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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
Private Health Plans Paid Hospitals 224 Percent of What Medicare Would Pay
During 2020, prices paid to hospitals by employers and private insurers for both inpatient and outpatient services averaged 224 percent of what Medicare would have paid for the same services. Prices among states varied widely.
May 17, 2022
Commentary
Toward 'Smarter' Federal Funding of Public Health Emergencies
The next public health emergency or large-scale disaster may be looming. It may be time to rethink the way federal relief funds are sought and allocated so that aid is more rapidly, accurately, and fairly distributed to hospitals and health systems. This could help ensure patients and communities get the care when and where they need it when crisis hits.
Dec 20, 2022

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Journal Article
The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity
This retrospective cohort study evaluated the quality and cost implications of receiving primary care from nurse practitioners (NPs) compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service physician rate (pay parity).
May 16, 2023
Journal Article
CalAIM and Specialty Behavioral Health Care: Lessons from Other States on Value-Based Payment
This report examines the experience of state Medicaid agencies with implementation of value-based payment models for behavioral health care and the implications of that experience for future payment reform in California.
May 5, 2023
Commentary
Informing the Debate About Telemedicine Reimbursement: What Do We Need to Know?
At the start of the COVID-19 pandemic, U.S. payers and policymakers broadly expanded payment for telemedicine services and relaxed many regulations. To decide the long-term fate of pandemic-era temporary telemedicine, policymakers should consider the effects of telemedicine on health care spending, patient outcomes, and health equity.
Nov 21, 2022
Journal Article
Evaluation of the Million Hearts® Cardiovascular Disease Risk Reduction Model: Fourth Annual Report
In this model, CMS pays participating organizations for assessing each of their eligible Medicare beneficiary's risk of having a heart attack or stroke over the next 10 years and for reducing CVD risk among high-risk beneficiaries.
Oct 25, 2022
Journal Article
Evaluation of the Million Hearts® Cardiovascular Disease Risk Reduction Model: Third Annual Report
In its first three years, the Million Hearts® Model improved cardiovascular preventive care, but did not yet reduce observed heart attacks and strokes or lower Medicare spending.
Oct 25, 2022
Journal Article
Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First Two Years of Implementation (2020–2021), and Appendixes
This report presents the RAND Corporation team's findings from its evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design model test, for the years 2020 and 2021.
Oct 19, 2022
Journal Article
Comparing Two Federal Financing Strategies on Penetration and Sustainment of the Adolescent Community Reinforcement Approach for Substance Use Disorders: Protocol for a Mixed-Method Study
The project will advance understanding of effective financing strategies to support the implementation and sustainment of evidence-based practices for the treatment of adolescent substance use disorders.
Oct 13, 2022
Journal Article
Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration
This study highlights how the growing trend of vertical integration, combined with differences in Medicare payment between hospitals and nonhospital providers, leads to higher Medicare spending.
Sep 20, 2022
Journal Article
Predicting Race And Ethnicity To Ensure Equitable Algorithms For Health Care Decision Making
We describe two applications in which imputation of race and ethnicity can help mitigate potential algorithmic biases: equitable disease screening algorithms using machine learning and equitable pay-for-performance incentives.
Aug 23, 2022
Commentary
Doubling NIH Funding for Women's Health Would Yield Substantial Return on Investment
The scientific evidence base generally is biased toward the male body as a result of a long history of generous funding for diseases that predominantly affect men and underfunding for those that predominantly affect women. But the cost of the science pales in comparison to the price we continue to pay for what we don't know about caring for women.
Jul 8, 2022
Journal Article
The Financial Ecosystem of Pharmaceutical R&D: An Evidence Base to Inform Further Dialogue
This study's overarching conclusion is that a drug's expected financial return ultimately determines whether it is developed up to launch.
Jun 24, 2022
Report
RAND Technical Expert Panel Medicare Advantage (MA) and Part D Contract Star Ratings, February 7, 2022 Meeting
On February 7, 2022, the RAND Corporation convened a Technical Expert Panel web meeting to gather input about the potential development of a measure to capture value-based care arrangements Medicare Advantage organizations have with their contracted providers.
Jun 17, 2022
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
Report
Carve-In Models for Specialty Behavioral Health Services: Lessons for California
Many states separate, or
Feb 11, 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
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
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
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

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RAND Health Care

Researcher Spotlight

Andrew W. Mulcahy

Senior Policy Researcher

Andrew Mulcahy is a senior policy researcher at the RAND Corporation. His key research areas are prescription drugs, payment for health care services and drugs, and policy evaluation in general. He routinely uses large-scale health care claims and transactional data in his research.
Melony E. Sorbero

Senior Policy Researcher

Melony Sorbero is a senior policy researcher at the RAND Corporation. A health services researcher with a background in public policy analysis and public health, Sorbero has extensive experience with both quantitative and qualitative research methods and over 15 years of experience conducting…

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