Emmett B. Keeler

Knowing When to Say Yes to Medical Technology

CT lung cancer screening turns out to be like many new medical technologies: It improves health but is quite expensive. Moreover, it needs implementation that targets those most likely to benefit and provides them the care they need efficiently.

Journal Article

Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery at a Safety-Net Health System

To evaluate a multipronged intervention to reduce low-value preoperative care for patients undergoing cataract surgery and analyze costs from various fiscal perspectives.

Journal Article

Simulated Effects of Policies to Reduce Diabetes Risk Among Adults With Schizophrenia Receiving Antipsychotics

Policies to promote early diabetes detection among Medicaid patients receiving antipsychotic medication could reduce the rate of diabetes over ten years, but would likely require higher spending.

Journal Article

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission: A Systematic Review and Meta-analysis

Many interventions reduce hospital readmissions, but not all generate cost savings, and many readmissions are in the patients' best interests and not avoidable.

Journal Article

Quality Improvement Interventions for Bloodstream Infections Related to Central Catheters: A Systematic Review

Interventions related to central venous catheters were, on average, associated with 57% fewer bloodstream infections among acute care patients and substantial savings to hospitals.

Journal Article

Development of an Algorithm to Identify Fall-Related Injuries and Costs in Medicare Data

We developed a comprehensive four-step algorithm for identifying episodes of care for fall-related injuries and associated costs, using fee-for-service Medicare and Medicare Advantage health plan claims data for 2,011 patients from 5 medical groups between 2005 and 2009.

Journal Article

Cost-effectiveness of Nutrition Intervention in Long-Term Care

This study aims to determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight.

Draft

Implementing Computerized Provider Order Entry in Acute Care Hospitals in the United States Could Generate Substantial Savings to Society: Methodological Appendix

Methodological appendix to the journal article, "Implementing Computerized Provider Order Entry in Acute Care Hospitals in the United States Could Generate Substantial Savings to Society."

Journal Article

Cost Effectiveness of Nonoperative Management Versus Laparoscopic Appendectomy for Acute Uncomplicated Appendicitis

Appendectomy remains the gold standard in the treatment of acute, uncomplicated appendicitis in the United States.

Journal Article

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

Despite previous studies demonstrating no difference in mortality or morbidity, the various surgical approaches for necrotizing enterocolitis (NEC) in infants have not been evaluated economically.

Journal Article

Cost-effectiveness of CT Screening in the National Lung Screening Trial

CT screening reduced death from lung cancer by 20% during a 6 year trial among heavy smokers age 50-74; the cost was about $81,000/QALY gained. If screening is extended to not-so-heavy smokers, its value falls dramatically, and radiation risks may outweigh screening gains.

Journal Article

Randomized Clinical Trial of an Emergency Department Observation Syncope Protocol Versus Routine Inpatient Admission

Older adults are frequently hospitalized from the emergency department (ED) after an episode of unexplained syncope. We hypothesize that an emergency department observation syncope protocol will reduce resource use without adversely affecting patient-oriented outcomes.

Research Brief

Healing Medical Product Innovation

Identifies promising policy options to spur the creation of new medical technologies that will reduce total U.S. health care spending or will provide health benefits that justify any increase in spending.

Report

Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value

This report identifies promising policy options to spur the creation of new medical technologies that will reduce total U.S. health care spending or will provide health benefits that justify any increase in spending.

Journal Article

The Value of Health Information Technology: Filling the Knowledge Gap

Despite rapid growth in the rate of adoption of health information technology, and in the volume of evaluation studies, the existing knowledge base for the value of health IT is not advancing at a similar rate.

Journal Article

Can Quality-Adjusted Life-Years and Subgroups Help Us Decide Whether to Treat Late-Arriving Stroke Patients with Tissue Plasminogen Activator?

Treatment of stroke patients is highly time-sensitive. The risk of death or disability caused by intracranial hemorrhage may increase with both stroke size and time.

Journal Article

A Graphical Method for Assessing Risk Factor Threshold Values Using the Generalized Additive Model: The Multi-Ethnic Study of Atherosclerosis

In this paper, we suggest approaching the estimation of risk factors on health with the use of a semi-parametric method and visualization for improvement of the threshold selection in variable dichotomization while accounting for mixture distributions in the outcome of interest and adjusting for covariates.

Journal Article

A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

This study evaluates the effects of a multicomponent intervention to reduce fecal incontinence and urinary incontinence.

Journal Article

A Cost-Effectiveness Analysis of a Proposed National Falls Prevention Program

This systematic review found that paying for a fall prevention program to increase the use of evidence-based interventions would be a cost-effective use of Medicare dollars.

Journal Article

General Cardiovascular Risk Profile Identifies Advanced Coronary Artery Calcium and Is Improved by Family History: The Multiethnic Study of Atherosclerosis

The research goal was to assess the ability of the General Cardiovascular Risk Profile to identify individuals with advanced coronary artery calcification, and determine whether identification is improved with family history.

Journal Article

The Impact of Functional Status on Life Expectancy in Older Persons

Functional status has a dramatic impact on life expectancy. 75-year-olds without limitations can expect to live 5 years longer than those with limitations in performing daily activities and more than 1 year longer than those with limited mobility.

