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.

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.

• 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.

• Effects of a Public Option on Health Insurance Costs and Coverage 2020

  Jodi L. Liu, Asa Wilks, Sarah A. Nowak, Preethi Rao, Christine Eibner

  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.

• The Extent of Externalities from Medicare Payment Policy 2020

  Alice J. Chen, Michael R. Richards, Christopher M. Whaley, Xiaoxi Zhao

  Uses a contemporary bundled payment reform and a difference-in-differences research design to estimate spillovers from Medicare payment reforms to non-Medicare populations

• Nationwide Evaluation of Health Care Prices Paid by Private Health Plans: Findings from Round 3 of an Employer-Led Transparency Initiative 2020

  Christopher M. Whaley, Brian Briscombe, Rose Kerber, Brenna O'Neill, Aaron Kofner

  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.

• Payment for Services Rendered: Updating Medicare's Valuation of Procedures 2020

  Andrew W. Mulcahy, Katie Merrell, Ateev Mehrotra

  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

• Practice Expense Methodology and Data Collection Research and Analysis: Interim Phase II Report 2020

  Lane F. Burgette, Catherine C. Cohen, Joachim O. Hero, Jodi L. Liu, Daniel J. Crespin, Stephanie Dellva, Roald Euller, Liisa Hiatt, Vishnupriya Kareddy, Monique Martineau, et al.

  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.

• Prevalence And Characteristics Of Surprise Out-Of-Network Bills From Professionals In Ambulatory Surgery Centers 2020

  Erin Lindsey Duffy, Loren Adler, Paul B. Ginsburg, Erin Trish

  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.

• The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care 2020

  Erin Lindsey Duffy, Christopher M. Whaley, Chapin White

  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.

• Public Options for Individual Health Insurance: Assessing the Effects of Four Public Option Alternatives 2020

  Jodi L. Liu, Asa Wilks, Sarah A. Nowak, Preethi Rao, Christine Eibner

  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.

• Subscription Models for Prescription Drugs: The Motivation, Potential, and Limitations of a New Payment Model 2020

  Harry H. Liu, Andrew W. Mulcahy, Adam J. Rose

  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.

• Treatment consolidation after vertical integration: Evidence from outpatient procedure markets 2020

  Michael R. Richards, Jonathan Seward, Christopher M. Whaley

  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.

• Who Pays for Health Care Costs? The Effects of Health Care Prices on Wages 2020

  Daniel Arnold, Christopher M. Whaley

  Leverages geographic variation in health care price growth caused by changes in hospital market structure, and in particular, mergers, to test the impact of health care prices on wages and benefit design.

2019

• Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results from a Markov Model 2019

  Patricia M. Herman, Tara Lavelle, Melony E. Sorbero, Eric Hurwitz, Ian D. Coulter

  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.

• Are Value-Based Incentives Driving Behavior Change to Improve Value? 2019

  Cheryl L. Damberg, Marissa Rose Silverman, Lane F. Burgette, Mary E. Vaiana, M. Susan Ridgely

  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.

• Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Final Report 2019

  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.

• Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading 2019

  Preethi Rao, Sarah A. Nowak

  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.

• Page 1 of 3
• 1
• 2
• 3
• Next