The Bing Center for Health Economics has current projects underway in several areas of health economics research. Current projects are organized according to topic:
ACA and Other Health Policies
Veteran Access, Choice, and Accountability Act (VACAA) Assessments
Three reports that discuss the future demands facing the VA Health Care System, the current resources in the system, and how care is provided to veterans outside the federal system have been released by the RAND Corporation. The reports were done as part of a congressionally mandated examination of the delivery of health care to veterans in facilities owned and operated by the Department of Veterans Affairs.
2018 National Impact Assessment
RAND continues its work in examining the impact of CMS' performance measurement programs in diverse healthcare settings.
Evaluation of Policy Options to Address Primary Care Shortages in Eastern Washington State
The legislature of Washington State is considering several policy options to address a perceived shortage of primary care providers in eastern Washington State. This study will characterize the problem, enumerate potential solutions (including those already under consideration), and generate estimates of their effects on any shortages that exist for primary care services.
Modeling Policy Alternatives to the Affordable Care Act
Currently Medicare benefits are fragmented across multiple plans, administratively costly and confusing to beneficiaries, and yet leave many low-income beneficiaries and those with complex care needs with high out-of-pocket cost. This project will produce five papers to help inform the debate over Medicare reform under a new Administration and Congress in the spring of 2017.
ACA Coverage of Lactation Support Services and Breastfeeding
The Affordable Care Act (ACA) mandated coverage of breast pumps and lactation consultant visits effective August 1, 2012. This study aims to understand how coverage of lactation support services influences breastfeeding behavior and will result in peer-reviewed manuscript(s).
International Alcohol Policy Model
In this study we will construct a dynamic micro simulation modelling platform capable of realistically representing the population of the United States and that of other comparison countries. Model projections of policy scenarios will be in continuous time and will accurately describe alcohol consumption at any time point, and cumulatively. Consumption measures would include a variety of drinking behaviours, so as to capture the different causal interactions among specific drinking patterns and their corresponding outcomes. In particular, the model will include binge drinking and alcohol dependency, as well as various levels of regular and occasional drinking (heavy, moderate and light use).
The specific aims of our five-year project are to:
- Develop, test and validate a dynamic micro simulation modeling platform, capturing both individual and social dynamics of alcohol use for the United States and a selection of other relevant high- and middle-income countries.
- Use the platform to project the health, social and economic consequences associated with current alcohol-use patterns, including injuries; alcohol-use disorders; selected chronic health problems, such as cancers, cardio-vascular diseases and alcoholic liver diseases; health care use and associated costs; labor market participation; criminal incidents; and government tax revenues.
- Assess the outcomes and costs of alternative alcohol control policies by projecting the impacts of policy changes before countries incur the costs of policy implementation. Interventions would include education and information campaigns; brief screening and treatment interventions in primary health care; enforcement penalties (e.g. drunk driving); and policies that address the marketing, price, taxation or availability of alcohol.
Can South Dakota's Innovative 24/7 Sobriety Project Work Outside South Dakota?
This study will evaluate the translation and implementation of South Dakota's successful 24/7 Sobriety Project to North Dakota. It will provide evidence on the program's implementation and utilization in North Dakota, evaluate its efficacy in reducing drunk driving and other alcohol-related outcomes, and monetize its benefits. Resulting analyses will impact the ongoing policy debate about how to effectively use alcohol testing to reduce alcohol misuse and its consequences, which is critical to balancing the competing concerns of reducing incarceration costs and safeguarding public safety, and will also provide evidence on the ability of other jurisdictions to learn from and replicate South Dakota's innovative program.
CCIIO SEG State-Based Marketplace Policy & Market Analysis Capability
This project will provide services and expertise to assist in analyzing and delivering enhanced technical assistance to improve the efficiency, effectiveness, and prospects for sustainability of state-based marketplaces. Specifically, we will collect proposed and approved rate filings from state-based marketplaces in order to better understand the landscape of premium changes and issuer participation.
Human Capital of Disabled Workers (Labor Supply Effects of Disability Insurance)
The objective of this project is to produce the most comprehensive evidence to date on how the U.S. disability insurance system impacts the human capital of disabled workers and to produce information to design effective policy interventions that would promote increased work effort among the disabled.