Draft

Overview of the COMPARE Microsimulation Model

To enhance the assessment of proposals to reform U.S. health policy, RAND researchers created the COMPARE microsimulation model, which develops a synthetic U.S. population and projects how it would respond to a variety of coverage-oriented options.

Journal Article

Waste in the U.S. Health Care System: A Conceptual Framework

Proposes a conceptual framework to guide researchers and policymakers in evaluating waste in the U.S. health care system, implementing waste-reduction strategies, and reducing the burden of unnecessary health care spending.

Journal Article

Prevention of Unintentional Weight Loss in Nursing Home Residents: A Controlled Trial of Feeding Assistance

Twice-daily feeding assistance promotes food and fluid intake and weight gain in nursing home residents at risk for weight loss. Delivery of snacks between meals requires less staff time than at mealtime and thus may be more practical to implement.

Research Brief

Modeling the Health and Medical Care Spending of the Future Elderly

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.

Journal Article

Attrition in the RAND Health Insurance Experiment: A Response to Nyman

The authors obtained follow-up health-status data on the great majority of those who left prematurely. The authors found the health-status findings were insensitive to the inclusion of the attrition cases.

Journal Article

Medicare HMO Impact on Utilization at the End of Life

Medicare beneficiaries who died while enrolled in independent practice association model HMOs, including the Kaiser model, had many fewer hospital days during the two years before death than beneficiaries who died with fee-for-service coverage.

Journal Article

Relation of Familial Patterns of Coronary Heart Disease, Stroke, and Diabetes to Subclinical Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis

Investigate the possibility that family history beyond early-onset coronary heart disease might contribute to coronary heart disease susceptibility, the authors studied associations between additional family history and the coronary artery calcium score.

Research Brief

Estimating the Global Health Impact of Improved Diagnostic Tools for the Developing World

This research brief summarizes research assessing how higher-quality and more-accessible clinical diagnostic tests could improve health outcomes in the developing world for a number of common diseases.

Periodical

RAND Review: Vol. 31, No. 2, Summer 2007

Feature stories discuss the precarious posture taken by the world toward Afghanistan, lessons for the U.S. National Guard from Hurricane Katrina, and competing claims stoked by the RAND Health Insurance Experiment.

Journal Article

The Effects of Multi-Hospital Systems on Hospital Prices

U.S. hospital prices are rising again after years of limited growth.

Journal Article

Can a Chronic Care Model Collaborative Reduce Heart Disease Risk in Patients with Diabetes?

There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes.

Journal Article

Elderly Patients' Preferences and Experiences with Providers in Managing Their Drug Costs

Federal employee plans were more likely to augment managed care through contracts with managed behavioral health carve-out firms after parity.

Journal Article

Identifying Widely Covered Drugs and Drug Coverage Variation Among Medicare Part D Formularies

Clinicians find it difficult to know which drugs are covered for their Medicare patients because formularies vary widely among Medicare Part D plans

Journal Article

Predicting Outcomes of Primary Care Patients with Major Depression: Development of a Depression Prognosis Index

The ability of the DPI to predict six-month outcomes compares favorably to that of prognostic indices for general medical problems.

Research Brief

The Health Insurance Experiment: A Classic RAND Study Speaks to the Current Health Care Reform Debate

This research brief summarizes the main findings of the RAND Health Insurance Experiment and clarifies its relevance for today's health care debate.

Draft

Determining the Priority Global Health Needs and Quantifying the Health Benefits Resulting From the Introduction of New Diagnostics in the Developing World

This working paper provides technical material to support Girosi F, Olmsted S et al. Developing and interpreting models to improve diagnostics in developing countries. Nature. S1 3-8 (2006).

Draft

A Technical Supplement: Reducing the Global Burden of Tuberculosis: The Contribution of Improved Diagnostics

This working paper provides technical material to support Keeler E, Mark D Perkins, Peter Small et al. Reducing the Global Burden of Tuberculosis. Nature. S1 49-57 (2006).

Research Brief

Effects of Medicare's Prospective Payment System on the Quality of Hospital Care

This research brief summarizes a study of how Medicare's prospective payment system (PPS) affected the quality of care for hospitalized Medicare patients.

Journal Article

Costs and Benefits of Health Information Technology

Health Information Technology has the potential to enable a dramatic transformation in the delivery of health care, making it safer, more effective, and more efficient.

Journal Article

Developing and Interpreting Models to Improve Diagnostics in Developing Countries

In this paper, the authors outline an approach for modelling the health benefits of new diagnostic tools.

Journal Article

Implementation and Maintenance of Quality Improvement for Treating Depression in Primary Care

There was evidence of broad success at implementation and maintenance of quality improvement for depression treatment in primary care.

Journal Article

Is Cataract Surgery Cost-Effective Among Older Patients with a Low Predicted Probability for Improvement in Reported Visual Functioning

Although cataract surgery has been demonstrated to be cost-effective, 5% to 20% of patients do not benefit functionally from the procedure.

Journal Article

Reducing the Global Burden of Tuberculosis: The Contribution of Improved Diagnostics

The authors estimated the impact of hypothetical new diagnostic tests for tuberculosis (TB) in patients with persistent cough in developing countries.

Research Brief

Will Smallpox Vaccinations Save Lives?

