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Health Care Financing

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Health care systems may be financed in various ways, including through government funding, taxation, out-of-pocket payments, private insurance, and donations or voluntary aid. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers.

Report

Carve-In Models for Specialty Behavioral Health Services: Lessons for California

Feb 11, 2022

Many states separate, or "carve out," Medicaid financing of behavioral health services from that for other types of health care, but there has been a recent trend in some states toward "carve-ins": combining financing for behavioral health services with the larger pool of Medicaid-covered services. What lessons do other states' experiences offer for California?
Report

Understanding Prescription Drug Supply Chains

Oct 27, 2021

The typical stakeholders, relationships, and financial incentives involved in prescription drug supply chains vary depending on the characteristics of a drug and how it reaches patients. Differences in business practices complicate a universal description of drug supply chains.

Explore Health Care Financing

Journal Article

Content and Actionability of Recommendations to Providers After Shadow Coaching

This study aimed to examine the content of the recommendations given to providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability.

Mar 4, 2022
Journal Article

Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems

This study was a cross-sectional mixed-methods analysis of in-depth multimodal data from 31 POs affiliated with 22 purposefully selected health systems in 4 states. Data were analyzed from June 2019 to September 2020.

Feb 8, 2022
Journal Article

Value of Family Involvement in Substance Use Disorder Treatment: Aligning Clinical and Financing Priorities

Family support has important impacts on recovery from substance use disorders (SUDs). This paper illustrates how financing gaps limit SUD service systems from offering family services. We offer two sets of recommendations for funding family involvement in SUD services.

Jan 7, 2022
Journal Article

Coordination of Sustainable Financing for Evidence-Based Youth Mental Health Treatments: Protocol for Development and Evaluation of the Fiscal Mapping Process

This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate a novel Fiscal Mapping Process that guides strategic planning efforts to finance the sustainment of evidence-based treatments in youth mental health services.

Jan 7, 2022
Commentary

Rethinking the Impact of Audio-Only Visits on Health Equity

New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. It may be time to consider limiting audio-only visits in the pursuit of health equity.

Dec 17, 2021
Commentary

Twelve-Month Continuous Eligibility for Medicaid Adults Can Stabilize Coverage with a Modest Cost Increase

Churning—frequent moving in and out of Medicaid due to income fluctuation—increases insurance coverage gaps, disrupts access to health care, increases unnecessary administrative burden, and leads to suboptimal health outcomes. Federal and state policymakers might consider continuous eligibility to help stabilize Medicaid enrollment.

Dec 8, 2021
Commentary

What Are the Practical Considerations for Outcome-Based Payment in the NHS?

Uncertainty can surround the effectiveness or cost-effectiveness of a new medicine, making it difficult to agree on a medicine's price. One solution to avoid unduly delaying or restricting patients' access is to link the medicine's price to the outcomes it produces in a patient. Despite some barriers, outcome-based payment could offer a “win” for patients, the NHS, and industry.

Dec 2, 2021
Report

New York State 1115 Demonstration Independent Evaluation: Interim Report

This report examines whether two components of New York State's Medicaid Section 1115 Waiver—the Managed Long-Term Care (MLTC) program and the 12-month continuous eligibility policy—have achieved their goals.

Dec 2, 2021
Journal Article

Making Outcome-Based Payment a Reality in the NHS: Phase 2: Practical Considerations

This study examines implementing an outcome-based payment model in the NHS, the quality and completeness of data on patient outcomes, implications for collecting such data, and establishing steps for the implementation of a pilot OBP scheme.

Dec 1, 2021
Journal Article

Money and My Mind: Maternal Cash Transfers and Mental Health

This paper documents important mental health spillovers in the context of a program that offered pregnant women modest cash incentives to use pre- and perinatal health care services.

Nov 10, 2021
Report

Practice Expense Data Collection and Methodology: Phase II Final Report

In this report, the authors address how the Centers for Medicare & Medicaid Services might improve the methodology used in practice expense (PE) rate-setting, update data that inform PE rates, or both.

Nov 1, 2021
Journal Article

Value-Based Payment and Health Care System Preparedness and Resilience

This report explores issues related to VBP and health system preparedness and resiliency to inform discussions about policy options for jointly promoting value, efficiency, and preparedness in the health care system.

Oct 7, 2021
Report

Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

This report describes how the Centers for Medicare & Medicaid Services could use claims-based data on post-operative visits to adjust the valuations of surgical procedures with 10- and 90-day global periods.

Sep 14, 2021
Report

Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2018 Data

The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in 2018 and paid for by Medicare. This report follows an earlier report that summarized these patterns from July 1, 2017, through June 30, 2018.

Sep 14, 2021
Report

Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in calendar year 2019 and paid for by Medicare. This report follows two earlier reports that summarized these patterns for earlier periods.

Sep 14, 2021
News Release

Republicans May Be Less Likely to Make Use of Federal Subsidies When Buying Individual Health Insurance Policies

Republicans who buy individual health plans may be less likely to shop through marketplaces created under the federal Affordable Care Act, leading them to forgo subsidies provided by the federal government.

Sep 8, 2021
Report

RAND Technical Expert Panel Medicare Advantage (MA) and Part D Contract Star Ratings, May 5, 2021 Meeting

The RAND team gathered input from experts about stratified reporting by Part D low-income subsidy (LIS) and dual eligibility (DE), and disability and assessing social risk factors of Medicare Advantage (MA) and Part D contract beneficiaries.

Aug 5, 2021
Commentary

Fintech's Role in Reducing Disparities and Financial Barriers to Health Care Access

Given the growing pressures on health care systems globally and the need for innovative approaches to financing health care, the time may be ripe to develop a robust evidence base and share learning on fintech-enabled approaches that could support universal health coverage agendas and healthier and more stable societies.

Jul 26, 2021

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