Roland Sturm

Five Myths About American Obesity

Two in three Americans are overweight or obese. There are many popular theories about what's causing the obesity epidemic, but many are not supported by data. What's clear is that most U.S. adults eat too many calories.

What's Behind the Obesity Epidemic? Easily Accessible Food, and Lots of It

That no group is immune to rising obesity rates suggests that universal environmental factors are driving the trend. The clearest change concerns food availability and cost.

Eating Better for Less

A combination of things might well slow the obesity epidemic while also improving the American people's overall nutritional well-being: lowering prices on healthier food, initiatives to control portion sizes, and a long-term campaign to support better food quality.

Worth Its Weight in Gold?

In terms of healthcare use and chronic health conditions, obesity is comparable to aging 20 years, with the health of a 30 year old resembling that of a 50 year old, writes Roland Sturm.

Tool

Heart Disease Data Portal

The Heart Disease Data Portal is designed to inform and support decisionmaking for public health by facilitating exploring of hypertension prevalence rates in each of the 26 health districts in Los Angeles County.

Journal Article

Improving Diet Quality in U.S. Adults: A 30-Year Health and Economic Impact Microsimulation

Microsimulation (Future Adult Model) predicted 30-year improved diet quality impacts across 12 demographic groups. Diet improvement reduced prevalence of heart disease by 7.6% to 13.8% across groups and reduced healthcare costs by $10B in year 30.

Journal Article

Depressive Symptoms Among US Adults During the Great Recession and Economic Recovery

National Health and Nutrition Examination Survey data show a statistically significant increase in depressive symptoms from 2005/2006 to 2007/2008 (the beginning of the Great Recession), but there were no significant or consistent changes after 2007/2008.

Journal Article

Diet Quality in the United States Improved During the Great Recession and Deteriorated During Economic Recovery

During the Great Recession, American diets became more consistent with Dietary Guidelines for Americans recommendations, possibly because of a shift toward food prepared at home instead of prepared food bought away from home.

Journal Article

Microsimulation Projections of Obesity Interventions on Cardiometabolic Health Disparities in the United States

Long-term health education campaigns can reduce obesity-related disease. All population groups benefit, but they would not substantially narrow cardiometabolic health disparities.

Journal Article

Diet Quality Improvement and 30-Year Population Health and Economic Outcomes: A Microsimulation Study

Microsimulation (Future Adult Model) predicted 30-year US population changes from improved diet quality. Diet improvement reduced prevalence of diabetes, heart disease and stroke by 11%, 7%, and 10%, and reduced healthcare costs by $144B in year 30.

Tool

How Would a Better Diet Affect Health and Economic Outcomes in the United States?

An online tool shows the effect that improving diet quality in the United States could have on health and economic outcomes, such as the prevalence of diet-related illness, health care spending, and labor force participation, over a 30-year period.

Journal Article

Obesity Prevention Interventions and Implications for Energy Balance in the United States and Mexico: A Systematic Review of the Evidence and Meta-Analysis

Obesity is preventable and yet continues to be a major risk factor for chronic disease. This review searched the vast literature on obesity prevention interventions to assess their effects on daily energy consumed and energy expended.

Report

Examining Consumer Responses to Calorie Information on Restaurant Menus in a Discrete Choice Experiment

In light of the 2014 U.S. Food and Drug Administration final rule requiring the calorie content of food items to be clearly displayed on menus, RAND researchers designed an online survey to look at how this information affects consumers.

Journal Article

Neighborhood Food Environment, Diet, and Obesity Among Los Angeles County Adults, 2011

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Journal Article

Diet and Obesity in Los Angeles County 2007-2012: Is There a Measurable Effect of the 2008 "Fast-Food Ban"?

We evaluate the impact of the Los Angeles Fast-Food Ban, a zoning regulation that has restricted opening/remodeling of standalone fast-food restaurants in South Los Angeles since 2008.

Report

Quantifying the Contribution of Public Parks to Physical Activity and Health: Introducing SOPARC

This paper introduces the System for Observing Play and Recreation in Communities (SOPARC), a reliable, valid, and easy-to-use tool for quantifying park use and park-based physical activity.

Research Brief

Too Much of a Good Thing? How the Economic Environment Plays a Role in the Obesity Epidemic

RAND researchers looking at the growth of obesity rates over time found that the epidemic has been fueled by historically low food prices relative to income and constant availability, which have driven high consumption.

Journal Article

Impact of a Patient Incentive Program on Receipt of Preventive Care

Patient financial incentives are being promoted as a mechanism to increase receipt of preventive care, encourage healthy behavior, and improve chronic disease management. However, few empirical evaluations have assessed such incentive programs.

Infographic

Check, Please: Many Single Entrées at U.S. Chain Restaurants Serve Up Masses of Calories, Fat, and Sodium

This infographic breaks down just how bad a full meal at a chain restaurant can be.

Journal Article

Proximity to Urban Parks and Mental Health

Policy evaluations should incorporate mental health measures when assessing neighborhood improvement programs and physical environments.