To prevent significant loss of life in the event of a smallpox bioterrorist attack, should smallpox vaccination be reintroduced?

Research Brief

Future Health and Medical Care Spending of the Elderly: Implications for Medicare

A team of economists and physicians explored how changes in medical technology, disease, and disability would affect health care spending for the population age 65 and older.

Journal Article

The Lifetime Burden of Chronic Disease Among the Elderly

The high costs of treating chronic diseases suggest that reducing their prevalence would improve Medicare's financial stability.

Draft

A Meta-Analysis of Interventions to Improve Chronic Illness Care: Technical Appendix

This appendix contains the evidence tables, sensitivity analyses, and references to accompany the paper

Report

Does the Collaborative Model Improve Care for Chronic Heart Failure?

This paper evaluates the effects of the Institute of Healthcare Improvement’s Breakthrough Series (IHI BTS) on quality of care for chronic heart failure (CHF).

Journal Article

A Meta-Analysis of Interventions to Improve Care for Chronic Illnesses

Interventions that contain at least 1 CCM element improve clinical outcomes and processes of care.

Draft

Costs and Effects of Participation in Collaboratives to Improve Chronic Illness Care: Technical Appendix

Costs and Effects of Participation in Collaboratives to Improve Chronic Illness Care: Technical Appendix

Draft

Assessing the Implementation of the Chronic Care Model in Quality Improvement Collaboratives: Methods Appendix

Technical (Methods) Appendix to Assessing the Implementation of the Chronic Care Model in Quality Improvement Collaboratives (Health Services Research)

Draft

Measuring the Effectiveness of a Collaborative for Quality Improvement in Pediatric Asthma Care: Does Implementing the Chronic Care Model Improve Processes and Outcomes of Care?: Technical Appendix

Technical appendix to the journal article, "Measuring the Effectiveness of a Collaborative for Quality Improvement in Pediatric Asthma Care: Does Implementing the Chronic Care Model Improve Processes and Outcomes of Care?" (Ambulatory Pediatrics)

Journal Article

Assessing the Implementation of the Chronic Care Model in Quality Improvement Collaboratives

QI collaboratives are a useful method to foster change in real world settings.

Journal Article

Evaluation of a Quality Improvement Collaborative in Asthma Care: Does It Improve Processes and Outcomes of Care?

The authors examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults.

Report

Evaluation of a Quality Improvement Collaborative in Asthma Care: Does it Improve Processes and Outcomes of Care?

Examines whether clinics that participated in the Institute for Healthcare Improvement Breakthrough Series Collaborative for asthma care improved the process and outcomes of care in asthmatic adults.

Journal Article

How Do Ethnicity and Primary Language Spoken at Home Affect Management Practices and Outcomes in Children and Adolescents with Asthma?

Examines the effects of language on asthma management practices and asthma-related outcomes.

Journal Article

Measuring the Effectiveness of a Collaborative for Quality Improvement in Pediatric Asthma Care: Does Implementing the Chronic Care Model Improve Processes and Outcomes of Care?

Patients who received care at intervention clinics also reported higher general and asthma-specific quality of life.

Journal Article

A Telephone Survey to Measure Communication, Education, Self-Management, and Health Status for Patients with Heart Failure: The Improving Chronic Illness Care Evaluation (ICICE)

Many aspects of quality of care for heart failure cannot be reliably obtained by chart review.

Draft

The Effect of HMOs on the Inpatient Utilization of Medicare Beneficiaries: Technical Appendix

In this Appendix, we explain and justify our analytic approach to estimating the pure managed care effect of Medicare HMOs.

Report

Möglichkeit oder Utopie? (Possibility or Utopia?): Wahlfreiheit im Gesundheitswesen Eine Literaturübersicht (Consumer Choice in Health Care: A Literature Review)

This literature review examines consumer choice in health insurance plans against the background of the German health system to examine models of consumer choice.

Report

Possibility or Utopia? Consumer Choice in Health Care: A Literature Review

This literature review examines consumer choice in health insurance plans against the background of the German health system to examine models of consumer choice and their effects anddescribes the health economics theory of consumer choice, the methodology for the literature review, the German health system, and studies on consumer choice of insurers and providers, and reflects on their relevance on the German system.

Journal Article

Cognitive Decline in High-Functioning Older Persons Is Associated with an Increased Risk of Hospitalization

High-functioning older persons who experienced decline in overall cognitive function were more likely to be hospitalized.

Journal Article

Cost-lowering Strategies Used By Medicare Beneficiaries Who Exceed Drug Benefit Caps and Have a Gap in Drug Coverage

Health professionals need to explore how they can lessen the impact of caps on patients' health and financial burden.

Report

Cross-Validation Performance of Mortality Prediction Models

Cross-Validation Performance of Mortality Prediction Models

Report

Differences in Quality of Care for Hospitalized Elderly Men and Women

Differences in Quality of Care for Hospitalized Elderly Men and Women

Journal Article

The Effect of HMOs on the Inpatient Utilization of Medicare Beneficiaries

To determine the effect of joining HMOs (health maintenance organizations) on the inpatient utilization of Medicare beneficiaries.

Journal Article

The Effect of Self-Reported and Performance-Based Functional Impairment on Future Hospital Costs of Community-Dwelling Older Persons

The authors determined the prognostic value of self-reported and performance-based measurement of function on utilization.

