIVE: State-level telehealth payment parity, requiring equal payment rates for telehealth and in-person visits, played an important role in ensuring access to telehealth services. The objective of our study is to evaluate how improved access, driven by telehealth payment parity, affected the utilization of disease-specific recommended care management services and emergency department (ED) services among insured patients with chronic conditions. RESEARCH DESIGN: We adopted a 2-way fixed-effect difference-in-differences approach using the Merative Commercial Claims and Encounters database from 2019 to 2021. SUBJECTS: We focused on insured workers aged 19-64 with pre-existing mental health disorders or cardiometabolic risks (CMRs). MEASURES: Outcomes include psychotherapy for mental health disorders, preventive care counseling for CMRs, and ED visits. RESULTS: Telehealth payment parity was associated with a significant increase in the number of psychotherapy visits and tele-psychotherapy by 0.221 visits (95% CI: 0.050-0.391) and 0.411 visits (95% CI: 0.003-0.818) per patient per quarter, respectively. The regulation significantly reduced E.D. visits among individuals with mental health disorders by 0.003 visits (95% CI: -0.007 to 0.000) per quarter, a 25% relative decrease compared with the control at preperiod. However, payment parity was not statistically associated with increasing preventive care visits and lowering ED visits among individuals with CMRs. CONCLUSION: Telehealth payment parity has effectively promoted the adoption of psychotherapy and reduced ED visits among insured workers with mental health disorders. However, it has not significantly improved the uptake of preventive care counseling for individuals with CMRs.

  PublisherDOI

• Preference for daily versus on‐demand pre‐exposure prophylaxis for HIV and correlates among men who have sex with men: the China Real‐world Oral PrEP Demonstration study

  UNC Libraries · 2025-05-16

  articleOpen access

  INTRODUCTION: This study explores the preference for daily versus on-demand pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in developing countries when both regimens are available. METHODS: From 11 December 2018 to 19 October 2019, we recruited MSM for an open-label real-world PrEP demonstration study in four major cities in China. Subjects selected their preferred PrEP (oral tenofovir/emtricitabine) regimen (daily vs. on-demand) at recruitment and underwent on-site screening before initiation of PrEP. We used logistic regression to assess preference for daily PrEP and correlates. RESULTS: Of 1933 recruited MSM, the median age was 29 years, 7.6% was currently married to or living with a female; the median number of male sexual partners was four and 6.1% had used post-exposure prophylaxis (PEP) in the previous six months. HIV infection risk was subjectively determined as very high (>75%) in 7.0% of subjects, high (50% to 75%) in 13.3%, moderate (25% to 49%) in 31.5% and low or none (0% to 24%) in 48.1%. On average, participants preferred on-demand PrEP over daily PrEP (1104 (57.1%) versus 829 (42.9%)) at recruitment. In multivariable analysis, currently being married to or living with a female was associated with 14.6 percentage points lower preference for daily PrEP (marginal effect = -0.146 [95% CI: -0.230, -0.062], p = 0.001); whereas the number of male sexual partners (marginal effect = 0.003 [95% CI: 0.000, 0.005], p = 0.034) and a subjective assessment of being very high risk of HIV infection (vs. low and no risk, marginal effect size = 0.105 [95% CI: 0.012, 0.198], p = 0.027) were associated with increased preference for daily versus on-demand PrEP. Among the 1933 potential participants, 721 (37.3%) did not attend the subsequent on-site screening. Lower-income, lower education level, lower subjective expected risk of HIV infection risk and younger age positively correlated with the absence of on-site screening. CONCLUSIONS: MSM in China prefer both daily and on-demand PrEP when both regimens are provided free. Social structural factors and subjective risk of HIV infection have significant impacts on PrEP preference and use. The upcoming national PrEP guideline should consider incorporating both regimens and the correlates to help implement PrEP in China.

