This report describes the status quo in the U.S. blood system, explores a set of six specific research questions related to the sustainability of this system through analysis and discussion, and presents policy alternatives and recommendations that aim to improve blood system is sustainability. We employed a mixed-methods approach, blending insight from analyses of available data and from interviews and other interactions with stakeholders.

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Toward a Sustainable Blood Supply in the United States

An Analysis of the Current System and Alternatives for the Future

by Andrew W. Mulcahy, Kandice A. Kapinos, Brian Briscombe, Lori Uscher-Pines, Ritika Chaturvedi, Spencer R. Case, Jakub P. Hlavka, Benjamin M. Miller

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Research Questions

  1. How do trends in the broader U.S. health care system affect the sustainability of the U.S. blood system?
  2. How could changes in payment for health care services and blood affect the sustainability of the U.S. blood system?
  3. What is the insurance value of blood, and can this value be estimated empirically?
  4. What are the risks to sustainability from emergencies?
  5. What are the potential effects of new business models, including brokerage models?
  6. What best practices do we observe in other nations' blood systems that can be practically applied to improve the U.S. blood system?

A robust, sustainable blood system is a crucial component of every health care system. The availability of safe blood and blood products is a prerequisite for various health care services — including some surgeries, treatments for cancer and other acute and chronic medical conditions, trauma care, organ transplantation, and childbirths — that extend and improve life for millions of patients annually.

This report describes the status quo in the U.S. blood system, explores a set of six specific research questions related to the sustainability of the U.S. blood system through analysis and discussion, and presents policy alternatives and tools that can help ensure that the U.S. blood system is sustainable. We employed a mixed-methods approach, blending insight from analyses of available data and from a series of interviews and other interactions with stakeholder groups.

Specifically, this report has the following three primary objectives: (1) describe the current blood system with a focus on relationships among key players and areas where market inefficiencies might exist; (2) outline potential opportunities to improve any identified inefficiencies and challenges under the current system, and explore the potential effects from changes in health care delivery, payment, technology, and clinical practice on blood supply, safety and prices; and (3) propose actionable solutions to the problems identified.

Key Findings

Overarching Findings

  • The U.S. blood system under the status quo operates effectively and, in many cases, efficiently.
  • The U.S. blood system is in a period of flux and uncertainty.
  • There are unlikely but possible scenarios in which the supply of blood would be disrupted.

Threats to Sustainability

  • The current system is not conducive to private investments in innovation.
  • Suppliers to blood centers face significant uncertainty and contribute to concerns about sustainability.
  • Services provided by local blood banks may be at risk.

Opportunities to Improve Sustainability

  • Stakeholders want support in making technology adoption decisions.
  • Blood center stakeholders are contemplating different market structures for the future.
  • All stakeholders recognize the important role of blood as a public health good.

Recommendations

  • Collect data on blood use and financial arrangements: Stakeholders have access to statistics on blood use and transactions tied to their individual organizations, but the U.S. government does not have access to comprehensive data describing the performance of the blood system.
  • Develop and disseminate a vision for appropriate levels of surge capacity: Describing a desired level of surge capacity from a public health and preparedness perspective will help stakeholders and policymakers plan and estimate the costs associated with maintaining surge capacity.
  • Subsidize blood centers' ability to maintain surge capacity: Surge capacity to respond to serious events and emergencies falls outside the typical financial arrangements between hospitals and blood centers, so there is an argument that the government should separately finance this surge capacity.
  • Build relationships with brokers and other entities to form a blood "safety net": A well-established set of relationships can reduce emergency response times.
  • Build and implement a value framework for new technology: We recommend that HHS invest in health technology assessment research for existing technologies with low adoption rates and for technologies on the horizon.
  • Pay directly for new technologies in which there is no private business case for adoption: Technologies often have clear public health and preparedness benefits. In these cases, U.S. government financing of technology acquisition costs might be appropriate.
  • Implement emergency use authorization and contingency planning for key supplies and inputs: The FDA could implement emergency use authorizations for replacement supplies and other inputs in the event of a shortage.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Overview of the U.S. Blood System

  • Chapter Three

    Methods

  • Chapter Four

    Trends Affecting Blood System Sustainability

  • Chapter Five

    Payment for Blood and Health Care Services Involving Blood

  • Chapter Six

    The Value of an Available Blood Supply

  • Chapter Seven

    Emergency Preparedness Risk Assessment

  • Chapter Eight

    Potential Innovation in Business Models

  • Chapter Nine

    Best Practices from Other Nations' Blood Systems

  • Chapter Ten

    Conclusion: Themes and Recommendations

  • Appendix

    Interview Protocols

This research was sponsored by the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary of Health (OASH), and conducted by RAND Health.

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