Publications on Health Insurance

Health care coverage protects individuals against the financial risk that might result from spending on health care services. In the United States, coverage may take the form of insurance offered by private companies and made available to individuals through employers or purchased directly. The government also provides coverage for certain populations via programs such as Medicare or Medicaid. RAND research on health care coverage dates from the RAND Health Insurance Experiment (HIE). Conducted in the 1970s and early 1980s, the HIE remains the only long-term, experimental study of cost sharing and its effect on health care utilization and spending, quality of care, and health. Since then, RAND studies have examined multiple dimensions of coverage, including the effects of premium costs on health care use, the cost and potential health effects of new insurance products such as high-deductible health plans, the challenges faced by small businesses in providing coverage to employees, the groups most at risk for being uninsured, state experiments with insuring the uninsured, coverage for behavioral health, and coverage for prescription drugs.

2019

• Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading 2019

  Preethi Rao, Sarah A. Nowak

  Although the federal government is no longer making cost-sharing reduction (CSR) payments to insurers, insurers are still required to provide CSR subsidies to qualifying enrollees. As a result, to fund CSRs, most states and insurers have adopted a practice known as silver loading, in which only the premiums of silver-tiered individual market plans are increased. In this report, the authors address the effects of disallowing this practice.

• Ensuring Access to Timely, High-Quality Health Care for Veterans: Insights from RAND Research 2019

  Carrie M. Farmer, Terri Tanielian

  Testimony submitted to the Senate Committee on Veterans' Affairs on April 10, 2019.

• Evaluation of California's Global Payment Program: Final Report 2019

  Justin W. Timbie, Maria DeYoreo, Jodi L. Liu, Denise D. Quigley, Lesley Baseman, Mary Ellen Slaughter, Alina I. Palimaru, Katherine L. Kahn

  The Global Payment Program (GPP) seeks to improve health care for California's uninsured by using federal funds to make prospective payments to public health care systems for providing inpatient, outpatient, and nontraditional services. This report presents the final evaluation of the program. Through the GPP, public health care systems have put in place a variety of strategies and offered a wider range of services during its first three years.

• Evaluation of Technology-Enabled Collaborative Learning and Capacity Building Models: Materials for a Report to Congress 2019

  Shira H. Fischer, Adam J. Rose, Ryan K. McBain, Laura J. Faherty, Jessica Sousa, Monique Martineau

  Technology-enabled collaborative learning and capacity-building models connect generalist providers, often located in remote areas, with specialist teams that help train these providers so that they can deliver care for conditions that generalists might not otherwise feel adequately prepared to handle. This report focuses on the quality of evidence for the effectiveness of such models and describes ways to improve measurement of effectiveness.

• Experiences of Medicaid Programs and Health Centers in Implementing Telehealth 2019

  Lori Uscher-Pines, Kathryn E. Bouskill, Jessica Sousa, Mimi Shen, Shira H. Fischer

  Despite telehealth's potential to improve access to care, it is underutilized by safety-net providers, including Federally Qualified Health Centers (FQHCs), due to a range of policy, organizational, and logistical barriers. This research facilitates state-to-state learning to inform both Medicaid policy and Medicare policy going forward and provide lessons learned for FQHCs interested in starting or expanding telehealth programs.

• Experiences With Chiropractic Care for Patients With Low Back or Neck Pain 2019

  Ron D. Hays, Cathy D. Sherbourne, Karen Spritzer, Lara Hilton, Gery W. Ryan, Ian D. Coulter, Patricia M. Herman

  This study provides information on the experiences of a national sample of chiropractic patients in the United States with chronic pain.

• Exploring the Prevalence and Construct Validity of High-Impact Chronic Pain Across Chronic Low-Back Pain Study Samples 2019

  Patricia M. Herman, Nicholas Broten, Tara Lavelle, Melony E. Sorbero, Ian D. Coulter

  Identifying high-impact chronic pain and reporting outcomes of trials by chronic pain impact level could help ensure that adequate resources are directed toward improving outcomes of the chronic pain patients in greatest need.

• Feasibility of Distinguishing Performance Among Provider Groups Using Patient-reported Outcome Measures in Older Adults with Multiple Chronic Conditions 2019

  Adam J. Rose, Elizabeth Bayliss, Lesley Baseman, Emily Butcher, Wenjing Huang, Maria Orlando Edelen

  This study determined the minimum sample sizes needed for reliability with two key health-related quality-of-life outcome-based performance measures among older adults. These estimates can guide the design of future patient-reported outcome-based performance measures.

