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.

• Eight Priorities for Improving Primary Care Access Management in Healthcare Organizations: Results of a Modified Delphi Stakeholder Panel 2020

  Lisa V. Rubenstein, Susanne Hempel, Marjorie S Danz, Danielle E Rose, Susan Stockdale, Idamay Curtis, Susan Kirsh

  The panel achieved consensus on definitions of optimal access and access management, on eight urgent and important priorities for guiding access management improvement, and on 1–3 recommendations per priority. Each recommendation is supported by referenced, panel-approved suggestions for implementation.

• 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.

• Examining the Association Between Religiosity and Medical Mistrust Among Churchgoing Latinos in Long Beach, CA 2020

  Daniel F. López-Cevallos, Karen Rocío Flórez, Kathryn Pitkin Derose

  The present study examined the association between religiosity and medical mistrust in a sample of Latino adults attending Catholic and Pentecostal churches in Long Beach, CA.

• The Expansion of National Healthcare Safety Network Enrollment and Reporting in Nursing Homes: Lessons Learned from a National Qualitative Study 2020

  Patricia Stone, Ashley M. Chastain, Richard Dorritie, Aluem Tark, Andrew W. Dick, Jeneita M. Bell, Nimalie D. Stone, Denise D. Quigley, Melony E. Sorbero

  We explored nursing home (NH) personnel perceptions of the National Healthcare Safety Network (NHSN), interviewing NH personnel about their facility's decision-making and infection prevention program. We identified barriers and facilitators to NHSN enrollment and reporting in NHs.

• 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.

• Federally Qualified Health Center Strategies for Integrating Care with Hospitals and Their Association with Measures of Communication 2019

  Justin W. Timbie, Ashley M. Kranz, Ammarah Mahmud, Claude Messan Setodji, Cheryl L. Damberg

  Health centers differ in the use of strategies to integrate care with hospitals. Overall, integration activity is associated with better communication.

• Generic Drug Policy and Suboxone to Treat Opioid Use Disorder 2020

  Rebecca Lee Haffajee, Richard G. Frank

  In this article, the authors use the case of Suboxone to demonstrate egregious anti-competitive practices that delay generic entry, estimate the costs of these delays to the public, and suggest legislative and regulatory reforms to prevent these practices going forward.

• Group and Individual-level Change on Health-related Quality of Life in Chiropractic Patients With Chronic Low Back or Neck Pain 2020

  Ron D. Hays, Karen Spritzer, Cathy D. Sherbourne, Gery W. Ryan, Ian D. Coulter

  This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain.

• Growth and Distribution of Child Psychiatrists in the United States: 2007–2016 2019

  Ryan K. McBain, Aaron Kofner, Bradley D. Stein, Jonathan Cantor, William B. Vogt, Hao Yu

  Despite the increased ratio of child psychiatrists per children over the past decade, a shortage remains, particularly in places with lower levels of income and education.

• 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.

• Health System and Beneficiary Costs Associated With Intensive End-of-Life Medical Services 2020

  Risha Gidwani-Marszowski, Steven M. Asch, Vincent Mor, Todd H. Wagner, Katherine Faricy-Anderson, Samantha Illarmo, Gary Hsin, Manali L. Patel, Kavitha Ramchandran, Karl Lorenz, et al.

  The objective of this paper is to quantify expected beneficiary and health system costs incurred in association with receipt of intensive medical services in the last month of life.

• Heterogeneity in Prescription Opioid Pain Reliever Misuse Across Age Groups: 2015–2017 National Survey on Drug Use and Health 2020

  Megan S. Schuler, Andrew W. Dick, Bradley D. Stein

  Results demonstrating heterogeneity in prescription opioid misuse characteristics across age groups highlight the need for a diverse range of clinical and policy responses.

• 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.

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