Publications on Health Care Costs
RAND Health has been analyzing major issues related to public and private financing of health care since the program? inception in 1968. An early landmark study in this body of work is the RAND Health Insurance Experiment, still the largest health policy study in U.S. history. RAND work in this research area includes the organization and regulation of health care markets, the effects of population health on public financing, cost-effective allocation of private and public financing, and distributional issues in health and health care associated with health care financing, among others.
Selected Publications, 2007 to Present
2011
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in California: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in California through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Connecticut: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Connecticut through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Illinois: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Illinois through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Montana: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Montana through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Texas: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Texas through 2020.
2010
Analysis of the Affordable Health Care for America Act (H.R. 3962) — January 7, 2010
Using the COMPARE microsimulation model, estimates proposed health care reform legislation's effects on the number of uninsured, the costs to the federal government and the nation, revenues from penalty payments, and consumers' health care spending.
Analysis of the Patient Protection and Affordable Care Act (H.R. 3590) — February 11, 2010
Using the COMPARE microsimulation model, estimates the effects of the Patient Protection and Affordable Care Act (H.R. 3590) on the number of uninsured, the costs to the federal government and the nation, and consumers' health care spending.
Cost-effectiveness of Shared Pharmaceutical Care for Older Patients: RESPECT Trial Findings — January 1, 2010
An economic evaluation was undertaken in which NICE reference case standards were applied to data collected in the RESPECT trial.
Could We Have Covered More People at Less Cost? Technically, Yes; Politically, Probably Not — January 1, 2010
Using the COMPARE (Comprehensive Assessment of Reform Efforts) microsimulation model, this study evaluated how the recently enacted health reform law performed compared with alternative designs on measures of effectiveness and efficiency and found that only a few different approaches would cover more individuals at a lower cost to the government; however, these appeared politically untenable because they included substantially higher penalties, lower subsidies, or less generous Medicaid expansion.
Coverage, Spending, and Consumer Financial Risk: How Do the Recent House and Senate Health Care Bills Compare? — February 12, 2010
Compares how two health care reform bills, HR. 3962 and H.R. 3590, passed by the U.S. House and Senate, respectively, in late 2009 compare on a variety of projections made using the RAND COMPARE microsimulation model.
Does Price Transparency Legislation Allow the Uninsured to Shop for Care? — February 1, 2010
Assesses the response rate of California hospitals to a patient price request and compares the price estimates received to Medicare reimbursement.
The Effects of the Affordable Care Act on Workers' Health Insurance Coverage — September 1, 2010
The nature of employer-sponsored coverage may change substantially after implementation of the Patient Protection and Affordable Care Act, with an increase in the number of workers offered coverage through the health insurance exchanges.
Establishing State Health Insurance Exchanges: Implications for Health Insurance Enrollment, Spending, and Small Businesses — August 11, 2010
The Patient Protection and Affordable Care Act will increase insurance offer rates at small businesses. By 2016, rates would increase from 53 to 77 percent at firms with ten or fewer workers and from 71 to 90 percent at firms with 11 to 25 workers.
Feasibility and Design Options for a Potential Entity to Research the Comparative Effectiveness of Medical Treatments — January 15, 2010
The options available to Massachusetts as it considers establishing a comparative effectiveness center to guide health care purchasing decisions are feasible, but design decisions depend on the prioritization of comparative effectiveness research.
Grandfathering in the Small Group Market Under the Patient Protection and Affordable Care Act: Effects on Offer Rates, Premiums, and Coverage — June 2, 2010
To avoid changes in current health coverage, the Patient Protection and Affordable Care Act exempts existing plans from some regulations. These exemptions may lead to higher employer-sponsored insurance enrollment and lower government spending.
Medicare Facts and Figures Chartbook — May 3, 2010
Provides a factual framework to help consumer advocates, health care providers, and policymakers better understand California's Medicare population and inform their efforts to design programs and policies that meet beneficiaries' needs.
Modify Federal Tax Code to Create Incentives for Individuals to Obtain Coverage — January 8, 2010
This document explores how a refundable tax credit to offset the cost of health insurance premiums would affect health system performance along nine dimensions.
Wrestling with the High Price of Cancer Care: Should We Control Costs By Individuals' Ability to Pay or Society's Willingness to Pay? — January 1, 2010
Rising costs of cancer treatment raise questions about how to ensure that patients receive access to the best therapy that is a
2009
Controlling Health Care Spending in Massachusetts — September 10, 2009
In 2006, Massachusetts passed landmark legislation ensuring near-universal health insurance coverage to its residents, but rising costs threaten the initiative; this policy brief assesses 21 options for controlling health care spending in the state.
Controlling Health Care Spending in Massachusetts: An Analysis of Options — August 17, 2009
Presents a comprehensive menu of cost containment strategies and options and determines their potential effect on Massachusetts' health care system.
Create or Expand Access to Purchasing Pools — October 12, 2009
This document explores how creating or expanding access to purchasing pools would affect health system performance along nine dimensions.
