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.

2021

• A Comparison of National and International Approaches to COVID-19-Related Measures 2021

  Mahshid Abir, Megan K. Beckett, Wenjing Huang, Hamad Al-Ibrahim, Joan Chang, Florian F. Schmitzberger, Kirstin W. Scott, Peter S. Hussey

  To track how well different countries and U.S. states are responding to the pandemic—and to make valid cross-country and cross-state comparisons of key outcomes—uniform measures are needed. The authors of this report evaluate the comparability of commonly used COVID-19-related measures and make recommendations for the use and development of measures that would allow for more standardized and valid comparisons.

• Concentration of Patient Care Among Buprenorphine-Prescribing Clinicians in the U.S. 2021

  Bradley D. Stein, Brendan Saloner, Megan S. Schuler, Jill Gurvey, Mark J. Sorbero, Adam J. Gordon

  Drawing on national retail pharmacy data, researchers identified and categorized clinicians who prescribed buprenorphine for OUD at least once between January 2017 and December 2018.

• Consensus-based Approach to Managing Opioids, Including Opioid Misuse and Opioid Use Disorder, in Patients with Serious Illness: Protocol for a Modified Delphi Process 2021

  Caroline King, Robert Arnold, Emily Dao, Jennifer Kapo, Jane Liebschutz, Diane Meier, Judith Paice, Christine Ritchie, Kristen Czajkowski, Dmitry Khodyakov, et al.

  Using a modified Delphi approach, we created seven patient cases that capture important management challenges in individuals with serious illness prescribed opioid therapy.

• Core Principles of Public Health Emergency Preparedness (PHEP) 2021

  Christopher Nelson

  Testimony presented before the Florida House of Representatives Pandemics and Public Emergencies Committee on March 16, 2021.

• The Coronavirus Pandemic Highlights Why Family Caregivers Need to Be Integrated into the Health Care Team and Shows Us How to Make It Happen 2021

  Esther M. Friedman, Patricia K. Tong, Robert S. Rudin

  Family caregivers provide a significant portion of health and support services in the United States to individuals with serious illnesses but are often overlooked by existing health care systems. The authors describe why, in light of COVID-19, it is more critical than ever to integrate family caregivers into patients' health care teams and highlight several solutions for accomplishing this goal.

• Cost Evaluation of Integrating Local HIV and Housing Data to Facilitate Service Coordination in Four Demonstration Sites 2021

  Michele Abbott, Ryan K. McBain, Lisa Wagner, Harry H. Liu

  As part of the evaluation of a federal initiative to integrate HIV medical and housing data at four local jurisdictions in the U.S., we estimated the financial costs of implementing data integration occurring from June 2016 to August 2018.

• Could Periodic Nonpharmaceutical Intervention Strategies Produce Better COVID-19 Health and Economic Outcomes? 2021

  Raffaele Vardavas, Pedro Nascimento de Lima, Lawrence Baker

  We developed a COVID-19 transmission model to compare the effects of nonpharmaceutical public health interventions (NPIs). We find that the periodic switch between low and high NPI levels could have produced similar health outcomes as static strategies but better social welfare outcomes.

• COVID-19 Testing in K–12 Schools: Insights from Early Adopters 2021

  Laura J. Faherty, Benjamin K. Master, Elizabeth D. Steiner, Julia H. Kaufman, Zachary Predmore, Laura Stelitano, Jennifer T. Leschitz, Brian Phillips, Heather L. Schwartz, Rebecca Wolfe

  To help schools safely return to in-person instruction, this report describes approaches that early adopters of COVID-19 testing in U.S. K–12 schools were using as of December 2020, highlighting key facilitators that made testing feasible, acceptable, and effective. It also provides recommendations to school leaders, district officials, and policymakers on how to support the implementation of COVID-19 testing in schools.

• COVID-19 Vaccine Intentions and Mistrust in a National Sample of Black Americans 2021

  Laura M. Bogart, Lu Dong, Priya Gandhi, David J. Klein, Terry L. Smith, Samantha Ryan, Bisola O. Ojikutu

  High mistrust among Black Americans around COVID-19 vaccines may lower vaccine confidence.