Journal Article

Changes in the Energy and Sodium Content of Main Entrées in US Chain Restaurants from 2010 to 2011

Industry marketing and pledges may create a misleading perception that restaurant menus are becoming substantially healthier, but both healthy and unhealthy menu changes can occur simultaneously.

Journal Article

Obesity and Economic Environments

This review summarizes current understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs.

Journal Article

The Effects of Obesity, Smoking, and Excessive Alcohol Intake on Healthcare Expenditure in a Comprehensive Medical Scheme

Health risks such as tobacco use, excessive alcohol consumption and unhealthy body weight contribute to the development of chronic health problems.

Journal Article

The Obesity Epidemic and Changes in Self-Report Biases in BMI

Increases in obesity rates based on self-reported height and weight are likely to reflect actual weight increases and are not inflated by changes in reporting accuracy.

Journal Article

Neighborhood Food Outlets, Diet, and Obesity Among California Adults, 2007 and 2009

The presence of food outlets near home is not associated with dietary intake or BMI. In general, shopping patterns are weakly related, if at all, to neighborhoods, perhaps because of easy access to cars.

Journal Article

Morbid Obesity Rates Continue to Rise Rapidly in the United States

Morbid obesity rates in the United States continue to rise rapidly. The relative rate of increase is similar across population subgroups, even though the prevalence at every point in time differs across groups.

Journal Article

What's on the Menu? A Review of the Energy and Nutritional Content of US Chain Restaurant Menus

The paper provides a comprehensive view of chain restaurant menu nutrition prior to nationwide labeling laws. It offers baseline data to evaluate how restaurants respond after laws are implemented.

Journal Article

A Cash-Back Rebate Program for Healthy Food Purchases in South Africa: Results from Scanner Data

This study examines the effect of a price reduction for healthy food items on household grocery shopping behavior among members of South Africa's largest health plan.

Journal Article

Provincial Screening Rates for Chronic Diseases of Lifestyle, Cancers and HIV in a Health-Insured Population

Screening for asymptomatic diseases can reduce the burden of morbidity and mortality in all population groups.

Journal Article

Eating Better for Less: A National Discount Program for Healthy Food Purchases in South Africa

Examines whether reducing prices for healthy food purchases leads to changes in self-reported measures of food consumption and weight status.

Journal Article

Is There a Robust Relationship Between Neighbourhood Food Environment and Childhood Obesity in the USA?

To the extent that there is an association between food environment and youth obesity, the existence of more types of food outlets in an area, including supermarkets, is associated with higher BMI.

Journal Article

School and Residential Neighborhood Food Environment and Diet Among California Youth

This study examines the relationship between school and residential neighborhood food environment and diet among youth in California.

Journal Article

Changes in Body Mass During Elementary and Middle School in a National Cohort of Kindergarteners

Many children gained substantial weight in elementary school, especially in grades 1-3. Gains were not just among children who were already overweight or obese; children who entered kindergarten at normal weight also gained substantially.

Research Brief

Preventing Obesity and Its Consequences: Highlights of RAND Health Research

Summarizes key RAND studies on the causes of obesity, its economic and health consequences, and potential strategies for prevention, including work on health care costs, junk food, food deserts, school meals, and proximity of parks.

Journal Article

Does the Response to Alcohol Taxes Differ Across Racial/Ethnic Groups? Some Evidence from 1984-2009 Behavioral Risk Factor Surveillance System

This study examines how the effect of alcohol excise taxes on the demand for alcohol varies across different racial and ethnic groups.

Journal Article

Economic Analysis of Physical Activity Interventions

This study compared the cost-effectiveness of different public interventions for promoting exercise and found that community-based campaigns and school-based interventions have the greatest potential to be scaled up at the lowest costs.

Journal Article

Regional Price Differences and Food Consumption Frequency Among Elementary School Children

Geographic variation in food prices across the US affects youth's consumption of fruit, vegetables and milk; price variation does not seem to affect consumption of fast food or soft drinks, perhaps because consumption is less price sensitive.

Journal Article

The Role of School Physical Activity Programs in Child Body Mass Trajectory

Meeting the national recommendation for physical education and recess at school can help prevent obesity in children.

Journal Article

Discretionary Calorie Intake a Priority for Obesity Prevention: Results of Rapid Participatory Approaches in Low-Income US Communities

Reducing consumption of salty snacks, candy, cookies may be more effective than exercise in combating obesity

Journal Article

Soda Taxes, Soft Drink Consumption, and Children's Body Mass Index

Taxes on sugar-sweetened beverages have been proposed to combat obesity.

Journal Article

Facility Provision in Elementary Schools: Correlates with Physical Education, Recess, and Obesity

The objectives were to: (1) document correlations among facility provision (availability and adequacy) in elementary schools, child sociodemographic factors, and school characteristics nationwide; and (2) investigate whether facility provision

Journal Article

Measuring the Physical Food Environment and Its Relationship with Obesity: Evidence from California

This study proposes an alternative measure to the Retail Food Environment Index (RFEI) called the 'Physical Food Environment Indicator' (PFEI), and tests its association with adult body mass index (BMI) and obesity in California.