Benefit Design and Formulary Strategies to Reduce Prescription Drug Overdoses
This study will evaluate the impacts of recent pharmacy benefit and prescription drug policy changes on prescription opioid use and related health outcomes in disabled Medicare and workers' compensation populations.
Health Behaviors and Wellbeing
Examining Consumer and Producer Responses to Restaurant Menu Labeling Requirements
This project examines consumer and producer responses to restaurant menu labeling requirements. There are two major parts. First, it will develop a discrete choice experiment to test the effects of calorie and other nutritional labeling on how consumers perceive and respond to different menus. Second, the project will analyze restaurant menu data to study variation in the nutritional composition of menu items and the characteristics of menus on which they appear.
Health and Retirement Study (HRS) Years 23-28
This project is collecting data needed to understand the dynamics of health and work in the cohorts born in 1931-1941.
Health Risk Behaviors Among Palestinian Youth
This study will collect nationally representative survey data on the risk behaviors, risk perceptions, and emotional well-being of approximately 3,000 youth in the Occupied Palestinian Territories to improve our understanding of the determinants of their attitudes toward and engagement in risk behaviors (e.g., smoking, drug use and sexual behavior); the determinants of their mental health and expectations for the future; and the impacts of prolonged violence and economic hardship on risk-taking behavior. The study will be the first of its kind in the region.
Understanding Household Retirement Savings
This project will study joint retirement savings decisions, focusing on how couples divide assets between accounts in each spouse's name.
Life Satisfaction around the World (Gallup World Poll)
This project will administer life satisfaction vignettes to respondents in about 120 countries using the Gallup World Survey providing data for approximately 120,000 respondents all over the world.
International Comparisons of Well-Being, Health and Retirement
The recent availability of comparable longitudinal data on older populations opens new opportunities for research on comparative effectiveness of policies for improving health and well-being. This project will use data from more than 15 countries to analyze how the interaction between individual behavior, social context, institutions, and policies shapes outcomes.
International Differences in Health, Longevity, and SES
By using comparative analysis of the United States, England, and other countries, this project will assess how and why over-all well being is related to health and socioeconomic status at older ages in these countries.
Benefit Design and Formulary Strategies to Reduce Prescription Drug Overdoses (PREP)
This study will evaluate the impacts of recent pharmacy benefit and prescription drug policy changes on prescription opioid use and related health outcomes in disabled Medicare and workers' compensation populations. Our focus on these populations is motivated in part by their frequent use of opioid pain medication.
Health and Economic Status in Older Populations
This integrated set of projects bears on issues related to the well-being of older Americans — whether they are financially secure enough after retirement to afford health care without giving up housing and other things they value, how their income and education influence their health (and vice-versa), and how they form expectations about their future that can influence their financial security and health.
Health Care Costs and Quality
Understanding the Relationship Between Health Care Delivery Systems and PCOR Processes and Outcomes
Centers of Excellence will identify, classify, track, and compare healthcare delivery systems ranging from integrated delivery systems to Accountable Care Organizations across the U.S. to help improve the speed of adoption and diffusion of CER-recommended practices through systems.
Updating and Expanding the AHRQ QI Toolkit for Hospitals
In this project, RAND is working with the University HealthSystem Consortium (UHC) to update and expand the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators Toolkit, originally developed by RAND and the UHC. The Toolkit will address a variety of hospitals' needs, including greater capacity to examine and improve their performance and monitoring and evaluating the impact of differing activities on quality of care and hospital finances. The updated Toolkit will include updated quality indicators reflecting advanced best practices and hospital understanding of quality-improvement needs as well as increased familiarity with use of the Toolkit. Specific modifications will include adding pediatric quality indicators and updating patient-safety indicators, inpatient quality indicators, and evidence-based quality improvement strategies for all included indicators.
Evaluation of the American Cancer Society's Primary Care Practice Facilitation Project
The American Cancer Society (ACS) is conducting a small-scale one-year pilot of an intervention to improve cancer screening rates in Federally Qualified Health Centers (FQHCs).
