Survey of Hospital Chargemaster Transparency 2022
We compared hospital chargemaster data within a local hospital market where patients would reasonably try to shop or compare services.
Publications on Health Care Costs
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.
2022
2021
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Reducing Hospital Spending: Three Policy Options 2021
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.
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Responses to Comments on RAND Global Services Reports 2021
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.
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Translating Economic Evaluations Into Financing Strategies for Implementing Evidence-Based Practices 2021
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.
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Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014–2018 2021
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.
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Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods 2021
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.
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Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data 2021
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.
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U.S. Prescription Drug Prices Are 2.5 Times Those in Other OECD Countries 2021
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.
2020
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Advancing the Development of a Framework to Capture Non–Fee-for-Service Health Care Spending for Primary Care 2020
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.
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Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder 2020
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.
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Comparative Effectiveness of Long-Term Acute Care Hospital Versus Skilled Nursing Facility Transfer 2020
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.
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Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis 2020
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.
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The Complex Cancer Care Coverage Environment: What Is the Role of Legislation? A Case Study from Massachusetts 2020
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.
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Consolidation by Any Other Name: The Emergence of Clinically Integrated Networks 2020
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.
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Cost Analysis of a Randomized Trial of Getting to Outcomes Implementation Support of CHOICE in Boys and Girls Clubs in Southern California 2020
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.
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Costs of Maintaining a High-Volume Telemedicine Program in Community Health Centers 2020
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.
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Disentangling Moral Hazard and Adverse Selection in Private Health Insurance 2020
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.
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Effects of a Public Option on Health Insurance Costs and Coverage 2020
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.
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End-of-Life Cost Trajectories in Cancer Patients Treated by Medicare Versus the Veterans Health Administration 2020
To evaluate differences in end-of-life cost trajectories for cancer patients treated through Medicare versus by the Veterans Health Administration (VA).
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The Extent of Externalities from Medicare Payment Policy 2020
Uses a contemporary bundled payment reform and a difference-in-differences research design to estimate spillovers from Medicare payment reforms to non-Medicare populations