Journal Article

Not Enough Fruit and Vegetables or Too Many Cookies, Candies, Salty Snacks, and Soft Drinks?

There are many contributors to obesity, including excess consumption of discretionary calories (foods high in sugar and fat and low in essential nutrients), lack of fruit/vegetable consumption, and insufficient physical activity.

Journal Article

Self-reported Unmet Need for Mental Health Care After California's Parity Legislation

Following passage of mental health parity legislation in California, perceived need for mental health care services increased significantly for all groups, regardless of insurance, resulting in a net increase of unmet need among the privately insured, among those with public insurance, and among the uninsured.

Research Brief

South Los Angeles Ban on Fast-Food Chains Misses the Mark

Summarizes the evidence for the ban on new fast-food chain restaurants in South Los Angeles (LA), including the density of such restaurants in the area and the eating habits of South LA residents, and concludes that the data do not support the ban.

Research Brief

Hold the Salt: Lowering Sodium Intake Would Improve Health and Save Money

Details the benefits that would accrue from reducing sodium consumption among Americans, including a reduced prevalence of high blood pressure, lower medical costs, and improved quality of life.

Journal Article

Zoning for Health? The Year-Old Ban on New Fast-Food Restaurants in South LA

A regulation banning new fast-food establishments for one year in Los Angeles, California, was passed unanimously by the city council in July 2008, motivated by health concerns and excessive obesity rates in South Los Angeles. This paper reviews the empirical evidence for the regulation and whether it is likely to target the primary levers of obesity.

Journal Article

Affordability and Obesity: Issues in the Multifunctionality of Agricultural/Food Systems

This commentary argues that using obesity as an argument to promote local produce or other multifunctional outcomes is questionable; framing obesity as an issue of poverty or food insecurity trivializes the continuing major problem of hunger worldwide.

Journal Article

Alcohol Environments and Disparities in Exposure Associated with Adolescent Drinking in California

The authors investigated sociodemographic disparities in alcohol environments and their relationship with adolescent drinking.

Journal Article

Developing Policy Solutions for a More Active Nation: Integrating Economic and Public Health Perspectives

Both economic and public health/medical perspectives play an important role in the policy process but often approach policy questions in an incompatible way. Harnessing any synergy requires an understanding of the other perspective.

Journal Article

Potential Societal Savings from Reduced Sodium Consumption in the U.S. Adult Population

Cross-sectional simulation scenarios were developed to estimate the effect of hypertension prevalence, direct medical costs, and quality of life years (QALYs) saved by reductions in sodium consumption. Population-level data on blood pressure, antihypertensive medication use, and sodium intake were from the National Health and Nutrition Examination Survey 1999-2004.

Journal Article

Food Prices and Weight Gain During Elementary School: 5-Year Update

Childhood overweight has increased rapidly over the last two decades. Energy-dense foods are cheaper per calorie, which could be a partial explanation for why the highest rates of obesity are observed among groups of limited economic means.

Journal Article

Stemming the Global Obesity Epidemic: What Can We Learn from Data About Social and Economic Trends?

Significant effort is devoted to promoting increased fruit/vegetable consumption and physical activity to fight obesity, but environmental intervention and economic incentives to reduce energy intake and sedentary entertainment may be more effective.

Journal Article

Disparities in the Food Environment Surrounding US Middle and High Schools

Hispanic youth are likely to attend schools surrounded by convenience stores, restaurants, or off-licenses. Middle schools have fewer surrounding businesses than high schools, and larger schools have fewer surrounding businesses than smaller schools.

Journal Article

Body Mass Index Is Increasing Faster Among Taller Persons

Taller people have been increasing their body mass indexes during the past 40 years at a faster rate than shorter people. Constraints on weight gain for taller people that existed in a more calorie-constrained environment may have been eliminated.

Research Brief

How Neighborhoods Can Reduce the Risk of Obesity

This research brief explores the relationship of a neighborhood's characteristics to obesity in its residents.

Research Brief

Obesity and Disability: The Shape of Things to Come

This research brief summarizes studies that found that individuals who are obese face greater challenges in terms of disability and chronic disease than do their non-obese counterparts.

Report

Alcohol and Environmental Justice: The Density of Liquor Stores and Bars in Urban Neighborhoods in the United States

Characterizes the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and finds mismatches between alcohol demand and the supply of liquor stores.

Journal Article

Increases in Morbid Obesity in the USA: 2000-2005

The aggressive and costly expansion of bariatric surgery in recent years has had no visible effect on containing morbid obesity rates in the USA.

Journal Article

School Characteristics and Behavior Problems of U.S. Fifth-Graders

Report based on a national survey of 11,283 fifth-graders in 2,390 schools from the Early Childhood Longitudinal Study-Kindergarten in 2003-2004.

Report

Park Use and Physical Activity in a Sample of Public Parks in the City of Los Angeles

Investigates how parks promote physical activity for individuals and how well parks serve the surrounding community.

Journal Article

Alcohol Outlets and Problem Drinking Among Adults in California

The purpose of the study was to examine the relationship between alcohol environments and problem drinking.

