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Hospital Prices, Border Solutions, Sri Lanka: RAND Weekly Recap

May 10, 2019

This week, we discuss how much private health plans pay hospitals compared with Medicare; potential solutions for the humanitarian crisis at the U.S.–Mexico border; reducing opioid overdose deaths; myths about the Sri Lanka bombings; the gap between America's defense strategy and its military capacity; and how to fund the rebuilding of U.S. infrastructure.

Calculator and mobile phone on top of medical invoice, photo by DNY59/Getty Images

Photo by DNY59/Getty Images

Private Health Plans Pay Hospitals 241 Percent of What Medicare Would Pay

In 2017, the prices paid to hospitals by private health plans averaged 241 percent of what Medicare would have paid. That's according to a new RAND analysis, which compared prices of nearly 1,600 U.S. hospitals and the medical claims of more than four million people.

Notably, there was wide variation in pricing among both hospitals and states. This suggests that employers have opportunities to redesign their health plans to better align hospital pricing with the value of care provided. Employers may also be able to exert pressure on health plans and hospitals to shift from the current pricing system to one that is more similar to Medicare.

Asylum-seeking families from Central America trek through a field after crossing the Rio Grande River, Penitas, Texas, March 31, 2019, photo by Adrees Latif/Reuters

Asylum-seeking families from Central America trek through a field after crossing the Rio Grande River, Penitas, Texas, March 31, 2019

Photo by Adrees Latif/Reuters

Common-Sense Solutions at the Border

Families and children from Central America have been arriving in growing numbers at the U.S. southern border. This is despite actions taken by the Trump administration, and its increasingly hard-line rhetoric on immigration. What's going on here? RAND's Blas Nuñez-Neto says one issue could be that most policies the administration has tried so far are not focused on families and unaccompanied children. But there are several options that Congress could consider. For one, adding capacity to the immigration court system could help reduce the backlog in asylum cases.

The drug Naloxone on a table during a free Opioid Overdose Prevention Training class provided by Lourdes Hospital in Binghamton, New York, April 5, 2018

A vial of Naloxone sits on a table during a free opioid overdose prevention training class at Lourdes Hospital in Binghamton, New York, April 5, 2018

Photo by Andrew Kelly/Reuters

If Pharmacists Directly Prescribe Opioid Antidote, Overdose Deaths May Fall

In some states, the opioid antidote naloxone can be dispensed by pharmacists without a doctor's prescription. A new RAND study finds that giving pharmacists this authority can sharply reduce opioid overdose deaths. Fatal overdoses fell by an average of 27 percent in the second year after such laws were passed. And in later years, overdoses fell even further—by 34 percent. Notably, weaker laws that expanded naloxone use but stopped short of giving pharmacists direct dispensing authority did not curb opioid deaths.

Security personnel stand guard in front of St. Anthony's Shrine, days after a string of suicide bomb attacks across the island on Easter Sunday, in Colombo, Sri Lanka, April 29, 2019, photo by Danish Siddiqui/Reuters

Security personnel stand guard in front of St. Anthony's Shrine in Colombo, Sri Lanka, just days after attacks across the island, April 29, 2019

Photo by Danish Siddiqui/Reuters

Myths About the Sri Lanka Attacks

More than 250 people were killed in the Easter Sunday bombings that shook Sri Lanka three weeks ago. Before this tragedy slips from American attention, it's worth debunking several misconceptions, writes RAND's Jonah Blank. The most dangerous myth is that the bombings were retaliation for attacks on two New Zealand mosques five weeks earlier. This is almost certainly false. But both attackers did share a common goal: “to drive a wedge between Muslims and Christians worldwide, and fuel a cycle of violence…across the globe.”

An aerial view of The Pentagon in Washington, D.C., photo by Ivan Cholakov/Getty Images

Photo by Ivan Cholakov/Getty Images

America's Strategy-Resource Mismatch

Does the United States have the resources to successfully carry out its strategic and defense policies? A new RAND report finds that there is a significant gap between stated U.S. strategy and the nation's military capacity. To close that gap, the government will have to make difficult choices. All investments should be prioritized by their importance to U.S. interests. According to the authors, the top priority is improving nuclear deterrence.

Chickamauga Lock and Dam, near Chattanooga, Tennessee

Photo by Mark Rankin/U.S. Army Corps of Engineers

Targeted Spending and Policies Needed to Fix U.S. Infrastructure

Last week, President Trump and Democratic leaders agreed to pursue a $2 trillion infrastructure plan. But how would these funds be allocated to improve the nation's highways, railroads, and bridges? According to a 2017 RAND study, a national consensus on priorities is a necessary first step. “Spreading federal dollars around to fund short-term, 'shovel-ready' projects without a sense of national purpose or priority will not get the nation where it needs to be,” says lead author Debra Knopman.

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