Impact of Consumer-Directed Health Plans on Low-Value Healthcare 2021
Switching to a consumer-directed health plan is associated with reduced overall outpatient spending, but not with reduced spending on low-value healthcare 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.
2021
2020
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Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries 2020
The objective of this study was to estimate the incremental direct medical care costs associated with first fracture observable in high-risk older adults.
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On the Value of the Umbilical Cord Blood Supply 2020
Several public cord blood banks are struggling financially, and the question remains whether additional allocations of funds to them are justified. This article estimates the social benefits of public cord blood bank inventory net of cord blood banks' operational costs.
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Hospital Readmission After Noncardiac Surgery: The Role of Major Complications 2020
To examine whether the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicted risk of major complications can be used to identify surgical patients at risk for rehospitalization.
2019
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Options for Reinvesting Savings from Restored Federal Cost-Sharing Reduction Payments: Examining the Effects of Two Policy Alternatives on Spending and Enrollment in the Individual Health Insurance Market 2019
Earlier research established that the federal government would likely save money if federal cost-sharing-reduction (CSR) payments to insurers under the Affordable Care Act were restored, but total health insurance enrollment would decrease. The authors of this report analyze what would happen if federal lawmakers used the savings from restoring CSR payments to provide additional health insurance subsidies or to finance reinsurance.
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Patient Willingness to Pay for Reductions in Chronic Low Back Pain and Chronic Neck Pain 2019
This study provides estimates of reported WTP for pain reduction from a large sample of patients using chiropractic care to manage their chronic spinal pain and compares these estimates to what these patients do for care over the next 3 months, to inform coverage policies for ongoing care.
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Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely: Findings from an Employer-Led Transparency Initiative 2019
Large price discrepancies exist between what private health plans pay for hospital services and what Medicare pays. RAND Corporation researchers used data from three sources — self-insured employers, state-based all-payer claims databases, and health plans — to assess $13 billion in hospital spending in terms of price levels, variation, and trends from 2015 to 2017 in 25 states. The report lists prices relative to Medicare for specific hospitals.
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Primary Care Spending in the Fee-for-Service Medicare Population 2019
Primary care spending represents a small percentage -- less than 3% -- of total fee-for-service Medicare spending, though it varies substantially across populations and states.
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Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report 2019
For many surgeries and other types of procedures, payment from Medicare and most other insurers covers the procedure itself and related services delivered within either ten or 90 days after a surgical procedure during what is called the global period. This report describes the development of a practitioner survey designed to capture the level of post-operative visits that take place during the global period.
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Addressing Social Determinants of Health Needs of Dually Enrolled Beneficiaries in Medicare Advantage Plans: Findings from Interviews and Case Studies 2019
Beneficiaries who are dually enrolled in Medicare and Medicaid are less likely to be enrolled in Medicare Advantage (MA) plans that perform well in the MA Star Rating program than non–dually enrolled beneficiaries. The authors identify the types of services that MA plans implement to meet the needs of dually enrolled and other high-cost, high-need beneficiaries, as well as the types of resources needed to implement these services.
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The Challenge of Determining Appropriate Care in the Era of Patient-Centered Care and Rising Health Care Costs 2019
The goal of health care is to ensure that patients receive the right care for the right patient for the right problem at the right time from the right provider. Inappropriate care is costly. The challenge is to define and increase delivery of appropriate care.
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The Problematic Economics of Integrative Oncology 2019
The economics of integrative oncology are problematic because of the lack of good studies, the lack of historic incentives for efficiency, and the high cost of cancer care and its financial toxicity on patients. However, these problems can be overcome, with help from one good economic evaluation at a time.
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Randomized Controlled Dissemination Study of Community-to-Clinic Navigation to Promote CRC Screening: Study Design and Implications 2019
The purpose of this study is to extend the pilot study in a group-randomized controlled trial to test the effectiveness of tailored messaging delivered by Community Health Navigators to guide individuals from especially hard-to-reach, multicultural, and underinsured communities into primary care clinics for referral for CRC screening (Phase I) and to continue navigation after referral to track effects of the intervention on completion of CRC screening (Phase II).
2018
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Practice Expenses Associated with Comprehensive Primary Care Capabilities 2018
Through the Comprehensive Primary Care (CPC) and Comprehensive Primary Care Plus (CPC+) programs, the Centers for Medicare & Medicaid Services (CMS) has encouraged primary care practices to invest in "comprehensive primary care" capabilities. To help CMS design alternative payment models (APMs) that reimburse primary care practices for these capabilities, the authors developed and piloted a method for estimating related practice expenses.
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RAND Hospital Data: Web-Based Tool 2018
Medicare-certified hospitals are required to submit an annual cost report to a Medicare Administrative Contractor. The Centers for Medicare & Medicaid Services (CMS) maintains the cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS).The RAND Hospital Data tool is an effort to enhance CMS HCRIS data to make them more useful and accessible to a broad audience, and to provide insights into the hospital industry.
2015
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Borrowing for the Cure: Debt Financing of Breakthrough Treatments 2015
This paper offers a research-grounded perspective on innovative financing mechanisms to facilitate access to expensive yet highly effective breakthrough medical treatments. The authors outline the scope of the problem; describe several policy and market options, including bond financing and linking repayment to real-world value generation; and describe real-world applications.
2010
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Is Physician Cost Profiling Ready for Prime Time? 2010
Physician cost profiling is intended to identify physicians with lower spending patterns, but RAND analysts found that common profiling methods result in 22 percent of physicians being assigned to the wrong cost category in a two-tier system.
2008
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Insurance Companies' Fears of Covering Acupuncture Appear Unfounded 2008
This fact sheet describes how patients' use of acupuncture affects use of conventional medical services and suggests that acupuncture often substitutes for other, more expensive services, thereby reducing total medical costs.
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Life Expectancy Is Better Than Age as a General Predictor of Health Care Expenditures 2008
This fact sheet summarizes a study using the 1992-1999 Medicare Current Beneficiary Survey to investigate whether age directly affects health care costs, or whether life expectancy would produce more accurate estimates of future expenditures.
2007
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A Look inside the "Doughnut Hole": How Drug-Benefit Limits Affect Retiree Prescription Use 2007
This research brief examines the likely effects of the gap in the Medicare Part D standard drug benefit after $2,400 in pharmaceutical spending, using data from a private employer.