Journal Article

An Evaluation of Collaborative Interventions to Improve Chronic Illness Care: Framework and Study Design

When analyzed, these data will shed new light on the effectiveness of collaborative improvement methods and the CCM.

Report

Hospital Characteristics and Quality of Care

This study compares quality of care measured by explicit criteria, implicit review, and sickness-adjusted outcomes at different types of hospitals.

Journal Article

Refining the Categorization of Physical Functional Status: The Added Value of Combining Self-Reported and Performance-Based Measures.

When considered individually, self-reported functional status and performance-based functional status predict functional status decline and mortality.

Journal Article

An Analysis of Unobserved Selection in an Inpatient Diagnostic Cost Group Model

Models that better captures selection bias are needed to reduce overestimation of Medicare HMO enrollees' resource use.

Journal Article

Assessing the Implementation of the Chronic Care Model in Quality Improvement Collaboratives: Does Baseline System Support for Chronic Care Matter?

Little is known about the implementation of collaborative processes or organizational change activities motivated by collaborative participation.

Journal Article

Development and Validation of a Grading System for the Quality of Cost-Effectiveness Studies

To provide a practical quantitative tool for appraising the quality of cost-effectiveness (CE) studies.

Journal Article

Identification of Risk for High Hospital Use: Cost Comparisons of Four Strategies and Performance Across Subgroups

A sequential screening strategy that administers laboratory tests selectively is slightly less expensive than one that uses only self-report items.

Journal Article

Impact of an Annual Dollar Limit or Cap on Prescription Drug Benefits for Medicare Patients

At lower caps, a substantial proportion of Medicare patients exceeded their annual drug benefit.

Journal Article

Medicare Calibration of the Clinically Detailed Risk Information System for Cost

The R 2 for the CD-RISC model is 11 percent.

Journal Article

A Model for a Smallpox-Vaccination Policy

The new reality of biologic terrorism and warfare has ignited a debate about whether to reintroduce smallpox vaccination.

Journal Article

Postpartum Length of Stay and Newborn Health: A Cost-Effectiveness Analysis

To evaluate the cost-effectiveness of increasing lengths of brief postpartum hospitalizations.

Journal Article

Development of a Method to Identify Seniors at High Risk for High Hospital Utilization

A small percentage of older persons account for most Medicare costs.

Journal Article

Do Patient Consent Procedures Affect Participation Rates in Health Services Research?

Few studies have examined the effects of Institutional Review Board (IRB) requirements to contact potential research participants.

Journal Article

The Value of Remaining Lifetime Is Close to Estimated Values of Life

Workers under 50 on average will spend 10-20% of their future hours working.

Journal Article

A Clinically Detailed Risk Information System for Cost

The authors discuss a system that describes the resources needed to treat different subgroups of the population under age 65, based on burden of disease.

Journal Article

Costs and Cost-Effectiveness of a Church-Based Intervention to Promote Mammography Screening

A church-based program to promote the use of mammography would be feasible for many churches with the use of volunteer labor and resources.

Research Brief

Extending Health Care Insurance to Specific Populations: Profile of RAND Work

In a series of studies, we have assessed the cost and consequences of various approaches to providing coverage for these groups (children, employees in small businesses, substance abusers, the uninsured, and the near-elderly).

Journal Article

Infant Mortality and Early Postpartum Discharge

To assess additional risk of newborn death owing to early discharge.

Journal Article

Lack of Progress in Labor as a Reason for Cesarean

Lack of progress in labor is a dominant reason for cesarean delivery.

Journal Article

Should Patients in Quality-Improvement Activities Have the Same Protections as Participants in Research Studies?

Protecting patients in local efforts to improve quality of care and propose criteria that extend current research protections to such QI studies.

Journal Article

Simulating the Impact of Medical Savings Accounts on Small Business

Our simulations suggest that MSAs will provide a limited impetus to businesses that do not currently cover insurance.

Journal Article

The Changing Effects of Competition on Non-Profit and For-Profit Hospital Pricing Behavior

This paper uses time-series cross-sectional methods on California hospital discharge data from 1986-1994 to show the association of hospital prices with measures of market concentration changed steadily over this period.

Journal Article

Cost-effectiveness of Outpatient Geriatric Assessment with an Intervention to Increase Adherence

The CE of this program compares favorably with many common medical interventions.

Journal Article

Market Power and Hospital Pricing: Are Nonprofits Different?

Dramatic changes in hospitals' operating environments are leading to major restructuring of hospital organizations.

Report

Relationship Between Age and Patients' Current Health State Preferences

Explores age differences in preferences for current health states, which is one way to measure trade-offs between "quantity of life" and the "quality" of those health states.

Draft

Medicare MSA Issues and Options

This report contains memos written by RAND on the topic of Medical Savings Account (MSA) products. Some memos provide background information on MSAs, while others address specific strengths, weaknesses, or implementation problems.

Journal Article

A Model of the Impact of Reimbursement Schemes on Health Plan Choice

Flat capitation (uniform prospective payments) makes enrolling healthy enrollees profitable to health plans.

Report

Adjusting cesarean delivery rates for case mix

Adjusting cesarean delivery rates for case mix

Journal Article

Correlates of Hypoalbuminemia in Community-Dwelling Older Persons

National Health and Nutrition Examination Survey is used to identify sociodemographic and health characteristics associated with hypoalbuminemia.

