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.
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.
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.
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
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.
This study presents the results of a proof-of-concept modeling effort that utilized individual patient-level data from ten randomized studies and the categorization of these study's participants by chronic pain impact level to estimate the effectiveness and cost-effectiveness of adding recommended nonpharmacologic therapies for CLBP to usual care.
Early indications suggest that value-based incentives are leading to changes; however, incentives remain small, potentially limiting their effectiveness in driving the significant changes needed to derive large improvements in performance.
To help inform accurate valuation of procedures with global periods, Medicare required select practitioners to report on their post-operative visits beginning July 1, 2017. Analysis of 1.4 million procedures with 10- or 90-day global periods, linked to 931,640 post-operative visits, found that the proportion of expected post-operative visits provided was low for all procedures, suggesting the need to revalue procedures with global periods.
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.
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.
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.
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.
California's experience implementing a policy to address surprise medical billing demonstrates that out-of-network payment standards can influence payer-provider bargaining leverage, affecting prices and network breadth.
Prices are the primary reason why the U.S. spends more on health care than any other country.
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.
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.
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.
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.
