Christopher M. Whaley

The End of the U.S. COVID-19 Public Health Emergency: Q&A with RAND Experts

We asked RAND experts to reflect on the past three years: What were the effects on the United States and around the world, what has changed, what are the most important takeaways, what was done right, and what was done wrong? At the same time, they looked ahead to what might be done to mitigate the health and geopolitical impacts of future pandemics.

We Studied COVID-19 Cases After Birthdays. Family Gatherings Can Still Be Dangerous

The high toll of COVID-19 in the United States is likely partly due to informal social gatherings that have not been subject to state and local restrictions. They are often small, intimate, and involve people we trust. And that makes them dangerous.

The Link Between Workplace Diversity and the Gender Pay Gap

Many factors explain the gender earnings gap, including workplace biases, differences in how credit is attributed, and differences in how men and women negotiate. But another factor could influence the pay women receive: the number of men in their workplace.

Non-Emergency Medical Transportation in the Time of COVID-19

More widespread availability of rideshare for non-emergency medical transport may save lives, reserve emergency resources for those who need them, and provide safe pathways to primary care for the chronically ill. It could also save livelihoods, providing employment in a time of economic hardship.

Addressing Surprise Medical Bills Without Raising the Cost of Health Care

Patients who try to stay within their insurers' networks can be hit with surprise bills when they unknowingly receive care from out-of-network physicians. How much should a physician be paid for providing a service that is critical but rendered without the patient's ready ability to choose an in-network provider?

Removing Maternity Care and Mental Health Treatment from Coverage Requirements Would Reduce Premiums, but Lead to Significant Spending Increases for Some Consumers

The American Health Care Act passed by the U.S. House of Representatives to repeal and replace the Affordable Care Act allows states to waive benefits that the ACA deemed “essential.” Dropping maternity care coverage, for example, would reduce premiums by 5 percent but increase out-of-pocket spending for new mothers.

Can a Continuous Coverage Requirement Produce a Healthy Insurance Market?

A continuous coverage requirement is intended to discourage individuals from waiting until they become sick to purchase insurance. Such a requirement works well in theory to maintain a healthy marketplace, but there is little evidence on how well it might work in practice.

Journal Article

Transparency in Coverage Data and Variation in Prices for Common Health Care Services

This study revealed how novel data can inform policies that improve the efficiency of the US health care system. The study was limited to a single insurer and 7 procedures; however, it opens the door to using TiC data in other, broader settings.

Journal Article

Changes in Employment in the US Health Care Workforce, 2016-2022

This study estimated recovery since the initial decrease in employment after the March 2020 public health emergency across US health care subsectors through the end of 2022.

Journal Article

Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance

In this study, we examined telehealth, in-person, and overall pediatric mental health service utilization and spending rates from January 2019 through August 2022.

Journal Article

Telehealth and In-Person Mental Health Service Utilization and Spending, 2019 to 2022

During the COVID-19 pandemic, telehealth for mental health boomed. Post-pandemic, little is known about mental health service trends. We studied 2019-2022 data on telehealth vs. in-person mental health utilization and spending in US adults pre-2023 PHE expiry.

Journal Article

The Impact of COVID-19 Shelter-In-Place Policy Responses on Excess Mortality

Using an event study approach awe measure changes in excess deaths following the implementation of COVID-19 policies. We do not find that countries or U.S. states that implemented policies earlier had lower excess deaths.

Draft

Hospital Behavior Over the Private Equity Life Cycle

Examines the largest private equity hospital takeover in history for a more detailed understanding of firm strategy and patient outcomes.

Journal Article

What's Behind Losses At Large Nonprofit Health Systems?

The authors aim to understand the financial performance of large nonprofit hospitals systems in the post-COVID-19 era by examining several of these systems' overall profit margin by using their most recent annual financial reports.

Testimony

Health Care Price Transparency: Opportunities to Improve Affordability and Data Effectiveness

Testimony presented before the U.S. House of Representatives Committee on Ways and Means on May 16, 2023.