Report

Long-Term Care Residents' Preferences for Health States on the Quality of Well-Being Scale

The aim of this study was to compare preferences of a long-term care population with those of the general population.

Report

Can medical savings accounts for the nonelderly reduce health care costs?

Can medical savings accounts for the nonelderly reduce health care costs?

Journal Article

Postdischarge Geriatric Assessment of Hospitalized Frail Elderly Patients

Reports on a randomized trial of comprehensive geriatric assessment intervention for frail older patients that is started before hospital discharge and is continued at home.

Journal Article

The Validity of a Nursing Assessment and Monitoring of Signs and Symptoms Scale in ICU and Non-Icu Patients

Validity of medical-record-based nursing assessment and monitoring of signs and symptoms in predicting patients admitted to ICUs and to non-ICUs.

Report

Benefits and costs of screening and treatment for early breast cancer : development of a basic benefit package

Benefits and costs of screening and treatment for early breast cancer : development of a basic benefit package

Journal Article

A Cost and Value Analysis of Two Interventions with Incontinent Nursing Home Residents

Analyzes the cost and value of implementing two interventions that have been shown to improve functional status in incontinent nursing home residents.

Journal Article

Cost-effectiveness of Low-Air-Loss Beds for Treatment of Pressure Ulcers

Examines the cost-effectiveness of low-air-loss beds for the healing of pressure ulcers in nursing homes.

Journal Article

The Cost Effectiveness of Preoperative Autologous Blood Donations

A decision-analysis model assessed the cost-effectiveness of donating autologous blood for four surgical interventions. Results indicated that substituting autologous for community blood resulted in little expected health benefits at considerable additional cost. The additional cost was primarily a function of discarding the units that were donated but not transfused and of a more labor-intensive donation process (autologous donors are typically less healthy than regular donors, and so take longer to give blood).

Journal Article

A Model of Demand for Effective Care

Presents a simple model intended to understand the potential gains of reducing ineffective care.

Journal Article

Reductions in Cost and Cesarean Rate by Routine Use of External Cephalic Version: A Decision Analysis

More than 80 percent of breech infants are currently delivered by cesarean section. This article describes the accepted methods for managing the term breech pregnancy and uses decision analysis to predict the cost of four methods of delivery.

Draft

Cost Effectiveness Principles and Controversies

Cost Effectiveness Principles and Controversies

Report

Economic incentives in the choice between vaginal delivery and cesarean section

Economic incentives in the choice between vaginal delivery and cesarean section

Journal Article

Effect of Epidural Analgesia for Labor on the Cesarean Delivery Rate

The results of this meta-analysis strongly support an increase in cesarean delivery associated with epidural analgesia.

Report

Health care for black and poor hospitalized Medicare patients

Health care for black and poor hospitalized Medicare patients

Report

Assessing the Performance of Mortality Prediction Models: Final Report for HCFA Severity Project

Concerns about the cost and quality of health care have resulted in a national effort to determine the health outcomes of medical and surgical services.

Report

Analysis of Quality of Care for Patients Who are Black and Poor in Rural and Urban Settings

This study finds racial and financial characteristics influence the quality of care received by acutely ill, insured patients after hospital admission.

Journal Article

Quality of Care for Hospitalized Depressed Elderly Patients Before and After Implementation of the Medicare Prospective Payment System

The authors evaluated the impact of Medicare's Prospective Payment System on aspects of quality of care and outcomes for depressed elderly inpatients in acute-care general medical hospitals.

Report

Simulating health expenditures under alternative insurance plans

Simulating health expenditures under alternative insurance plans

Report

Assessing Quality of Care for Hospitalized Medicare Patients with Hip Fracture Using Coded Diagnoses from the Medicare Provider Analysis and Review Files

HCFA developed a method for assessing quality of care for surgical patients using claims data. Coded diagnoses in the current or future admissions might indicate problems.

Report

Choosing Quality-of-Care Measures Based on the Expected Impact of Improved Quality of Care for the Major Causes of Mortality and Morbidity

This report presents an approach for selecting medical conditions for measuring technical quality of care, based on the expected impact of improved quality of care.

Draft

Effects of air pollution on health outcomes

Effects of air pollution on health outcomes

Report

Effects of Cost Sharing on Use of Medical Services and Health

Summarizes the major findings of the RAND Health Insurance Experiment. It concludes that cost sharing reduced care but had little effect on health.

Report

The Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: Final Report

Assesses the quality of inhospital care for Medicare patients age 65 and over, before and after the implementation of PPS, and estimates the effects of the PPS intervention on quality of care, ...

Journal Article

HMO Vs Fee-for-Service Care of Older Persons with Acute Myocardial Infarction

Compares care for older patients with acute myocardial infarction in HMOs with their care under the fee-for-service system.

Journal Article

New Deales: Other Approximation of Life Expectancy

Describes how the Deale can be used to combine information about disease-related mortality and natural life expectancy to compute life expectancy for people with severe disease.

Report

Causes and Effects of Expensive Hospitalizations

Medicare's prospective payment system (PPS) pays hospitals a fixed amount per case to give them incentives to economize.