Report

Childhood Overweight and Elementary School Outcomes

Examines the link between childhood overweight status and elementary school outcome and finds that change in overweight status during the first four years in school is a significant risk factor for adverse school outcomes among girls but not boys.

Report

Physical Activity and Changes in Health Care Costs in Late Middle Age

Finds that regular physical activity in late middle age may lower health expenditure over time and that the effect is likely to be more pronounced for the obese, smokers, and individuals with some health problems.

Journal Article

US-based Indices of Area-Level Deprivation: Results from HealthCare for Communities

The authors find that area-level deprivation predicts poor mental and physical health outcomes, but different components of deprivation have different effects.

Journal Article

Body Mass Index in Elementary School Children, Metropolitan Area Food Prices and Food Outlet Density

The authors found no effects of food outlet density at the neighbourhood level, possibly because availability is not an issue in metropolitan areas.

Journal Article

Childhood Obesity: What We Can Learn from Existing Data on Societal Trends, Pt. 2

Number of overweight and obese youth has increased in recent decades, few data assess how lives of children have changed during the obesity epidemic

Journal Article

Childhood Obesity: What We Can Learn from Existing Data on Societal Trends, Pt. 1

The number of overweight and obese youth has increased in recent decades, and numerous theories on causes have been proposed.

Journal Article

Depression and Comorbid Pain as Predictors of Disability, Employment, Insurance Status, and Health Care Costs

Relative to depression alone, depression plus pain and pain alone were associated with significant functional limitations and economic burdens.

Journal Article

Economics and Physical Activity: A Research Agenda

Economic and public health/medical perspectives play an important role in the policy process, often approach policy questions in an incompatible way.

Journal Article

Labor Market, Financial, Insurance and Disability Outcomes Among Near Elderly Americans with Depression and Pain

Economic burden of depression has been documented, but the role of comorbid pain among the depressed is unclear. Using Wave 3 of the Health and Retirement Survey in 1996, we conducted multivariate regression analyses to estimate associations between depression and comorbid pain, and labor market, financial, insurance and disability outcomes among near elderly Americans aged 55-65, controlling for socio-demographics and health conditions.

Journal Article

Use of Mental Health Care Among Youths in 1997 and 2002

This column examines mental health service use among youths in 1997 and 2002 for 13 U.S. states and for the nation.

Journal Article

Weight Gain Trends Across Sociodemographic Groups in the United States

To better understand health disparities, the authors compared US weight gain trends across sociodemographic groups between 1986 and 2002.

Journal Article

Moderate and Severe Obesity Have Large Differences in Health Care Costs

Obesity imposes a burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population.

Journal Article

Childhood Overweight and Academic Performance: National Study of Kindergartners and First-Graders

To examine the association between children's overweight status in kindergarten and their academic achievement in kindergarten and first grade.

Journal Article

Childhood Overweight and Parent- and Teacher-Reported Behavior Problems: Evidence from a Prospective Study of Kindergartners

To determine if there is a relationship between overweight and behavior problems among children as young as 5 years old by studying the association between overweight and behavioral health at entry into kindergarten and to determine whether overweight status is a risk factor for the onset of new behavior problems during the first 2 years in school.

Journal Article

Depression and Leaving Employment Among Older Adult Americans

The author's study suggests that depression takes a higher toll among older women in the workforce.

Journal Article

Does Relative Deprivation Predict the Need for Mental Health Services?

Investigates whether low income relative to a reference group is associated with a higher probability of depressive disorders or anxiety disorders.

Journal Article

The Economics of Physical Activity: Societal Trends and Rationales for Interventions

What are Americans doing with their time and their money and what has changed in recent decades?

Journal Article

The Effects of State Mental Health Parity Legislation on Perceived Quality of Insurance Coverage, Perceived Access to Care, and Use of Mental Health Specialty Care

Comprehensiveness of state legislation appears to be related to the traditional level of use of mental health specialty care.

Journal Article

Increasing Obesity Rates and Disability Trends: If It Continues at Its Current Rate, Rising Obesity Could Wipe Out Recent Improvements in Disability Among Older Americans

Unhealthy body weight has increased dramatically, but other data show that disability rates have declined.

Journal Article

Mental Health and Employment Transitions

This paper provides insight into the ways in which women and men are affected by mental illness in the labor market.

Report

Nuclear Power in Eastern Europe: Learning or Forgetting Curves?

Nuclear Power in Eastern Europe: Learning or Forgetting Curves?

Journal Article

Physical Education in Elementary School and Body Mass Index: Evidence from the Early Childhood Longitudinal Study

The authors examined the effect of physical education instruction time on body mass index (BMI) change in elementary school.

Periodical

RAND Review: Vol. 28, No. 1, Spring 2004

Argues that new threats to national security represent fundamental changes in the ecology of conflict and that America's approach must evolve to meet the challenges; education, obesity, and wind tunnels in aeronautical research are also discussed.

Journal Article

Suburban Sprawl and Physical and Mental Health

Suburban design may be an important new avenue for health promotion and disease prevention.

