This issue of RAND Health Quarterly covers a broad range of topics. Our lead article exemplifies RAND Health's growing engagement with global health policy issues. In support of a UN conference on non-communicable diseases (NCDs), which now account for the majority of global illness and death, a RAND team took a first step toward developing a policy research agenda for improving access to medicines for NCDs in developing countries. When fully fleshed out, the agenda will provide a framework that the pharmaceutical industry in particular can carry forward as part of a broader global effort to combat NCDs.
Two studies address quality of care issues faced by workers' compensation (WC) systems. The first focuses on California's system, which has taken significant steps since 2004 to improve the quality and efficiency of care delivered to beneficiaries. The study concludes that California should consider further steps to improve incentives for providing medically appropriate care, including revised fee schedule allowances, nonmonetary incentives for medically appropriate care in the medical provider network, and reduced incentives for inappropriate prescribing practices via curtailing of in-office physician dispensing. The second study focuses on carpal tunnel injuries, which are common in WC systems. The study produced two unique tools for institutions to use, one for assessing the quality of care received by a population of patients who have or may have carpal tunnel syndrome and the other for identifying the appropriateness of surgery for individual patients.
In addition, two studies examine military health issues. As part of an effort to improve efficiency in military treatment facilities (MTFs), the Department of Defense is considering setting targets for health care use and rewarding or penalizing MTFs according to their performance. A RAND team examined the potential and limitations of using utilization and costs as measures of MTF performance and found that these metrics face substantial data limitations. The second study evaluates the use of a new tool to screen the physical fitness of applicants to the U.S. Army. The study finds that the tool—the Assessment of Recruit Motivation and Strength—is a highly cost-effective means for screening potential applicants who may be overweight or physically unfit.
Finally, a group of studies examines the likely effects of provisions of the Patient Protection and Affordable Care Act (PPACA), using RAND's COMPARE microsimulation model. One of these studies estimates the impact of PPACA on employers' offers of health coverage. It finds that PPACA will increase the percentage of U.S. firms offering coverage to workers, with the largest increase expected among small businesses (with 10 or fewer workers): 77 percent of these firms are expected to offer coverage, up from 53 percent in 2010. Simultaneously, the uninsurance rate in the United States is expected to fall from 19 to 6 percent of the nonelderly population by 2016. A second study examines the impact of “grandfathering”—that is, exempting existing plans from new regulations to allow some Americans to keep their current coverage—and finds that grandfathering may lead to slightly higher premiums among policies offered on the exchanges but is also associated with higher employer-sponsored insurance enrollment and lower government spending.
David M. Adamson, Ph.D., Guest Editor
Robin M. Weinick, Ph.D., Editor