Commercial Book

The Costs of Poor Health Habits

The authors describe exactly how and to what extent drinking, smoking, and lack of exercise are currently subsidized, and make recommendations for reducing or reallocating the expense.

Report

The Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: Executive Summary

This report constitutes the executive summary of an evaluation of the impact of the DRG-based PPS system.

Report

Explaining Variations in Hospital Death Rates: Randomness, Severity of Illness, Quality of Care

Hospital death rates vary markedly, even for the same disease.

Journal Article

Changes in Sickness at Admission Following the Introduction of the Prospective Payment System

The authors developed disease-specific measures of sickness at admission based on medical record data to study mortality of Medicare patients.

Journal Article

Comparing Outcomes of Care Before and After Implementation of the DRG-based Prospective Payment System

The authors compared patient outcomes before and after the introduction of the diagnosis related groups (DRG)-based prospective payment system (PPS) in a nationally representative sample of 14,012 Medicare patients hospitalized in 1981 through 1982 and 1985 through 1986 with one of five diseases.

Journal Article

The Effects of the DRG-based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: An Introduction to the Series

Review of the medical record supplemented by data on postdischarge outcomes drawn from the files of the HCFA and fiscal intermediaries

Journal Article

Explaining Variations in Hospital Death Rates: Randomness, Severity of Illness, Quality of Care

Identifying hospitals that provide poor-quality care based on administrative data and single-year death rates is unlikely

Report

Explaining Variations in Hospital Death Rates: Randomness, Severity of Illness, Quality of Care

The authors used administrative (Part A Medicare) data to identify a representative sample of 1,126 patients with congestive heart failure and 1,150 with acute myocardial infarction in hospitals with significant unexpectedly high inpatient, ...

Journal Article

Measuring Quality of Care with Explicit Process Criteria Before and After Implementation of the DRG-based Prospective Payment System

Overall, process improvements across all four medical conditions were associated with a 1 percentage point reduction in 30-day mortality rates

Journal Article

Patterns of Outpatient Mental Health Care Over Time: Some Implications for Estimates of Demand and for Benefit Design

The article examines patterns of starting and continuing outpatient mental health care as a function of time.

Journal Article

Quality of Ambulatory Care: Epidemiology and Comparison By Insurance Status and Income

This study assessed levels of depressive symptomatology in a household probability sample of Mexico-born and U.S.-born Mexican Americans.

Journal Article

Quality of Care Before and After Implementation of the DRG-based Prospective Payment System: A Summary of Effects

In this article the authors report on a mortality analysis, patient and hospital subgroup comparisons, and time series studies they have conducted.

Report

Short-Term Health Effects of Air Pollution: A Case Study

Documents the findings of a study on the health effects of air pollution. The data on which the study is based were collected in Dayton, Ohio, in the Health Insurance Experiment conducted by RAND for the U.S. Department of Health and Human Services.

Report

A Summary of the Effects of DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients

The series of articles reports on the findings of a four-year evaluation, begun in 1985, of the effects on quality of care of the diagnosis-related-groups-based prospective payment system.

Report

Adjusting Capitation Rates Using Objective Health Measures and Prior Utilization

Several analysts have proposed adding adjusters based on health status and prior utilization to the adjusted average per capita cost formula. ... estimates how well such adjusters predict annual medical expenditures among non-elderly adults.

Report

Effects of Mental Health Insurance: Evidence from the Health Insurance Experiment

Using data from the RAND Health Insurance Experiment, the authors examined the effect of mental health insurance on individuals' mental health outcomes, use of mental health services, and economic welfare.

Journal Article

The External Costs of a Sedentary Life-Style

Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less pensions.

Journal Article

How Free Care Improved Vision in the Health Insurance Experiment

The authors studied reasons for the improvement in the functional vision of enrollees receiving free care in the Rand Health Insurance Experiment.

Report

Mandating Health Insurance Benefits for Employees: Effects on Health Care Use and Employers' Costs

Presents estimates of the increase in health services use and the increase in employers' liability for health care costs that would result from mandating employer health insurance.

Report

The Taxes of Sin: Do Smokers and Drinkers Pay Their Way?

Estimates the lifetime discounted costs that smokers and drinkers impose on others through collectively financed health insurance, pensions, disability insurance, group life insurance; fires; motor vehicle accidents;...

Report

The Demand for Episodes of Medical Treatment in the Health Insurance Experiment

This report contains a statistical and economic analysis of data on the demand for medical care from the RAND Health Insurance Experiment.

Report

Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment

This report examines the effects of varying levels of cost sharing on the demand for medical care and other health services.

Report

Insurance Aspects of DRG Outlier Payments

This Note characterizes the outlier payment formulas that minimize risk for hospitals under any fixed constraints on the sum of outlier payments and minimum hospital coinsurance rate.

Journal Article

Interpreting Hospital Mortality Data: How Can We Proceed?

Uses for data about whether patients live or die following short-term-care hospitalization

Journal Article

Effect of a Health Maintenance Organization on Physiologic Health: Results from a Randomized Trial

Authors conclude that the cost savings achieved by this HMO through lower hospitalization rates were not reflected in lower levels of health status.