• Creating Culture-Centered Health and Health Insurance Literacy Resources: Lessons Learned from Haitian Creole, Mandarin, Native American, and Vietnamese Communities 2021

  Elizabeth L. Petrun Sayers, Kathryn E. Bouskill, Thomas W. Concannon, Laurie T. Martin

  A culture-centered approach to health literacy programs enhances meaningful and effective health communication.

• Decline in Trust in the Centers for Disease Control and Prevention During the COVID-19 Pandemic 2021

  Michael S. Pollard, Lois M. Davis

  Researchers present a subset of results from May and October 2020 surveys fielded through the RAND American Life Panel to assess changes in levels of trust in the Centers for Disease Control and Prevention during the coronavirus disease 2019 pandemic. Non-Hispanic white and Hispanic respondents reported significant declines in trust, while the changes were not statistically significant for non-Hispanic black or respondents of other races.

• Developing Health Equity Measures 2021

  Steven C. Martino, Sangeeta C. Ahluwalia, Jordan M. Harrison, Alice Y. Kim, Marc N. Elliott

  Medicare’s value-based purchasing programs do not currently include health equity measures. This work identified 10 existing approaches to health equity measurement and convened a technical expert panel to identify the most promising approaches.

• The Doctor Will See You: Online Physician Transformations During COVID-19 2021

  Jonathan Cantor, Christopher M. Whaley

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

• Does Marijuana Legalization Affect Work Capacity? Evidence from Workers' Compensation Benefits 2021

  Rahi Abouk, Keshar M. Ghimire, Johanna C. MacLean, David Powell

  We study the effect of state recreational marijuana laws on workers' compensation benefit receipt among adults 40–62 years old.

• Does Removing Financial Incentives Lead to Declines in Performance? A Controlled Interrupted Time Series Analysis of Medicare Advantage Star Ratings Programme Performance 2021

  Rachel O. Reid, Mallika Kommareddi, Susan M. Paddock, Cheryl L. Damberg

  We performed an observational cohort analysis of Medicare Advantage plans that were eligible for the Star Ratings program.

• Do Supply-Side Forces Explain Geographic Variation in Health Care Use? 2021

  Matthew R. Rosengart, Robert Kaestner, Jason M. Ward

  We provide new evidence on causal factors behind geographic variation in health care utilization by examining changes in health care use for the near-elderly as they transition from being uninsured into Medicare.

• The Effect of the Minimum Wage on Employer-Sponsored Insurance for Low-Income Workers and Dependents 2021

  Michael Dworsky, Christine Eibner, Xiaoyu Nie, Jeffrey B. Wenger

  Minimum wage increases lead to reductions in employer-sponsored insurance coverage in families with incomes below 300% of the federal poverty level.

• Effects of Employer-Offered High-Deductible Plans on Low-Value Spending in the Privately Insured Population 2021

  Brendan Rabideau, Matthew Eisenberg, Rachel O. Reid, Neeraj Sood

  This study uses insurance claims data and changes in plan offerings within firms over time to estimate treatment effects of high-deductible plans on spending on 24 low-value services received in the outpatient setting.

• Electronic Health Data Quality and Population Health Management Algorithms 2021

  Zachary Predmore, Shira H. Fischer

  In this perspective piece, we explore the implications of poor quality electronic health data on the use of population health management algorithms for patients, clinicians, and policymakers.

• Evaluation of Los Angeles County's COVID-19 Mental Health Campaign 2021

  Rebecca L. Collins, Nicole K. Eberhart, Amy L. Shearer, Elicia M. John, Elizabeth Roth

  In response to the coronavirus disease 2019 (COVID-19) pandemic and subsequent policies, the Los Angeles County Department of Mental Health launched a campaign to promote awareness of county mental health resources and communicate messages of hope and support. RAND evaluators found that the campaign successfully reached residents, fostered a feeling of support among those it reached, and conveyed how to seek mental health help.

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