Journal Article

Geographic Disparities in Children's Mental Health Care

It is widely believed that only a minority of vulnerable children and adolescents receive any mental health services.

Journal Article

Increases in Clinically Severe Obesity in the United States, 1986-2000

The prevalence of clinically severe obesity is increasing much faster than obesity.

Journal Article

A National Study of the Effect of Chronic Pain on the Use of Health Care by Depressed Persons

Comorbid pain among persons with depression is associated with intensive use of medical services but lower rates of use of mental health services.

Journal Article

The Role of Managed Care and Financing in Medical Practices: How Does Psychiatry Differ from Other Medical Fields?

The organization and financing of medical practice has experienced substantial changes during the past decade.

Journal Article

Adverse Selection and Generosity of Alcohol Treatment Benefits

Two potential avenues of adverse selection, namely biased enrollment into plans and biased exit from plans offered by employers between 1991 and 1997.

Journal Article

Alcohol, Drug Abuse, and Mental Health Care for Uninsured and Insured Adults

To compare adults with different insurance coverage in care for alcohol, drug abuse, and mental health (ADM) problems.

Journal Article

An Early Case Study of the Effects of California's Mental Health Parity Legislation

In 2001, Congress defeated a proposed amendment that would have mandated nationwide parity for mental health coverage.

Journal Article

Effect of Managed Care and Financing on Practice Constraints and Career Satisfaction in Primary Care

Physicians in solo and 2-physician practices were least satisfied with careers and reported more constraints on their clinical freedom and income.

Report

Effects of Cost-Containment Strategies Within Managed Care on Continuity of The Relationship Between Patients with Depression and Their Primary Care Providers

Effects of Cost-Containment Strategies Within Managed Care on Continuity of The Relationship Between Patients with Depression and Their Primary Care Providers

Report

The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs

The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs

Journal Article

Evidence-based Health Policy Versus Evidence-Based Medicine

Argues that the most valuable research integrates information from three levels of investigation: clinical efficacy studies; real life effectiveness research, including studies of cost-effectiveness; and health policy research.

Research Brief

The Health Risks of Obesity: Worse Than Smoking, Drinking or Poverty

Obesity is the most serious problem. It is linked to a big increase in chronic health conditions and significantly higher health expenditures. And it affects more people than smoking, heavy drinking, or poverty.

Journal Article

The Impact of Practice Setting and Financial Incentives on Career Satisfaction and Perceived Practice Limitations Among Surgeons

To study how practice setting and financial incentives affect career satisfaction and perceived impact on practice in surgery.

Journal Article

Relations of Income Inequality and Family Income to Chronic Medical Conditions and Mental Health Disorders: National Survey

This study provides no evidence for the hypothesis that income inequality is a major risk factor for common disorders of physical or mental health.

Journal Article

Variations in Mental Health Specialty Care Across Metropolitan Areas

Investigates how area of residence affects use of health care services.

Journal Article

Alcoholism Treatment in Managed Private Sector Plans How Are Carve-Out Arrangements Affecting Costs and Utilization?

Many U.S. employers and health plans have carved out their mental health and substance abuse benefits from a comprehensive health care plan.

Report

Are Barriers to Mental Health and Substance Abuse Care Still Rising?

Uses data from a national household survey to estimate unmet need and barriers to alcohol, drug, and mental health services.

Journal Article

Are Psychiatrists More Dissatisfied with Their Careers Than Other Physicians?

The growth of managed care has been associated with a decrease in physicians' professional satisfaction.

Journal Article

Can Utility-Weighted Health-Related Quality-of-Life Estimates Capture Health Effects of Quality Improvement for Depression?

Utility measures that capture the mental health and non-health outcomes associated with treatment for depression are needed.

Journal Article

Changes in Alcohol-Related Inpatient Care: An International Trend Comparison

Paper studies two utilization measures of alcoholism treatment, discharge rate and average length of stay, in the US, Australia, Sweden and Canada.

Testimony

The Costs of Covering Mental Health and Substance Abuse Care at the Same Level as Medical Care in Private Insurance Plans

Testimony presented to the Health Insurance Committee, National Conference of Insurance Legislators on July 13, 2001.

Report

Does Obesity Contribute as Much to Morbidity as Poverty or Smoking?

This paper compares the effects of overweight, poverty, smoking, and problem drinking on occurrence of chronic conditions and health-related quality-of-life.

Journal Article

Does the Sunset of Mental Health Parity Really Matter?

The 1996 Mental Health Parity Act (MHPA), which became effective in January 1998, is scheduled to expire in September 2001.

Journal Article

Financial Burden and Out-Of-pocket Expenditures for Mental Health Across Different Socioeconomic Groups: Results from Health Care for Communities

Report

Financial Burden and Out-of-Pocket Expenditures for Mental Health across Different Socioeconomic Groups: Results from HealthCare for Communities

Examines differences in out-of-pocket expenditures for mental health services and their burden across different populations.

Journal Article

How Do Trends for Behavioral Health Inpatient Care Differ from Medical Inpatient Care in U.S. Community Hospitals?