Report

Effect of a Health Maintenance Organization on Physiologic Health: Results from a Randomized Trial

This report, which originally appeared in Annals of Internal Medicine, v. 106, no. 1, January 1987, presents results from analysis of data collected as part of the RAND Health Insurance Experiment.

Report

Effects of Cost Sharing on Physiological Health, Health Practices, and Worry

In a randomized trial of the effects of medical insurance on spending and the health status of the nonaged, the authors previously reported that patients with limited cost sharing had approximately one-third less use of medical services;...

Journal Article

Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment

The authors estimate how cost sharing, the portion of the bill the patient pays, affects the demand for medical services.

Report

Health Outcomes for Adults in Prepaid and Fee-for-Service Systems of Care: Results from the Health Insurance Experiment

... it has not been clear whether the cost reductions in HMOs, achieved largely by reductions in hospital admissions, have adverse effects on health.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 1, Overview of Chronic Disease in a General Adult Population

Combines information from the Health Insurance Experiment (HIE) on the prevalence, associated effects, and use of medical care for several important chronic conditions or impairments.

Report

The Demand for Episodes of Mental Health Services

Using data from the RAND Health Insurance Experiment, this report examines expenditures for mental health services to see whether demand for mental health services is more responsive to varying cost sharing, than is the demand for medical services.

Journal Article

The Effect of Cost Sharing on the Use of Medical Services by Children: Interim Results from a Randomized Controlled Trial

Health care expenditures of 1,136 children whose families participated in a randomized trial, The Rand Health Insurance Experiment, are reported.

Report

The Effect of Cost Sharing on the Use of Medical Services by Children: Interim Results from a Randomized Controlled Trial

This report, a shorter version of which appeared in the May 1985 issue of Pediatrics, considers how cost sharing affects the use of medical care by children under age 14.

Report

The Episodes-of-Illness Processing System

This Note documents the methods and assumptions used to process the expenditure claims of families and organize them into episodes which reflect the economics of participants' medical decisions.

Journal Article

How Free Care Reduced Hypertension in the Health Insurance Experiment

Free care also led to higher compliance by hypertensives with diet and smoking recommendations and higher use of medication by those who needed it.

Report

How Free Care Reduced Hypertension of Participants in the RAND Health Insurance Experiment

The cause of the difference was the additional contact with physicians under the free-care plan; this led to better detection and treatment of hypertensives not under care at the start of the study.

Report

The Effect of Coinsurance on the Health of Adults: Results from the RAND Health Insurance Experiment

Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost?

Journal Article

How Cost Sharing Reduced Medical Spending of Participants in the Health Insurance Experiment

In a controlled trial of the effects of medical insurance on spending and health status, less was spent on medical care when patients pay themselves.

Report

The Demand for Episodes of Medical Treatment: Interim Results from the Health Insurance Experiment

This report contains a statistical and economic analysis of data on the demand for medical care from the Health Insurance Experiment (HIE).

Report

Discounting of Nonmonetary Effects

Cost-effectiveness analysts generally assume that preferences over time are such that streams of monetary and nonmonetary program effects can be reduced to one discounted sum of monetary costs and another of effects.

Report

Some Interim Results from a Controlled Trial of Cost Sharing in Health Insurance

Interim results indicate that persons fully covered for medical services spend around 50 percent more than similar persons insured with an income-related catastrophic plan.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 13, Hay Fever

Reviews pertinent medical literature, details the HIS definition of hay fever, describes the HIS methods for measuring its presence and impact on people's lives, presents and discusses the enrollment data from the six HIS sites, and outlines ...

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 11, Hypercholesterolemia

Hypercholesterolemia (excessively high blood cholesterol) is an important laboratory finding because of its marked association with increased risk of coronary heart disease.

Report

Geriatrics in the United States: Manpower Projections and Training Considerations

Demographic projections indicate that the elderly segment of the U.S. population will grow substantially over the next 50 years, posing additional requirements for medical geriatrics manpower.

Report

The value of screening trials

Screening trials provide information on cancer treatment which is otherwise practically impossible to obtain. Such trials are inherently expensive because of the size, but are easily justified economically by the solid information they produce. If ...

Report

Algorithms for Health Planners: Vol. 2, Infant Mortality

One of a series of reports presenting a methodology to help health planners develop objectives and actions by means of selected health status indicators that may be amenable to health care interventions.

Report

Algorithms for Health Planners: Vol. 3, Breast Cancer Mortality

One of a series of reports presenting a methodology to help health planners develop objectives and actions by means of selected health status indicators that may be amenable to health care interventions.

Report

Algorithms for Health Planners: Vol. 6, Hypertension

Assists health planners, especially those in Health Systems Agencies (HSAs), in developing objectives and taking action toward ameliorating the problem of hypertension, or high blood pressure (HBP).

Report

Algorithms for Health Planners: Vol. 1, An Overview

One of a series of reports presenting a methodology to help health planners develop objectives and actions by means of selected health status indicators that may be amenable to health care interventions.

Report

Algorithms for Health Planners: Vol. 4, Heart Attack Mortality

One of a series of reports presenting a methodology to help health planners develop objectives and actions by means of selected health status indicators that may be amenable to health care interventions.

Journal Article

An Empirical Study of the Differences Between Family and Individual Deductibles in Health Insurance

Distribution of medical expenses and the manner in which these expenses are divided between insurer and insured under various medical plans.

