Reducing Hospital Prices, Vaccinating the Most Active, Myanmar: RAND Weekly Recap

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February 19, 2021

We discuss what would happen if hospital prices were regulated; how vaccinating the most active can protect the most vulnerable; the calculus of Myanmar’s generals; curbing “low-value” health care; how the Capitol attack could affect the future of government security clearances; and how to influence adversaries.

The emergency room entrance at Essentia Health, a 133-bed hospital in Fargo, North Dakota, October 25, 2020, photo by Bing Guan/Reuters

Photo by Bing Guan/Reuters

What if Hospital Prices Were Regulated?

A number of strategies have been proposed to reduce hospital spending in the United States, including price regulation, improving price transparency, and increasing competition among hospitals. According to a new RAND study, regulation that sets or caps hospital prices for private health plans is likely to achieve greater savings than the other two approaches.

Price regulation could save an estimated $61.9 billion to $236.6 billion annually. That's significantly more than the estimated annual savings provided by improving price transparency ($8.7 billion to $26.6 billion) or increasing competition ($6.2 billion to $68.9 billion).

Although direct price regulation may provide the greatest savings, it faces the greatest political obstacles of the strategies we examined. Regulation could also lead to hospital closures and erode quality of care.

Nurse practitioner Nicole Monk, 44, receives a coronavirus vaccination at the LA Mission homeless shelter on Skid Row, in Los Angeles, California, February 10, 2021, photo by Lucy Nicholson/Reuters

Nurse practitioner Nicole Monk, 44, receives a COVID-19 vaccination in Los Angeles, California, February 10, 2021

Photo by Lucy Nicholson/Reuters

Protecting the Most Vulnerable by Vaccinating the Most Active

The debate between protecting vulnerable people and stopping the spread of the coronavirus might be a false choice. According to a new RAND paper, vaccinating critical workers and other people who play the largest role in spreading the virus may provide more protection for the vulnerable than vaccinating vulnerable people directly. More controversially, it could even be beneficial to prioritize vaccinating groups that may comply less with social-distancing rules—such as college students and other young adults—because they can pose a huge risk to others.

A person shows the three-finger. salute in front of a placard with the image of Aung San Suu Kyi during a protest against the military coup in Yangon, Myanmar, February 15, 2021, photo by Stringer/Reuters

A person shows a three-finger salute in front of an image of Aung San Suu Kyi during a protest against the military coup, Yangon, Myanmar, February 15, 2021

Photo by Stringer/Reuters

Myanmar's Generals Plotted a Coup. Why?

In their decision to seize power, the behavior of Myanmar's generals may appear reckless and defiant. But the coup plotters were perhaps motivated by an ironic logic, says RAND's Sean Zeigler. Although Aung San Suu Kyi's election last November was hailed as a landslide victory, the generals may have been betting that public support wouldn't be strong enough to offset the consequences of their decision. Time will tell whether they were right.

A doctor giving a prescription to senior patient, photo by doble-d/Getty Images

Photo by doble-d/Getty Images

Curbing 'Low-Value' Health Care

Low-value health care services offer no net clinical benefits to patients (and sometimes even cause harm) while increasing costs for both patients and payers. Examples include prescribing opioids for acute back pain and prescribing antibiotics for upper respiratory infections. According to a new RAND study, spending on such low-value services among Medicare recipients dropped only marginally from 2014 to 2018, despite efforts to discourage their use.

Security fencing surrounds the U.S. Capitol days after supporters of President Donald Trump stormed the building, in Washington, January 11, 2021, photo by Erin Scott/Reuters

Security fencing surrounds the U.S. Capitol days after supporters of then-President Donald Trump stormed the building, January 11, 2021

Photo by Erin Scott/Reuters

What the Capitol Attack Means for Security Clearances

The mob that stormed the Capitol included municipal employees, police officers, and members of the military. Some of these individuals may have had or currently have a national security clearance—and thus access to classified information. The deadly events of January 6th could have a lasting effect on how the U.S. government approaches personnel vetting and insider-threat detection, say RAND experts.

Red and blue profiles with thinking gears in their heads, illustration by JakeOlimb/Getty Images

Illustration by JakeOlimb/Getty Images

How to Influence an Adversary

When it comes to influencing adversaries, threatening punishment alone is seldom effective. In fact, this narrow approach can sometimes backfire. According to a new RAND report, it may be better to focus on understanding how an adversary thinks. This could help U.S. leaders develop more effective influence strategies that include a mix of several measures, such as providing reassurances that reduce an adversary's fears, establishing conditional reciprocity, and relationship-building.

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