Draft

Outside Equity and Healthcare Firm Behavior

Extends the literature devoted to private equity in healthcare by focusing on an influential and growing dimension of care (outpatient surgery) and key contributing industry (ambulatory surgery centers) where private equity has been aggressive.

Journal Article

Association Between Hospital-Physician Vertical Integration and Medication Adherence Rates

Increases in vertical integration were not associated with changes in medication adherence rates. However, adherence rates after vertical integration declined for non-Whites, patients over 80 years old, and patients with greater comorbidities.

Journal Article

Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration

This study highlights how the growing trend of vertical integration, combined with differences in Medicare payment between hospitals and nonhospital providers, leads to higher Medicare spending.

Testimony

Health Care Affordability: State Policy Options to Control Costs

Testimony presented before the Texas House of Representatives Select Committee on Health Care Reform on August 4, 2022.

Journal Article

Linking State Health Care Data to Inform Policymaking: Opportunities and Challenges

This report provides additional detail on the objectives of and use cases for APCDs, the current APCD landscape, and implementation challenges that constrain the use of APCDs for some valuable applications.

Journal Article

US Health Care Workforce Changes During the First and Second Years of the COVID-19 Pandemic

Health care employment levels declined from 22.2 million in 2019 to 21.1 million, in 2020 but rebounded to 21.8 million in second quarter of 2021.

Report

Prices Paid to Hospitals by Private Health Plans: Findings from Round 4 of an Employer-Led Transparency Initiative

The lack of transparency of prices in the health care market limits the ability of employers to knowledgeably develop or implement benefit design decisions. This report is designed to allow an easy comparison of hospital prices using a single metric.

Journal Article

Trends In Hospital Prices Paid By Private Health Plans Varied Substantially Across The US

We describe how commercial hospital payment rates changed relative to Medicare rates during 2012–19 and how trends differed by hospital referral region.

Journal Article

The Impact of the COVID-19 Pandemic and Policy Response on Health Care Utilization: Evidence from County-Level Medical Claims and Cellphone Data

Shelter-in-place policies during the COVID-19 pandemic were associated with reductions in the use of preventive care, elective care, and the number of weekly visits to physician offices, hospitals and other health care-related industries.

Report

Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic: Results from the Connected Care Accelerator Initiative

This mixed-methods study followed 45 health centers serving low-income populations for 18 months of the COVID-19 pandemic. Researchers investigated changes in telehealth utilization and health center staff experiences with implementation.

Journal Article

The Health Plan Environment in California Contributed to Differential Use of Telehealth During the COVID-19 Pandemic

Examining the patient and health plan differences in use of telehealth during the COVID-19 pandemic, this study highlights the role of health plan and provider differences in driving disparities in access to telehealth services.

Journal Article

Female Physicians Earn An Estimated $2 Million Less Than Male Physicians Over A Simulated 40-Year Career

Over a simulated forty-year career, male physicians earned an average adjusted gross income of $8,307,327 compared with an average of $6,263,446 for female physicians—an absolute adjusted difference of $2,043,881 and relative difference of 24.6 percent.

Journal Article

Physician Compensation In Physician-Owned And Hospital-Owned Practices

Vertical integration of physician practices with hospitals or health systems was associated with lower income for nonsurgical specialists, no difference in income for primary care physicians, and slightly higher income for surgical specialists.

Journal Article

Association Between COVID-19 Relief Funds and Hospital Characteristics in the US

CARES Act funds may have disproportionately gone to hospitals that were in a stronger financial situation prior to the pandemic compared to those that were not.

Journal Article

Use of Buprenorphine for Those with Employer-Sponsored Insurance During the Initial Phase of the COVID-19 Pandemic

This study examined changes in the use of buprenorphine to treat opioid use disorder in 2020 during the onset of the COVID-19 pandemic using pharmaceutical claims.