Inpatient care in the United States accounts for one third of the health care expenditures

Report

Income and Mental Health: Unraveling Community and Individual Level Relationships

Explores the relationships between mental disorders and socioeconomic status and environment and find a strong association between individual income and mental health.

Journal Article

Medical Cost Offset: Do the Numbers Add Up?

Two field experts discuss whether evidence of a medical cost offset exists.

Research Brief

Mental Health Care for Youth: Who Gets It? How Much Does It Cost? Who Pays? Where Does the Money Go?

A team of RAND researchers has assembled a current national picture of mental health costs and utilization for children ages 1-17.

Journal Article

The Myth of Medical Cost Offset

Increased access to or use of behavioral health services can substantially reduce expenditures in other medical care services.

Journal Article

National Estimates of Mental Health Utilization and Expenditures for Children in 1998

No recent data on expenditures and utilization are available to provide a benchmark for reform of mental health systems for children and adolescents.

Journal Article

Psychotropic Medication Costs Among Youth with Private Insurance in 1998

Recent studies have documented a substantial increase in the use of psychotropic medications by children and adolescents.

Journal Article

The Role of Computer Use in Different Medical Specialties

Health-related Web sites are among the most visited sites on the Internet, and their use may change the patient-provider relationship.

Journal Article

Toward Full Mental Health Parity and Beyond: Managed Behavioral Health Care Has Made Full Parity Affordable--And Therefore Thinkable

The 1996 Mental Health Parity Act (MHPA), which became effective in January 1998, is scheduled to expire in September 2001.

Research Brief

Are People With Mental Illness Getting the Help They Need? New Findings About Parity Laws, Insurance Coverage, and Access to Care

In recent years, concerns about the adequacy of insurance benefits and quality of care for individuals with mental illness have led the majority of states and the federal government to require equal coverage for both mental health and medical conditions.

Journal Article

The Effect of Copayments on Drug and Alcohol Treatment Following Inpatient Detoxification Under Managed Care

These findings indicate that the rate of participation in outpatient treatment after detoxification is high, but room for improvement remains.

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).

Report

Health Insurance May Be Improving, But Not For Individuals With Mental Illness

To explore the question of how insurance coverage has changed among individuals with mental problems compared to the general population in the last two years.

Report

How Does Risk Sharing Between Employers and Managed Behavioral Health Organization Affect Mental Health Care?

To study the ways in which allocating the risk for behavioral health care expenses between employers and a managed behavioral health organization affects costs and the use of services.

Report

How Expensive are Unlimited Substance Abuse Benefits Under Managed Care?

This article studies how many patients are affected by SA coverage limits and the likely implications of limits on insurance payments, using 1996-97 claims from 25 managed care plans with unlimited SA benefits.

Journal Article

The Impact of Prior Authorization on Outpatient Utilization in Managed Behavioral Health Plans

The authorization effect differs by provider type and is weaker among psychiatrists than among nonphysician providers.

Journal Article

Managed Care and Unmet Need for Mental Health and Substance Abuse Care in 1998

This report demonstrates the importance of defining access to care more broadly.

Report

Managed Care Risk Contracts and Substance Abuse Treatment

Several pending health care bills propose employer mandates to improve coverage for substance abuse treatment. In today's managed care environment, however, mandating "nominal" benefits no longer may achieve intended goals.

Journal Article

Mental Disorders and the Use of Alternative Medicine: Results from a National Survey

The study examined the relationship between mental disorders and the use of complementary and alternative medicine.

Journal Article

Mental Health Parity and Employer-Sponsored Health Insurance in 1999-2000

The authors examined changes in copayments and coinsurance for covered benefits.

Journal Article

Mental Health Parity and Employer-Sponsored Health Insurance in 1999-2000

Limits protect the insurer against high costs, not the individual.

Report

Mental Health Parity Legislation: Much Ado About Nothing?

To determine whether state-level parity legislation has led to an increase in utilization of mental health services.

Journal Article

New Dimensions of Economic Well-Being Among People with Mental Illness: Evidence from Health Care for Communities

Less the sizeable gap in the percentage of savers among individuals who have and do not have a mental disorder than the strong interaction with age.

Journal Article

Patient Risk-Taking Attitude and the Use of Complementary and Alternative Medical Services

Report

Patient Risk-Taking Attitude and the Use of Complementary and Alternative Medical Services

Reports the results of a survey of users and nonusers of complementary and alternative medicine with respect to their attitude toward risk.

Journal Article

Psychiatric Care Expenditures and Length of Stay: Trends in Industrialized Countries

The report shows that the share of inpatient expenditures for psychiatric disorders has been decreasing in many industrialized countries.

Journal Article

State Legislation and the Use of Complementary and Alternative Medicine

There are increasing attempts at the federal and state levels to change regulations for complementary and alternative medicine (CAM).

Report

State Mental Health Parity Laws: Cause Or Consequence Of Differences In Use?

State Mental Health Parity Laws: Cause Or Consequence Of Differences In Use?