• Federal Block Grants to States for Mental Health, Substance Abuse, and Homelessness: Potential Improvements to Funding Formulas 2019

  J. Scott Ashwood, Karen Chan Osilla, Maria DeYoreo, Joshua Breslau, Jeanne S. Ringel, Cheryl K. Montemayor, Nima Shahidinia, David M. Adamson, Margaret Chamberlin, M. Audrey Burnam

  RAND researchers analyzed the formulas for distributing funds to states under three block grants for services related to mental health, substance abuse, and homelessness (unchanged since 1992) to determine whether they should be modified.

• Healthcare Costs and Opioid Use Associated with High-Impact Chronic Spinal Pain in the United States 2019

  Patricia M. Herman, Nicholas Broten, Tara Lavelle, Melony E. Sorbero, Ian D. Coulter

  Opioid dosage and use increased annually for individuals with all levels of chronic pain; those with high-impact pain had average dosing 5.5 times higher than those with low-impact pain.

• How Are Medical Groups Identified as High Performing? The Effect of Different Approaches to Classification of Performance 2019

  Sangeeta C. Ahluwalia, Cheryl L. Damberg, Ann C. Haas, Paul G. Shekelle

  To accurately identify "high-performing providers", a standard definition of high-performance and an agreed-upon approach to measurement are necessary.

• Identifying Safety-Net Resources at Health Centers to Prevent Infectious Disease Transmission Resulting from the Opioid Epidemic 2019

  Joshua Breslau, Ryan K. McBain, Molly Simmons

  This study highlights factors that affect Community Health Centers' ability to reduce infectious disease transmission related to the opioid epidemic. The emphasis is on rural areas, which have suffered disproportionately from the opioid epidemic and lack resources to address the complex social and medical issues related to opioid use, opioid use disorder, and risk for infectious diseases.

• Improving the Child Welfare System to Respond to the Needs of Substance-Exposed Infants 2019

  Stephen W. Patrick, Richard G. Frank, Elizabeth McNeer, Bradley D. Stein

  To realize the gains envisioned by recent legislation, the Administration and Congress should prioritize additional funding to modernize our child welfare system to meet the unique needs of families affected by substance misuse.

• Influence of Out-of-Network Payment Standards on Insurer-Provider Bargaining: California's Experience 2019

  Erin L. Duffy

  California's experience implementing a policy to address surprise medical billing demonstrates that out-of-network payment standards can influence payer-provider bargaining leverage, affecting prices and network breadth.

• Level of Agreement on Health Information Technology Adoption and Use in Survey Data: A Mixed-Methods Analysis of Ambulatory Clinics in 1 US State 2019

  Robert S. Rudin, Yunfeng Shi, Shira H. Fischer, Paul G. Shekelle, Alejandro Amill-Rosario, Bethany Shaw, M. Susan Ridgely, Cheryl L. Damberg

  Analyses of HIT survey findings should take into consideration the validity of the data used to develop estimates of prevalence and use.

• Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel 2019

  Ian D. Coulter, C. J. Crawford, Howard Vernon, Eric Hurwitz, Raheleh Khorsan, Marika Booth, Patricia M. Herman

  The purpose of this systematic review was to evaluate the randomized controlled trials published from January 2000 through September 2017 on chronic nonspecific neck pain, comparing the effects of manipulation and/or mobilization as therapies to those of other active therapies (such as acupuncture, massage therapy, exercise, etc.) to sham or no treatment, and when combined with other therapies such as exercise or advice commonly seen in practice.

• Measuring Health Care Utilization in Medicare Advantage Encounter Data: Methods, Estimates, and Considerations for Research 2019

  Andrew W. Mulcahy, Melony E. Sorbero, Ammarah Mahmud, Asa Wilks, Jennifer Gildner, Anne Hornsby, Arthur Pignotti

  This report describes methodologies, estimates, and technical considerations related to measuring health care utilization in Medicare Part C encounter data (ED). The primary aim of the report is to provide technical details for researchers on the structure and scope of ED and on the methodological steps and analytical decisions necessary to assess utilization of health care services using ED.

• Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability 2019

  Claire E. O'Hanlon, Christopher Whaley, Deborah Anne Freund

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

• National Health Spending Estimates Under Medicare for All 2019

  Jodi L. Liu, Christine Eibner

  This report draws from previous RAND research on single-payer health care to estimate the 2019 spending effects of a Medicare for All plan similar to some proposals being discussed in Congress.

• Obesity Prevention Interventions and Implications for Energy Balance in the United States and Mexico: A Systematic Review of the Evidence and Meta-Analysis 2019

  Andrea Richardson, Christine Chen, Roland Sturm, Gulrez Shah Azhar, Jeremy N. V. Miles, Jody Larkin, Aneesa Motala, Susanne Hempel

  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.

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