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.
In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
We conducted a retrospective cohort study of patients hospitalized on a medicine service in a high-LTACH use region and discharged to either an LTACH or SNF and followed for one year.
Insulin prices have increased dramatically over the past decade in the United States. The authors compared international prices for insulins using a price index approach. They describe the shares of volume and sales for all insulins and different categories of insulin in the United States and 32 comparison countries in 2018.
We identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of the laws and how well they meet the current needs of cancer care given rapid changes in therapies.
In this report, the authors offer an initial assessment of clinically integrated networks (CINs) based on interviews with health system executives, describe how health systems (large and small) are using CINs strategically to compete in crowded health care markets, and identify why CINs bear watching by the Federal Trade Commission and the larger health care community.
This study estimates the societal costs of implementing CHOICE, a voluntary after-school alcohol and other drug prevention program for adolescents, in Boys and Girls Clubs across Southern California with and without an implementation support system called Getting To Outcomes.
Research on the costs of telemedicine programs shows that they are not self-sustaining and require grants and other resources to operate. However, given the significant changes to state telemedicine policies that have occurred in the past few years, this research base is outdated. RAND researchers describe telemedicine-related costs incurred by health centers participating in the Sustainable Models of Telehealth in the Safety Net initiative.
This study disentangled the effects of moral hazard from health plan selection. Our estimates imply that 53% of the additional medical spending observed in the most generous plan in our data relative to the least generous is due to adverse selection.
This brief describes how a public option for health care—that is, a government-sponsored health insurance plan with publicly determined provider payment rates—would affect insurance costs and coverage.
To evaluate differences in end-of-life cost trajectories for cancer patients treated through Medicare versus by the Veterans Health Administration (VA).
Uses a contemporary bundled payment reform and a difference-in-differences research design to estimate spillovers from Medicare payment reforms to non-Medicare populations
Although family caregivers provide a significant portion of health and support services to individuals in the United States with serious illnesses, they are often overlooked by existing health care systems. The report is intended to spur a conversation about potential ways to promote integration and provide a blueprint for the next steps to implementing to support for the integration of family caregivers into the patient's health care team.
The authors use data from 2016 to 2018 — covering $33.8 billion in hospital spending from three sources (self-insured employers, state-based all-payer claims databases, and health plans) — to document variation in facility prices for the commercially insured population. They report differences in standardized negotiated prices and prices relative to Medicare reimbursement rates for the same procedures and facilities.
Medicare appears to be overpaying surgeons for post-operative care associated many medical procedures. Federal officials should incorporate ways to more objectively measure the amount of postoperative care surgeons provide to patients
Key data used to set practice expense (PE) payment rates under the Medicare Physician Fee Schedule have not been updated since 2008, though the U.S. economy and health care system have changed since then. There are concerns that continued reliance on these data might result in misvalued PE rates. In this report, the authors address how the Centers for Medicare and Medicaid Services can improve the methodology or update data used to set PE rates.
8 percent of episodes at in-network ambulatory surgery centers generated surprise bills, averaging $1,483 in 2017; most bills came from anesthesiologists and certified registered nurse anesthetists.
There is interest among U.S. policymakers in using out-of-network payment limits to control rising health care spending. RAND researchers estimated the effects that four proposed out-of-network payment limits for hospital care—125 percent of Medicare payments, 200 percent of Medicare payments, state average payment by private plans, and 80 percent of billed charges—would have on negotiated in-network prices and total payments for hospital care.
There is growing interest in a "public option" for individual market insurance to improve affordability and enrollment. The authors consider four public option alternatives that vary based on the rates providers are paid, whether the option is implemented on or off Health Insurance Marketplaces, and whether premium tax credits are available to higher-income individuals.
The authors argue that, conceptually, the main advantage of subscription models over traditional prescription drug payment arrangements is that they could reduce some sources of uncertainty in spending for payers and in revenue for manufacturers.
Using detailed physician ownership information and a universe of Florida discharge records, shows novel evidence of hospital-physician integration foreclosure effects within outpatient procedure markets.