Journal Article

State Parity Legislation and Changes in Health Insurance and Perceived Access to Care Among Individuals with Mental Illness: 1996-1998

This paper contrasts how insurance coverage has changed for individuals with mental health problems in states with and without parity legislation.

Research Brief

Tracking Changes in Behavioral Health Services: How Has Managed Care Changed Care?

RAND studies of managed care plans that had already implemented full parity showed that under comprehensively managed care -- today's dominant arrangement -- unlimited mental health benefits cost not much more than capped benefits.

Report

Tracking Changes in Behavioral Health Services: How Have Carve-Outs Changed Care?

Tracking Changes in Behavioral Health Services: How Have Carve-Outs Changed Care?

Journal Article

Labor Force Participation by Persons with Mental Illness

How individuals with probable risk for mental illness are faring in this economy, using data from the HCC survey conducted fall 1997 through 1998.

Journal Article

Cost and Quality Trends Under Managed Care: Is There a Learning Curve in Behavioral Health Carve-Out Plans?

This paper studies the performance of network plans over time using data from 52 managed behavioral health plans.

Report

The Design of Healthcare for Communities: A Study of Health Care Delivery for Alcohol, Drug Abuse, and Mental Health Conditions

This paper describes Healthcare for Communities (HCC), a component of the Robert Wood Johnson Foundation's Health Tracking Initiative that was designed to fill this gap for alcohol, drug abuse, and mental health care.

Report

Effectiveness Research and Implications for Study Design: Sample Size and Statistical Power

Contrasting a broad range of outcome and cost measures, the authors analyze the implications for sample sizes and study design using data from prior mental health and primary care studies that span a wide range of practice settings, patient populations and geographic areas.

Testimony

Effects of Substance Abuse Parity in Private Insurance Plans Under Managed Care

Testimony presented Submitted to the U.S. House of Representatives Subcommittee on Criminal Justice, Drug Policy and Human Resources on October 21, 1999.

Report

Mental Health and Substance Abuse Parity: A Case Study of Ohio's State Employee Program

The Ohio state case study demonstrates that 'parity' -- equal benefits for drug abuse and mental health (ADM) and medical care -- level benefits for ADM care are affordable under managed care.

Journal Article

A Naturalistic Study of Psychotherapy: The Medical Outcomes Study Approach

In this chapter, the authors describe the Medical Outcomes Study (MOS) approach.

Journal Article

New Research Alliances in the Era of Managed Care

The rise of managed behavioral health care in the United States was accompanied by reductions in costs.

Report

Substance Abuse Service Utilization under Managed Care: HMOs versus Carve-Out Plans

Evaluates changes in service utilization and costs when managed behavioral healthcare organizations use carve-outs to manage their substance abuse services compared with HMOs.

Report

Use of Psychiatrists, Psychologists, and Master's-Level Therapists in Managed Behavioral Health Care Carve-Out Plans

Examines the extent to which patients using a managed behavioral health company received services from different types of mental health care provider.

Report

What Outcomes Matter to Patients?

Estimates the relative value to patients of physical, mental, and social health when making treatment decisions, and concludes that health care resources should target treatments that improve mental and social health outcomes.

Journal Article

What Type of Information Is Needed to Inform Mental Health Policy?

The most valuable research integrates information from three levels of investigation: clinical efficacy, real life effectiveness and policy research

Journal Article

Who Leaves Managed Behavioral Health Care?

The growth of managed care and the possibility of biased enrollment and disenrollment rates have raised concerns about cost shifting.

Journal Article

Costs and Use of Mental Health Services Before and After Managed Care

This paper tracks access, utilization, and costs of mental health care for a private employer over nine years.

Journal Article

Costs and Utilization of Substance Abuse Care in a Privately Insured Population Under Managed Care

Cost and utilization patterns of substance abuse and mental health treatment under private, employer-sponsored, managed behavioral health care plans.

Journal Article

Empirically Defined Health States for Depression from the SF-12

The authors conclude that cluster analysis is demonstrably a powerful methodology for forming clinically valid health states from health status data.

Research Brief

How Does Managed Care Affect the Cost of Mental Health Services?

RAND conducted three studies examining issues surrounding mental health benefits under managed care. The studies focused on the costs of mental health services under managed care and the implications of the 1996 parity legislation for cost and benefit design.

Journal Article

Implementing Publicly Funded Risk Contracts with Community Mental Health Organizations

The study analyzed the experience of the Los Angeles County Department of Mental Health.

Research Brief

Improving the Quality and Cost-Effectiveness of Treatment for Depression

In a series of recent studies, RAND examined the quality and cost-effectiveness of care for severely depressed patients treated under different payment systems by general medical clinicians and mental health care professionals.

Journal Article

Managed Behavioral Health Services for Children Under Carve-Out Contracts

Service costs and utilization patterns of children in carved-out behavioral health care plans were examined and compared with those of adults.

Journal Article

Mental Health and Substance Abuse Benefits in Carve-Out Plans and the Mental Health Parity Act of 1996

The authors analyze the benefit designs of 4,000 current behavioral health carve-out plans and contrast them to medical benefits.

