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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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Report
Reviewing, Refining, and Validating Claims-Based Algorithms of Frailty and Functional Impairment: Final Report
The authors developed new claims-based frailty algorithms that were validated using patient assessment data from post-acute care providers. They then compared the performance of the new algorithms with existing claims-based frailty algorithms.
Nov 6, 2023
Journal Article
Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial
The study estimated model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years as part of an evaluation of the Million Hearts Model.
Oct 20, 2023
Journal Article
Evaluation of the Million Hearts® Cardiovascular Disease Risk Reduction Model: Final Evaluation Report
Presents findings from a test of the Million Hearts model for CMS through a large, randomized trial, including hundreds of thousands of beneficiaries across the United States of the Million Hearts model from 2017 to 2021.
Oct 20, 2023
Journal Article
Defining Narrow Cost Analysis: A Brief for CCDF Lead Agencies
This brief has three goals: define narrow cost analysis; define and discuss child care costs and prices; explain how narrow cost analysis helps inform payment rates.
Oct 18, 2023
Journal Article
Comparing Organization-Focused and State-Focused Financing Strategies on Provider-Level Reach of a Youth Substance Use Treatment Model: A Mixed-Method Study
This study compared two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level implementation outcomes for the Adolescent Community Reinforcement Approach, an evidence-based practice for youth substance use.
Oct 16, 2023
Journal Article
Using a Narrow Cost Analysis to Inform Payment Rates: A Brief for CCDF Lead Agencies
This brief describes how Child Care and Development Fund (CCDF) Lead Agencies can use cost data when setting payment rates. It covers two main topics: analyzing gaps between costs and payment rates and exploring strategies to close gaps.
Oct 16, 2023
Journal Article
Approaches to Narrow Cost Analysis: A Report for CCDF Lead Agencies
This is the second in a series on narrow cost analysis. The aim of the series is to help Child Care and Development Fund (CCDF) Lead Agencies understand the requirements, approaches, and uses of a narrow cost analysis.
Oct 16, 2023
Journal Article
Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First Three Years of Implementation (2020–2022)
RAND researchers are conducting a multiyear evaluation of the VBID Model test using a mixed-methods approach that involves surveys, interviews, and quantitative analyses of the relationship between VBID implementation and a variety of outcomes.
Oct 13, 2023
Research Brief
Exploring Alternative Health Care Payment Models for California’s Workers’ Compensation System: Alternatives, Recommendations, and Next Steps
Researchers considered possible alternative payment models for use in the California workers’ compensation (WC) system, including discussion of the unique constraints and factors embedded within the California WC environment.
Aug 24, 2023
Journal Article
Development and Validation of Algorithms to Predict Activity, Mobility, and Memory Limitations Using Medicare Claims and Post-Acute Care Assessments
This study aims to create Medicare-based algorithms for predicting functional impairment, crucial for mortality and care use. Using machine learning and PAC data, memory and activity limitations were assessed with moderate success. While promising for PAC, broader older adult application is uncertain.
Aug 16, 2023
Multimedia
The Fiscal Mapping Process: A Strategic Planning Tool for Sustainable Financing of Evidence-Based Treatment Programs in Youth Behavioral Health Services
Limited funding can make it difficult for behavioral health service agencies to sustain critical evidence-based treatment (EBT) programs for youth. The Fiscal Mapping Process helps agencies plan for financial sustainment of their EBT programs.
Aug 10, 2023
Report
Alternative Payment Models for California's Workers' Compensation System: A Review of Issues and Possible Next Steps
The authors consider possible alternative payment models for use in the California workers' compensation (WC) system, including discussion of the unique constraints and factors embedded within the California WC environment.
Jul 31, 2023
Report
Improving Mental Health Care Systems in the United States: Policy Questions Arising from a Case Study of Sheppard Pratt
The authors interviewed senior staff at Sheppard Pratt, a community-based mental health specialty care system in Maryland and West Virginia, to understand how Sheppard Pratt's experiences can potentially inform national mental health policy.
Jul 12, 2023
Journal Article
What's Behind Losses At Large Nonprofit Health Systems?
The authors aim to understand the financial performance of large nonprofit hospitals systems in the post-COVID-19 era by examining several of these systems' overall profit margin by using their most recent annual financial reports.
Jun 7, 2023
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

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RAND Health Care

Researcher Spotlight

Jon Sussex

Chief Economist

Jon Sussex (he/him) is chief economist at RAND Europe and co-director of the Cambridge Centre for Health Services Research, a collaboration between RAND Europe and the University of Cambridge. He has over 30 years of experience in research and consultancy in the fields of healthcare and life…
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.

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