Welcome Baby Evaluation
First 5 LA is seeking a contractor to design and conduct an evaluation of Welcome Baby—a locally designed, free and voluntary home visiting program for pregnant and post-partum women in Los Angeles County. The objective is to create tools and processes that help First 5 LA and its collaborators improve the implementation of the Welcome Baby program and boost outcomes for Welcome Baby families.
Economic Burden of Surgical Treatment for Non-union Fractures
This study will assess the prevalence of and surgical intervention costs associated with delayed and non-union fractures.
Evaluating the Impact of Direct-to-Consumer Telehealth on Utilization and Costs: CalPERS Experience with Teladoc
This project will expand our analyses to assess the impact of Teladoc on overall utilization and costs. Although Teladoc and other direct-to-consumer telehealth companies claim that they will save money for patients and payers because they are cheaper than alternatives on a per-visit basis, there is no empirical data to support this claim. We hypothesize that precisely because Teladoc makes care so convenient, it may result in increased utilization and costs spending because the majority of visits will represent new utilization rather than substitution for other, more costly sites for care.
Health and Economic Impacts of PCSK9 Inhibitors
This study will estimate the potential health and economic impacts of PCSK9 inhibitor treatments, discuss likely adoption patterns, and describe policy issues related to these treatments.
Estimating the Burden of Osteoporosis-Related Fractures
This study will use linked HRS and CMS data to estimate a range of health, wellbeing, and labor outcomes related to osteoporosis-related fracture.
Impact of Bariatric Surgery on Long-term Diabetes Remission and Complications
The primary goal of this project is to explore the legacy effect of Roux en-Y gastric bypass (RYGB) through a series of analyses that characterize long-term micro- and macrovascular outcomes across three patient groups: those who do not remit their Type 2 diabetes mellitus (T2DM) after RYGB; those who experience durable T2DM remission after RYGB; and those who relapse their T2DM after an initial remission.
Implications of the 2004-2005 Vaccine Shortage
What was the impact of the 2004-2005 influenza vaccine shortage on health and labor/school productivity outcomes? The 2004-2005 U.S. flu vaccine shortage was due to the contamination of a Chiron vaccine production factory. Since Chiron was one of only 2 manufacturers producing the flu vaccine for the United States, this failure led to substantial reductions in vaccination rates in the U.S. during the 2004-2005 flu season. This study will identify the effect of flu vaccination rates on several outcomes including health, health care utilization, and work/school productivity.
Healthcare Cost and Utilization Project
RAND is leading and/or playing an advisory role with analyses and other work related to the Health Cost and Utilization Project (HCUP).
RAND Center for the Study of Aging, Years 21-25
RAND's Center for the Study of Aging promotes the efficiency and productivity of research on aging, the development of research projects and of junior researchers, and the communication of research findings. These functions, all of which are essential if research is to benefit the public health, are achieved through making data easier to use by researchers, ensuring the comparability of different nations' surveys on the health and well-being of their elderly populations, conducting pilot projects to test new lines of research, and providing venues for interactions among researchers across the United States and the world.
Implementation of the Medicare PDP and MA Plan Disenrollment Reasons Survey
This project will implement a survey to capture the reasons that beneficiaries choose to voluntarily disenroll from Medicare Advantage (MA) Plans, and stand-alone Prescription Drug Plans (PDPs).
The Value of Long-Term Care Insurance to Married and Single Persons
Few people buy long-term care insurance, yet costs of long-term care are high. This project will look at the value of long-term care insurance for the individual consumer by assessing the scope of insurance, financial risk it poses to retirement, and barriers to purchase.
Coverage Expansion and Medicaid Primary Care Physician Payment Increase
This study will estimate the effect of health reform policies, including coverage expansions and payment increases, on utilization and coverage.
Department of Labor IDIQ: Various Economic and Statistical Studies Related to Employer Provided Benefit Plans
This project will conduct research activities in pursuit of the Department of Labor's (DOL's) Employee Benefit Security Administration (EBSA) mission to conduct economic research studies with application to important employee benefits policy issues.