Journal Article

Physician Knowledge, Financial Incentives and Treatment Decisions for Depression

Estimates the relative role of financial incentives and provider information on quality of care for less and more severely depressed patients.

Report

How Expensive is Unlimited Mental Health Care Coverage Under Managed Care?

It shows that the assumptions used in 1996's policy debates overstated actual managed care costs by more than 300%.

Journal Article

Instrumental Variable Methods for Effectiveness Research

Research questions such as quality of specific providers or guideline-concordant care in typical practices, commonly studied in observational setting.

Journal Article

Measuring Health Outcomes for Depression

The authors describe the clinical and health-related quality of life outcome measures for depressed patients in the Medical Outcomes Study.

Journal Article

Private Health Insurance and Public Expenditures in Jamaica

Many governments who have large public health care systems are looking for means to reduce the public's financial burden.

Commercial Book

Caring for Depression

This book documents the inefficiencies of our national systems -- prepaid as well as fee-for-service -- for treating depression and explores how they can be improved.

Report

Provider choice and continuity for the treatment of depression

Provider choice and continuity for the treatment of depression

Report

Switches between Prepaid and Fee-for-Service Health Systems among Depressed Outpatients: Results from the Medical Outcomes Study

Switches between prepaid and fee-for-service health systems among depressed outpatients : results from the Medical Outcomes Study

Report

Care for Depression in a Changing Environment

Focusing on care for clinical depression as a test case, this paper summarizes the authors previously published findings on the effects of various payment strategies, managed care, and primary care gatekeepers on the outcomes and costs for the treatment of mental health conditions.

Report

How Can Care for Depression Become More Cost-Effective?

... to determine the cost and health effects of changes in the content and quality of care for depressed patients treated in prepaid general medical practices (internal and family medicine) and mental health specialty practices and shifts in the proportion of patients treated in general medicine.

Report

Mental Health Care Utilization in Prepaid and Fee-For-Service Plans Among Depressed Patients in the Medical Outcomes Study

The authors analyzed outpatient mental health care utilization in prepaid and fee-for-service plans for a panel of depressed outpatients in the longitudinal part of the Medical Outcomes Study.

Journal Article

Why Does Nuclear Power Performance Differ Across Europe?

Compares the performance of nuclear power plants in five European countries by estimating a microeconomic model of managerial decision making.

Draft

Can Prepaid Care for Depression be Improved Cost-Effectively?

This report analyzes the effects of changes in (1) the content and quality of care for depressed patients treated in prepaid general medical and mental health specialty practices and (2) the proportion of patients treated in general medicine.

Report

Do Soviet nuclear reactors outperform Western reactors?

Do Soviet nuclear reactors outperform Western reactors?

Journal Article

Proportional Hazard Regression Models for Point Processes: An Analysis of Nuclear Power Plant Operations in Europe

The safety and reliability of nuclear power have been hotly debated in the last 30 years.

Draft

Provider Choice and Continuity for the Treatment of Depression

Provider Choice and Continuity for the Treatment of Depression

Report

Stochastic process analysis for nuclear power plant operations

Stochastic process analysis for nuclear power plant operations

Research Brief

Trial By False Fire: Education's Role in U.S. "Economic Decline"

Most parties assume that the United States is losing its industrial core, U.S. workers are less productive than competitors' workers, U.S. education and training bear much of the blame.

Draft

Using Private Health Insurance to Reduce and Better Target Public Expenditures

Using Private Health Insurance to Reduce and Better Target Public Expenditures

Journal Article

V-230 Performance: How Good Is It Really?

V-230s deteriorate over time, while Western reactors generally improve.

Journal Article

When Do Couples Sign the One-Child Certificate in Urban China?

Analyzes China's one-child policy: when do eligible couples sign the one-child certificate and what are socioeconomic determinants of this decision?

Report

How Do Education and Training Effect a Country’s Economic Performance? A Literature Survey

This report reviews research on the role of education and training in economic performance.

Journal Article

Fecundability and Social Development in China: Changes in the Distribution of the First Conception Interval

The authors find evidence that the hazard of conception of a susceptible woman is increasing with the duration of marriage in China.

Draft

Health plan and provider switching among depressed outpatients in the Medical Outcomes Study

Health plan and provider switching among depressed outpatients in the Medical Outcomes Study

Draft

Information and the Demand for Supplemental Medicare Insurance

... to investigate the role of uncertain information about health insurance benefits on the demand for supplemental Medicare insurance that allows imperfect information to affect both the mean and the variance of the expected benefits distribution.

Report

Outcomes for adult outpatients with depression under prepaid or fee-for-service financing

Outcomes for adult outpatients with depression under prepaid or fee-for-service financing

Journal Article

Educational Attainment and the Returns to Education for Australian Youth: Evidence of Self-Selection?

Debates concerning the re-introduction of tertiary fees in Australia have made rates of return on education an active topic for investigation.

Journal Article

Parametric and Parametrically Smoothed Distribution-Free Proportional Hazard Models with Discrete Data

This paper discusses discrete time proportional hazard models and suggests a new class of flexible hazard functions.