RAND Health Care has been analyzing major issues related to public and private financing of health care since the program? inception in 1968. An early landmark study in this body of work is the RAND Health Insurance Experiment, still the largest health policy study in U.S. history. RAND work in this research area includes the organization and regulation of health care markets, the effects of population health on public financing, cost-effective allocation of private and public financing, and distributional issues in health and health care associated with health care financing, among others.
We review and synthesize papers estimating drug R&D costs incurred by industry. We find a substantial range of per-drug costs, from $113 million–$6 billion. We discuss the data sources, methods, and assumptions used in each study and suggest areas for future research and data collection.
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.
International reference pricing would have lowered 2020 US spending on select prescription drugs by 52% ($83.5 billion).
The authors analyze the spending impact of policy options to reduce hospital prices paid by private health plans, with various design choices and effectiveness levels for each approach. They estimate that price regulation could have the largest impact on hospital prices and spending but would likely face political challenges, while improving price transparency and competition could help reduce prices—but to a lesser extent than price regulation.
Price transparency is one strategy that policymakers have proposed to help consumers identify and select lower-priced health care providers and services, but use of price transparency websites remains low. This report examines current price transparency efforts and their features, describes barriers to more widespread availability and use of price information, and discusses possible ways to overcome those barriers.
Understanding the extent to which drug prices are higher in the United States than in other countries is useful when developing and targeting policies to address both growth in drug spending and the financial impact of prescription drugs on consumers. This report provides findings related to international prescription drug price comparisons, noting that 2018 drug prices in the United States were substantially higher than those in other countries.
RAND Health Care researchers used public and private data, such as data from health care claims, to understand telehealth's effect on health care delivery and how it affects care quality, access, equity, and costs.
In 2020, the Immediate Office of the Secretary of the Department of Health and Human Services sought to identify measures that could improve the ability of the United States and other countries to learn from international comparisons of health system performance. RAND Corporation researchers worked with 15 experts in quality measurement, clinical care, and health economics to generate and prioritize potential measure constructs.
To determine whether and how to respond to the evolving health care market, policy makers need to better understand how health systems are actually organized and the relationships among the entities that comprise them.
In this report, the authors address how the Centers for Medicare & Medicaid Services (CMS) might improve the methodology used in practice expense (PE) rate-setting, update data that inform PE rates, or both. The system of data and methods that CMS uses to support PE rate-setting is complex; thus, CMS must take into account a number of competing priorities when considering changes to the system.
The authors describe the stakeholders involved in prescription drug supply chains and the flows of products, payments, and information between stakeholders. Many stakeholders and steps are involved in the life cycle of a prescription drug as it moves from chemical synthesis and formulation through dispensing or administration to patients.
RAND researchers used data from 49 states and Washington, D.C., to assess hospital prices paid by private health plans. Data sources included $33.8 billion in spending from 3,112 community hospitals—more than half of community hospitals nationwide.
This Research Brief summarizes the spending impact of policy options to reduce hospital prices paid by private health plans, outlining design choices and effectiveness levels for each approach.
RAND researchers respond to comments on three earlier reports related to post-operative visits bundled into Medicare payments for procedures. The authors remain confident in their main conclusion that fewer post-operative visits were provided than expected, leading to Medicare overpayment for some procedures and underpayment for other services. They recommend that the Centers for Medicare & Medicaid Services revalue procedures using the new data.
We use three case examples to illustrate the importance of implementation financing strategies, which secure and direct funds to support Evidence-Based Practices adoption and continued use.
Among individuals with fee-for-service Medicare receiving any of 32 measured services, low-value care use and spending decreased marginally from 2014 to 2018.
Medicare payment for many health care procedures covers not just the procedure itself but also most post-operative care during a fixed "global period." This report describes how CMS could use the new claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. These results may inform further policy development around revaluation for global procedures.
Medicare payment for many health care procedures covers the procedure itself and most post-operative care during a fixed "global period." This report describes how the Centers for Medicare & Medicaid Services could use claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. These results may inform further policy development around revaluation for global procedures.
RAND researchers used 2018 prescription drug volume and price data to compare U.S. drug prices with those in 32 other nations, both overall and for specific categories of drugs, such as brand-name and generic medications.
This report describes work conducted to understand the non–fee-for-service payment data collected by states and other stakeholders. Based on interviews and discussion with an expert panel, the research summarizes current practice and offers preliminary recommendations to develop a standardized methodology for collecting non–fee-for-service payment data to support measurement of primary care spending as a proportion of total health care spending.