Journal Article

Trends in Visits to Substance Use Disorder Treatment Facilities in 2020

This study examined weekly changes in the number of substance use disorder treatment facility visits in 2020 compared to 2019, and explored variation in change in weekly visits by COVID-19 incidence and historical fatal drug overdose rate.

Report

Going to the Doctor: Rideshare as Nonemergency Medical Transportation

The authors examine rideshare's role in nonemergency medical transportation (NEMT) and identify key populations for whom and the types of rides for which NEMT could be a model, rideshare's role in NEMT, and the policies that support such a role.

Draft

Raising the Stakes: Physician Facility Investments and Provider Agency

Explores medical regulations concerning physician investment in ambulatory surgery centers.

Research Brief

Reducing Hospital Spending: Three Policy Options

This Research Brief summarizes the spending impact of policy options to reduce hospital prices paid by private health plans, outlining design choices and effectiveness levels for each approach.

Research Brief

U.S. Prescription Drug Prices Are 2.5 Times Those in Other OECD Countries

RAND researchers used 2018 prescription drug volume and price data to compare U.S. drug prices with those in 32 other nations, both overall and for specific categories of drugs, such as brand-name and generic medications.

Journal Article

Who Is (and Isn't) Receiving Telemedicine Care During the COVID-19 Pandemic

COVID-19 has affected telehealth utilization disproportionately. The increase in telemedicine use was greatest among patients in counties with low poverty levels, among patients in metropolitan areas, and among adults compared with children.

Research Brief

10Plan, How Would It Affect Health Care Spending by Consumers and the Federal Government

The 10Plan is a self-pay plan for individuals currently uninsured or covered by a private nongroup health insurance plan. The authors built a microsimulation model to estimate health care spending under both the status quo and the 10Plan.

Research Brief

Private U.S. Health Plans Pay Hospitals 247 Percent of What Medicare Would Pay

RAND researchers used data from 49 states and Washington, D.C., to assess hospital prices paid by private health plans. Data sources included $33.8 billion in spending from 3,112 community hospitals—more than half of community hospitals nationwide.

Report

Impact of Policy Options for Reducing Hospital Prices Paid by Private Health Plans

The authors analyze the spending impact of policy options to reduce hospital prices paid by private health plans, with various design choices and effectiveness levels for each approach.

Draft

The Doctor Will See You: Online Physician Transformations During COVID-19

Examines physicians use of telemedicine during COVID-19 to quantify physician-level substitution between in-person interactions with patients and virtual interactions.

Journal Article

Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic

During the COVID-19 pandemic, visit volume at a sample of FQHCs declined modestly for primary care visits and remained stable for behavioral health visits because telehealth visits replaced in-person visits.

Report

International Prescription Drug Price Comparisons: Current Empirical Estimates and Comparisons with Previous Studies

This report provides findings related to international prescription drug price comparisons, noting that 2018 drug prices in the United States were substantially higher than those in other countries.

Report

Analysis of the 10Plan: A Self-Pay System Designed to Minimize the Burden of Health Care Costs

The 10Plan is a self-pay plan for individuals currently uninsured or covered by a private nongroup health insurance plan. The authors built a microsimulation model to estimate health care spending under both the status quo and the 10Plan.

Report

Balancing Access and Cost Control in the TRICARE Prescription Drug Benefit

The Military Health System provides health and drug coverage to beneficiaries through TRICARE. This report describes the TRICARE pharmacy benefit and the trade-offs in TRICARE pharmacy policies between increasing access and controlling costs.

Journal Article

Vaccinations Against COVID-19 May Have Averted Up To 140,000 Deaths In The United States

As of May 9, 2021, reductions in COVID-19 deaths associated with vaccines had translated to value of statistical life benefit ranging between $625 billion and $1.4 trillion.

Report

Nationwide Evaluation of Health Care Prices Paid by Private Health Plans: Findings from Round 3 of an Employer-Led Transparency Initiative

The authors use data from 2016 to 2018 to document variation in facility prices for the commercially insured population. They report differences in standardized negotiated prices and prices relative to Medicare reimbursement rates.