Report

U.S. Grain Reserves Policy: Objectives, Costs, and Distribution of Benefits

Examines rationales for and against U.S. Government intervention in private grain storage, and simulates some of the costs and effects of intervention.

Report

The Demand for Supplementary Health Insurance, Or Do Deductibles Matter?

Will consumers purchase private insurance policies to supplement a deductible that might be part of a national health insurance plan?

Report

A Materials Quiz.

Discusses issues related to material markets, price fluctuations, shortages and stockpiling. The following topics are examined: (1) the behavior of the price of exhaustible materials; (2) the effect of long-term contracts on materials markets; (3) ...

Report

Policy Analysis for Federal Biomedical Research

An essay addressing two questions: First, is it possible to perform analysis--cost benefit analysis--that will provide answers to the questions of how much and where the federal government should make its investment in biomedical research? Second, if outright answers are not possible, is it possible to perform analysis that will lead to better informed judgments as to how much, where, and in what manner the government should invest in biomedical research?

Report

The Value of a Diagnostic Test.

Presents the simple Bayesian analytic approach to medical decisionmaking. In this approach, doctors are assumed to minimize the average costs (in health or money) of their actions. A model of the diagnostic process is given which allows tests and t...

Report

The Choice between Family and Individual Deductibles in Health Insurance

A study of how the choice of deductible type affects the variance of insurance payouts.

Report

Effects of Pooled Samples.

Pooling of specimens before laboratory testing may reduce the costs of expensive tests for rare medical conditions. This paper presents models of how test performance is degraded by such pools, and of the financial savings that pooling allows. The ...

Report

Deductibles and the Demand for Medical Services: The Theory of the Consumer Facing a Variable Price Schedule Under Uncertainty

A theoretical model of a consumer who faces a price that varies with the number of units bought, and who faces random future changes in his demand for the good.

Report

A New Method for Ergodic Analysis.

The ergodic theorems of demography show that initial differences in population profiles are unimportant in the long run. This paper uses the projective metric to give simpler proofs of these theorems and gives necessary and sufficient conditions for...

Report

A Note on Optimal Insurance.

According to K. J. Arrow, if an insurance company is willing to offer any insurance policy against loss desired by the buyer at a premium depending only on the policy's actuarial value, the policy chosen by a risk-averting buyer will take the form of...

Report

Analysis of the Educational Personnel System: IV. Teacher Turnover

Attempts to predict the rates of teacher turnover in the 1970s.

Report

A Classification of Large American Urban Areas.

A Classification of Large American Urban Areas.

Report

A Note on the Effectiveness of Teacher Experience.

Does teacher experience affect student achievement or does a school's average reading ability determine the faculty's average level of experience? In other words, do teachers tend to move to schools attended by superior test takers? To establish the...

Report

Horizon in a Simple Model of Economic Growth.

In plans of long run economic growth, the targets are often set further in the future than economic technologies can be reasonably estimated. Thus, planners may worry that plans which look good for the known future may in hindsight prove wasteful. W...

Report

Simultaneous Estimation of Teacher Mobility and Reading Scores

Analyzes teacher mobility in San Diego schools, using a two-stage least squares approach. Argues that the average reading ability of students at a specific school depends on the degree of teacher movement from the school.

Report

Bridge as a Game.

There are two main classes of games. In games such as chess, nothing is concealed. Everyone has perfect information about the state of the game, and each player has a best strategy that costs him nothing to announce. In games without perfect infor...

Report

Models of Disease Costs and Their Use in Medical Research Resource Allocations.

Biomedical research today is selected on the basis of its "scientific merit" as panels of experts see it; instead, it should be judged by its probable effects on American health. Two cost models to help judge those effects--and allocate medical rese...

Report

A Normative Model of Medical Research Resource Allocation

This memorandum is concerned with the allocation of resources to biomedical research. In particular, it asks the question: How much should the country spend on such research?

Report

A Twisted Turnpike.

In a closed linear model of production, a path of maximal balanced growth is called a Neumann ray; long, efficient paths of capital accumulation remain near a Neumann ray most of the time. This paper uses McKenzie's version of the Morishima nojoint-...

Report

A Twisted Turnpike Theorem.

Weather, conflict, and sectorally uneven technical progress may cause production possibilities to vary with time. This paper generalizes the Morishima turnpike theorem to bounded, but not constant, normalized production possibilities. The variation...

Report

Another Type of Risk Aversion.

A formulation incorporating the concept of "size-of-risk" aversion into the process of selecting a utility function. This concept extends and complements Pratt's normative observation of risk aversion--namely, as wealth increases, many decisionmaker...

Report

Projective Metrics and Economic Growth Models.

A newly developed mathematical approach that permits technological change to be incorporated into models of economic growth. A detailed investigation is made of certain economic models and their long-term behavior in an effort to illuminate the conn...

Report

Proper Raising Points in a Generalization of Backgammon

Optimal game-theoretic strategies for betting in a two-person perfect information game with chance in which the players know their probability of winning at any given time.

Report

A Theorem on Contraction Mapping.

A proof that the conclusion of a well-known theorem of Banach holds more generally from a condition of weakly uniformly strict contraction. The following fixpoint theorem is demonstrated: Let (X,d) be a complete metric space and f a mapping of X int...