Analysis Related to Medicare Advantage and Part D Contract Star Ratings
In this follow-on to a project for the Centers for Medicare and Medicaid Services (CMS), RAND will conduct the annual calculation of the CMS Star Ratings, which measure quality and performance of Medicare Advantage (MA) and Part D contracts, and will provide analytic work to support enhancements to the calculation of the Star Ratings.
How Will the Cadillac Tax Affect Private Insurance Plans?
In 2018, the ACA imposes a 40% tax on health insurance premiums above a certain threshold. The motivation for this "Cadillac Tax" is to reduce the provision and purchase of overly-generous health insurance plans. This study will predict the effects of the Cadillac Tax on plan characteristics, cost-sharing, and medical care consumption.
Health Care Markets
Variability in Primary Care Share of Health Care Expenditures across Health Systems and Markets
This project is a benchmarking exercise that describes how the share of primary care costs, as a percentage of total health care spending, varies across health systems and markets within the United States.
Evaluating Local Dental Labor Shortages
The Pennsylvania Department of Health intends to enter into an agreement with the PA Coalition for Oral Health, a statewide oral health coalition, and the RAND Corporation to analyze data to understand the maldistribution of dental services in Pennsylvania. Our goal is to develop a dental provider workforce report that complements the Bureau of Health Planning's 2013 Pulse of Pennsylvania's Dentist and Dental Hygienist Workforce by more thoroughly examining regional differences in dental health care provision, such as Medicaid provision and pediatric dentistry. The report will help provide context that further analysis may use to identify solutions for the workforce issues in Pennsylvania. The workforce report will also inform policy and incorporate workforce issues into the state oral health plan.
CCIIO SEG State-Based Marketplace Policy & Market Analysis Capability
The goal of this project is to better understand the landscape of premium changes and issuer participation. RAND will develop a tracking system to follow exchange premium increases, plan offering, enrollment, and market share.
Assessing Relationships between Integrated Physician Group Structures and Integrated Patient Care
In this subcontract to the Harvard School of Public Health, RAND will assess the psychometric properties of a patient survey instrument designed to assess the integration of patient care; field the patient survey among Medicare beneficiaries attributed to physician groups that have responded to the third round of the National Study of Physician Organizations (NSPO-3) regarding their degrees of structural integration; and, examine the relationships between measures of structural integration and patient-reported ratings of integration of care.
Physician Distribution and Health Care Access, Costs, and Quality
Despite numerous studies reporting on the unequal distribution of physicians across geographic areas in the U.S, there remains a dearth of research on whether health care is more accessible and quality is better in areas with more physician supply. Furthermore, the published studies do not provide convincing evidence on the nature of the relationship. Is it linear, whereby increasing supply is associated with steadily improved access and quality, or is there a threshold above which improvements in access and quality level off with increases in physician supply? This project will use large national datasets to address these questions and fill these gaps in the literature.
Estimating the Returns to Provider Human Capital
Many developing country programs focus on stimulating demand for health services as a means to improving maternal and child health outcomes, but recent evaluations of these programs show small to no improvements in health outcomes. Many of these studies conclude that supply-side barriers, in particular care quality, act as a 'wedge' and constrain improvements in health outcomes. In this randomized experiment, a first of its kind, we study the relationship between provider human capital, care quality, and health outcomes. In partnership with the Primary Health Care Development Agency in Nigeria we assign a pool of recently trained doctors and nurses to rural primary health care clinics in Nigeria. One third of the clinics will be randomly assigned a doctor for one year, another third will be randomly assigned a nurse, and the remaining clinics will serve as a control group. Using a combination of direct observation, patient, and household surveys, we study the effect of on health services utilization, care quality and birth outcomes.
Florida Marketplace Drug Formulary Safe Harbor
This work is for the HHS Office for Civil Rights. We will examine prescription drug formularies offered by issuers in the Florida Marketplace for 2016, specifically to see whether the structure of their formularies is discriminatory with regard to HIV/AIDS drugs. We will work with the client to agree on a measure of discrimination, and estimate the out-of-pocket costs for HIV patients enrolled in the Marketplace plans and taking specific common HIV-related medications.