Draft

The Extent of Externalities from Medicare Payment Policy

Uses a contemporary bundled payment reform and a difference-in-differences research design to estimate spillovers from Medicare payment reforms to non-Medicare populations.

Draft

Who Pays for Health Care Costs? The Effects of Health Care Prices on Wages

Leverages geographic variation in health care price growth caused by changes in hospital market structure, and in particular, mergers, to test the impact of health care prices on wages and benefit design.

Draft

Treatment consolidation after vertical integration: Evidence from outpatient procedure markets

Using detailed physician ownership information and a universe of Florida discharge records, shows novel evidence of hospital-physician integration foreclosure effects within outpatient procedure markets.

Report

The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care

Researchers estimated the effects that four proposed out-of-network payment limits for hospital care would have on negotiated in-network prices and total payments for hospital care.

Journal Article

Changes in Health Services Use Among Commercially Insured US Populations During the COVID-19 Pandemic

This study found that during the initial phase of the COVID-19 epidemic in March and April of 2020, patients significantly reduced use of preventive and elective care and increased use of telemedicine but not enough to offset reductions in in-person care.

Journal Article

Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability

Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.

Report

Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely: Findings from an Employer-Led Transparency Initiative

Based on all hospitals analyzed in this report, RAND Corporation researchers found that the prices paid to hospitals by private employer-sponsored health plans rose from 236 percent of Medicare reimbursement rates in 2015 to 241 percent in 2017.

Journal Article

First Annual Evaluation Report of the Medicare Advantage Value-Based Insurance Design Model Test: 2017, Year 1 of the Intervention

RAND researchers are evaluating a five-year model test to assess whether value-based insurance design can increase use of high-value services, reduce use of avoidable services, improve quality of care, and improve health outcomes and reduce spending.

Report

Integrating Department of Defense and Department of Veterans Affairs Purchased Care: Preliminary Feasibility Assessment

An integrated approach to purchasing health care for U.S. Department of Defense and U.S. Department of Veterans Affairs could have important implications for access, quality, and costs but could face legislative, policy, or contractual challenges.

Research Brief

Preliminary Feasibility Assessment of DoD-VA Purchased Care Integration

An integrated approach to purchasing health care for U.S. Department of Defense and U.S. Department of Veterans Affairs could have important implications for access, quality, and costs but could face legislative, policy, or contractual challenges.

Journal Article

Firm Responses to Targeted Consumer Incentives: Evidence from Reference Pricing for Surgical Services

In response to reference pricing for high-priced surgical providers, the study found some evidence of price reductions.

Journal Article

Consumer Responses to Price Transparency Alone Versus Price Transparency Combined With Reference Pricing

Reference pricing simplifies the "choice architecture" of health care decision making for patients by steering them to low-priced providers and giving them a financial incentive to comply with the nudge.

Journal Article

The Moral Hazard Effects of Consumer Responses to Targeted Cost-sharing

A targeted cost-sharing program implemented by the California Public Employees Retirement System led to an increase in the use of low-price colonoscopy providers.

Report

Challenges to the Sustainability of the U.S. Public Cord Blood System

We describe the existing public cord blood bank (CBB) system, assess current trends and economic relationships from the perspective of stakeholders in the CBB system, and provide recommendations for ways to improve the sustainability of the system.

Research Brief

Public Cord Blood Banks: Worthy of National Investment

RAND studied trends affecting public cord blood banks and considered changes to the program to buttress banks' financial stability. Researchers found a system worthy of investment, especially if it helps improve the quality of the national inventory.

Journal Article

Association of Reference Pricing with Drug Selection and Spending

Over an 18 month period, reference pricing for drugs was associated with a reduction in employer spending of $1.34 million but an out-of-pocket spending increase of $0.12 million for employees.

Report

Toward Improved Management of Officer Retention: A New Capability for Assessing Policy Options

This report documents efforts to implement a capability for the U.S. Department of Defense to assess alternative policies to enhance officer retention provides source code and foundations of a spreadsheet version of the model.