  PublisherDOI

• Telehealth Payment Parity and Outpatient Service Utilization: Evidence from Privately Insured Workers

  UNC Libraries · 2025-05-02

  articleOpen accessSenior author

  Introduction Telehealth was catalyzed by the COVID-19 pandemic and has become a new norm in healthcare. In response to the pandemic, some states passed telehealth payment parity legislation, mandating equal payment rates for telehealth and in-person services. We evaluated the relationship between telehealth payment parity and health service utilization, focusing on insured workers in commercial insurance plans. Method Using the Merative Commercial Claims and Encounters database from 2019 to 2021, we leverage variation in the timing of policy changes across states using a Difference-in-Difference approach. Results Payment parity was significantly associated with increased telehealth visits and total outpatient visits, but without a notable rise in in-person visits. Furthermore, payment parity was pronounced in increasing telehealth utilization within self-funded large employer plans, while not significantly associated with telehealth visits among fully insured small employer plans. Conclusion Our findings underscore the important role of the payment parity in increasing telehealth service utilization by incentivizing providers. Future policies should support the sustainable integration of telehealth services, shifting from solely focusing on equal payment rates to adopting value-based reimbursement models that improve equitable healthcare access for all employees in commercial insurance.

  PublisherDOI

• Mechanisms explaining a pay-it-forward approach: A qualitative analysis among men who have sex with men in China

  UNC Libraries · 2025-04-12

  articleOpen access
  PublisherDOI

• Opening the “Black Box”: A Conversation with Microsoft’s Rich Caruana About AI in Health Care

  North Carolina Medical Journal · 2024-07-11 · 1 citations

  articleOpen access1st authorCorresponding

  By Sean Sylvia. “Statisticians have figured out how to build a class of machine learning models that are just as accurate but are completely interpretable...[putting] the human expert back in the loop.”

  PublisherOA PDFDOI

• Primary care quality and provider disparities in China: a standardized-patient-based study

  The Lancet Regional Health - Western Pacific · 2024-08-23 · 13 citations

  articleOpen accessSenior author

  Background: Primary health care is the foundation of high-performing health systems. Achieving an improved primary care system requires a thorough understanding of the current quality of care among various providers within the system. As the world's largest developing country, China has made significant investments in primary care over the past decade. This study evaluates the quality of primary care across different provider types in China, offering in-sights for enhancing China's primary care system. Methods: We merged data from four standardized patient (SP) research projects to compare the quality of five major primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health cen-ters (CHCs), and online platforms. We evaluated quality of care across process quality (e.g., checklist completion), diagnosis quality (e.g., diagnostic accuracy), and case management (e.g., correct medication), employing multiple regression analyses to explore quality differences by provider type, and their associations with physician characteristics. Findings: We document a poor quality of primary care in China, with no-table disparities across different providers. CHCs emerge as relatively reliable primary care providers in terms of process quality, diagnostic accuracy, and cor-rect medication prescriptions. Online platforms outpace rural clinics, county hospitals, and migrant clinics in many areas, showcasing their potential to en-hance access to quality healthcare resources in under-resourced rural regions. We observe a positive association between the qualifications of physicians and the quality of primary care, underscoring the necessity for a greater presence of more highly qualified practitioners. Interpretation: Primary care quality in China varies greatly among providers, reflecting inequalities in healthcare access. While online platforms indicate po-tential for improving care in under-resourced areas, their high referral rates suggest they cannot completely substitute traditional care. The findings em-phasize the need for more qualified practitioners and stringent regulation to enhance care quality and reduce unnecessary treatments. Funding: No founders had a role in the study design, data collection, data analysis, data interpretation, or writing of the report. We have acknowledged this in the revised manuscript.

  PublisherDOI

Frequent coauthors

• Scott Rozelle

  Stanford University

  158 shared

• Huan Zhou

  Sichuan University

  90 shared

• Chengchao Zhou

  Shandong University

  58 shared

• Yaojiang Shi

  Shaanxi Normal University

  58 shared

• Sasmita Poudel Adhikari

  52 shared

• Hein Raat

  Erasmus MC

  52 shared

• Renfu Luo

  Peking University

  51 shared

• Alexis Medina

  Stanford University

  49 shared