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

• Analysis of the 10Plan: A Self-Pay System Designed to Minimize the Burden of Health Care Costs 2021

  Kandice A. Kapinos, Carter C. Price, Drew M. Anderson, Adrienne M. Propp, Raffaele Vardavas, Christopher M. Whaley

  The 10Plan is a self-pay plan for individuals currently uninsured or covered by a private nongroup health insurance plan. Individuals would pay no premiums up front, face Medicare rates, pay a copayment for each encounter, and have the option to pay cash for services or borrow from the government at a low interest rate to pay for care. The authors built a microsimulation model to estimate health care spending under the status quo and the 10Plan.

• Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Final Report 2021

  Ashley M. Kranz, Teague Ruder, Ateev Mehrotra, Andrew W. Mulcahy

  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.

• Do Supply-Side Forces Explain Geographic Variation in Health Care Use? 2021

  Matthew R. Rosengart, Robert Kaestner, Jason M. Ward

  We provide new evidence on causal factors behind geographic variation in health care utilization by examining changes in health care use for the near-elderly as they transition from being uninsured into Medicare.

• Effects of Employer-Offered High-Deductible Plans on Low-Value Spending in the Privately Insured Population 2021

  Brendan Rabideau, Matthew Eisenberg, Rachel O. Reid, Neeraj Sood

  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.

• Impact of Policy Options for Reducing Hospital Prices Paid by Private Health Plans 2021

  Jodi L. Liu, Zachary M. Levinson, Nabeel Shariq Qureshi, Christopher M. Whaley

  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.

• Increasing Price Transparency in Health Care: Key Themes and Policy Options from a Technical Expert Panel 2021

  Christine Buttorff, Chapin White, Monique Martineau, Spencer R. Case, Cheryl L. Damberg

  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.

• International Prescription Drug Price Comparisons: Current Empirical Estimates and Comparisons with Previous Studies 2021

  Andrew W. Mulcahy, Christopher M. Whaley, Mahlet G. Tebeka, Daniel Schwam, Nathaniel Edenfield, Alejandro U. Becerra-Ornelas

  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.

• The Perils Of PECOS: Using Medicare Administrative Data To Answer Important Policy Questions About Health Care Markets 2021

  M. Susan Ridgely, Cheryl L. Damberg, Mark E. Totten, Jose J. Escarce

  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.

• Responses to Comments on RAND Global Services Reports 2021

  Andrew W. Mulcahy, Ateev Mehrotra, Courtney A. Gidengil, Susan L. Lovejoy

  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.

• Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014–2018 2021

  John N. Mafi, Rachel O. Reid, Lesley Baseman, Scot Hickey, Mark E. Totten, Denis Agniel, A. Mark Fendrick, Catherine A. Sarkisian, Cheryl L. Damberg

  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.

• Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods 2021

  Andrew W. Mulcahy, Harry H. Liu, Teague Ruder, Susan L. Lovejoy, Katie Merrell, Ateev Mehrotra

  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.

2020

• Advancing the Development of a Framework to Capture Non–Fee-for-Service Health Care Spending for Primary Care 2020

  Katherine Grace Carman, Rachel O. Reid, Cheryl L. Damberg

  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.

• Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder 2020

  Stephen W. Patrick, Michael R. Richards, William D. Dupont, Elizabeth McNeer, Melinda Beeuwkes Buntin, Peter R. Martin, Matthew A. Davis, Corey S. Davis, Katherine E. Hartmann, Ashley A. Leech, et al.

  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.

• Comparative Effectiveness of Long-Term Acute Care Hospital Versus Skilled Nursing Facility Transfer 2020

  Anil N. Makam, Oanh Kieu Nguyen, Michael D. Miller, Sachin J. Shah, Kandice A. Kapinos, Ethan A. Halm

  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.

• Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis 2020

  Andrew W. Mulcahy, Daniel Schwam, Nathaniel Edenfield

  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.

• The Complex Cancer Care Coverage Environment: What Is the Role of Legislation? A Case Study from Massachusetts 2020

  Christine Leopold, Rebecca Lee Haffajee, Christine Y. Lu, Anita K. Wagner

  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.

• Consolidation by Any Other Name: The Emergence of Clinically Integrated Networks 2020

  M. Susan Ridgely, Justin W. Timbie, Laura J. Wolf, Erin Lindsey Duffy, Christine Buttorff, Ashlyn Tom, Mary E. Vaiana

  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.

• Cost Analysis of a Randomized Trial of Getting to Outcomes Implementation Support of CHOICE in Boys and Girls Clubs in Southern California 2020

  Patricia M. Herman, Matthew Chinman, Jill S. Cannon, Patricia A. Ebener, Patrick S. Malone, Joie D. Acosta, Elizabeth J. D'Amico

  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.

• Costs of Maintaining a High-Volume Telemedicine Program in Community Health Centers 2020

  Mark Zocchi, Lori Uscher-Pines, Allison J. Ober, Kandice A. Kapinos

  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.

• Disentangling Moral Hazard and Adverse Selection in Private Health Insurance 2020

  David Powell, Dana P. Goldman

  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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