Expand the Use of Disease Management Programs — October 12, 2009
This document explores how increased use of disease management programs would affect health system performance along nine dimensions.
Increase Cost-Participation by Employees (e.g., Through High-Deductible Health Plans) — October 12, 2009
This document explores how increased cost participation by employees would affect health system performance along nine dimensions.
Increase the Use of Comparative Effectiveness — October 12, 2009
The RAND Corporation's COMPARE initiative provides information and tools to help policymakers, the media, and others understand, design, and evaluate health care policies.
Insurer Bargaining and Negotiated Drug Prices in Medicare Part D — January 1, 2009
The authors test whether insurers that experience larger enrollment increases due to Medicare Part D negotiate lower drug prices with pharmacies. Overall, the authors find that 100,000 additional insureds lead to 2.5-percent lower pharmacy prices negotiated by the insurer, and 5-percent reductions in pharmacy profits earned on prescriptions filled by enrollees of that insurer.
Possible Outcomes of Comparative Effectiveness Research — July 8, 2009
With substantial support across the political spectrum, the Obama administration has included in the American Recovery and Reinvestment Act more than $1 billion to support comparative effectiveness research.
Prescription Drug Cost Sharing: A Powerful Policy Lever to Use with Care — October 21, 2009
Describes the effects that prescription drug cost sharing has on drug spending, compliance with drug therapy, patient health, and overall health care costs.
RAND COMPARE: Understanding the Effects of Health Care Reform from a National Perspective — August 28, 2009
Provides an overview of COMPARE and shows the estimated effect of four policies: employer mandates, Medicaid and SCHIP expansions, individual mandates, and refundable tax credits.
The Science of Health Care Reform — June 17, 2009
Another health policy window has opened; through it will stream proposals to reform the US health care system. President Obama has demanded that reform proposals improve both coverage and quality of care and make health care more affordable for all Americans. Extending coverage without worrying about costs would be relatively easy. Improving quality of care without worrying about costs might also be achievable. But extending coverage and improving quality while also making coverage more affordable will be difficult.
When Drug Cost-Sharing Increases, Patients Newly Diagnosed with a Chronic Illness Delay Starting Medication — June 29, 2009
Describes a study showing that increasing copayments for prescription drugs causes patients newly diagnosed with hypertension, high cholesterol, and diabetes to delay starting treatment, which in turn increases their risk for heart attack and stroke.
2008
High-deductible Health Plans and Better Benefit Design — May 1, 2008
Advocates of high-deductible health plans, which shift more of the cost of care to individuals, believe that consumers will more carefully assess the balance of health care benefits versus costs, ultimately improving efficiency and quality of care.
Hospital Pricing and the Uninsured: Do the Uninsured Pay Higher Prices? — January 1, 2008
Uses data from California to compare actual prices paid by uninsured patients with prices paid by commercial and Medicare patients. Uninsured patients pay prices similar to those of Medicare patients, and hospital prices to the uninsured have risen.
Identity Crisis? Approaches to Patient Identification in a National Health Information Network — October 8, 2008
This research brief summarizes an analysis and comparison of two methods of patient identification -- statistical matching and unique patient identifier -- on error rates, operational efficiency, costs, and privacy and security issues.
Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System — September 21, 2008
This monograph examines the operational advantages and disadvantages, compares the errors, examines the costs, and discusses the privacy issues associated with the unique patient identifier and with statistical matching based on personal attributes.
Modeling the Health and Medical Care Spending of the Future Elderly — March 9, 2008
This research brief summarizes studies showing that medical innovations will improve health and extend life but will likely increase Medicare spending; eliminating obesity and better prevention could save Medicare money and improve health.
2007
Consumer-Directed Health Care: Early Evidence Shows Lower Costs, Mixed Effects on Quality of Care — February 8, 2007
This research brief summarizes research on the effect of enrollment in consumer-directed health care (involving plans with high deductibles -- $1,000 or more annually) on the use, cost, and quality of medical care.
The Effects of Health Sector Market Factors and Vulnerable Group Membership on Access to Alcohol, Drug, and Mental Health Care — June 1, 2007
Uses Andersen's Behavioral Model to see if health sector market conditions affect vulnerable subgroups' use of ADM differently than general population
The Effects of Multi-Hospital Systems on Hospital Prices — March 1, 2007
U.S. hospital prices are rising again after years of limited growth.
Partially Capitated Managed Care Versus FFS for Special Needs Children — January 1, 2007
Little research has examined whether MCPs that incorporate case management are effective in coordinating services for CSHCN.
The Promise of Health Care Cost Containment — January 1, 2007
Today the United States may be on the cusp of changing from a cost-unconscious health care system to one that seeks value.
State Insurance Mandates and Consumer-Directed Health Plans: Are They Helping Small Business Provide Health Insurance to Employees? — December 5, 2007
This research brief describes the effects of state health-insurance mandates and consumer-directed health plans (CDHPs) on the access to and affordability of health insurance for small businesses.
The Welfare Effects of Public Drug Insurance — January 1, 2007
Rewarding inventors with inefficient monopoly power has long been regarded as the price of encouraging innovation.
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