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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
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?
Feb 11, 2022
Report
Understanding Prescription Drug Supply Chains
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.
Oct 27, 2021

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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
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
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
Evaluating New York's Medicaid Section 1115 Waiver
New York State’s Medicaid Section 1115 Waiver seeks to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. RAND researchers examined whether two components of the 1115 Demonstration Waiver have helped achieve the program’s 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

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