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Health Care Payment Approaches

Journal Article

Journal Article

Bundling Payments to Curb Health Care Costs Proves Difficult to Realize

Under bundled payments, doctors, hospitals, and other providers share one fee for treating all aspects of a procedure such as a hip replacement or a chronic disease like diabetes. The approach should eliminate unnecessary care and improve quality, but putting it into practice is proving to be more difficult than anticipated.

Nov 1, 2011
Brochure

Brochure

Focus on the Rising Cost of Health Care

A substantial body of RAND research has focused on evaluating policies to lower health care costs; promoting health and preventing disease; and improving health system value and quality of care.

Oct 5, 2011
Report

Addressing Medicare Payment Differentials Across Ambulatory Settings

Medicare's payment for physician work and malpractice liability expenses is the same regardless of where a service is provided, but payments differ for facility-related components of care.

Sep 30, 2011
Journal Article

Journal Article

Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A Guide for Community Quality Collaboratives

This white paper prepared for the Agency on Healthcare Research and Quality examines methodological issues raised by the generation of public-reporting of scores for measuring health care provider performance.

Sep 1, 2011
Journal Article

Journal Article

How Do the Experiences of Medicare Beneficiary Subgroups Differ Between Managed Care and Original Medicare?

Quality improvement in Medicare managed care plans should target care for particular subgroups such as beneficiaries who have low incomes, are less healthy, older, female, and who did not complete high school.

Aug 1, 2011
Tool

Managed Health Care Survey Categorizes Critical Elements of Public Sector Arrangements

This RAND Health survey captures key differences between managed and "unmanaged" care as well as differences among managed care arrangements, and it includes six domains predicted to have an impact on access, service utilization, costs, and quality.

Jul 22, 2011
Report

Using Prizes to Support and Reward Excellence in Health Research

Research indicates that there is merit in developing incentives to support excellence in health research in addition to “standard” performance management and routine inspection in the United Kingdom.

Jun 28, 2011
Journal Article

Accountable Care Organizations and Community Empowerment

This commentary argues that involving communities in the formation of accountable care organizations would be a dramatic step toward more patient-centered care.

May 4, 2011
Journal Article

Journal Article

Differential Item Functioning By Survey Language Among Older Hispanics Enrolled in Medicare Managed Care

Failure to account for language differences in CAHPS survey items may result in misleading conclusions about disparities in health care experiences between Spanish and English speakers.

May 1, 2011
Journal Article

Journal Article

The Impact of Patient Choice of Provider on Equity: Analysis of a Patient Survey

More educated, affluent patients were no more likely to be offered a choice than other population groups, but there does appear to be a social gradient in who chose to travel beyond the local area for treatment. If these results were replicated across England, there is at least the potential risk that when local hospitals are failing, patient choice could result in inequitable access to high quality care, rather than enhancing equity as the policy's architects had hoped.

Apr 1, 2011
Report

Paying for Quality in the German Healthcare System

Germany's National Association of Statutory Health Insurance Physicians is looking to develop a unified reimbursement framework that accounts for regional prices and incorporates quality indicators. Research by RAND Europe has informed the development of the quality component of the proposed framework.

Mar 22, 2011
News Release

News Release

Investment in New Health Care Quality Measures Needed as Cost-Cutting Strategies Grow

As the health care industry, employers, and government officials seek to control the growth of health spending, new efforts are needed to develop and refine quality-of-care and other performance measures that can assure changes will improve medical care and do not harm patients.

Feb 22, 2011
Report

Investment in New Health Care Quality Measures Needed as Cost-Cutting Strategies Grow

Health care spending reforms should be met with new efforts to develop and refine quality of care and other performance measures in order to assure that any changes will improve medical care and not harm patients.

Feb 22, 2011
Journal Article

Journal Article

Depression and the Health Care Experiences of Medicare Beneficiaries

Depressed patients report poorer health care experiences and have less confidence that they can recognize their need for care.

Jan 1, 2011
Journal Article

Journal Article

Hospital Executives' Perspectives on Pay-for-Performance and Racial/Ethnic Disparities in Care

Hospitals executives hesitant about using pay-for-performance programs to reduce racial/ethnic disparities in care.

Oct 1, 2010
Journal Article

Journal Article

Where Americans Get Acute Care: Increasingly, It's Not at Their Doctor's Office

Only 42 percent of the 354 million annual visits in the U.S. for acute care—treatment for newly arising health problems—are made to patients' personal physicians. The rest are made to emergency departments (28 percent), specialists (20 percent), or outpatient departments (7 percent).

Sep 1, 2010
Commentary

Commentary

Physician Compensation, Cost, and Quality

Pay for performance, transparency, and other innovative ways of compensating physicians will work only if, at the same time, the system for providing care is changed to one that has clear objectives and provides specific tools to help physicians achieve those objectives, writes Robert H. Brook.

Aug 18, 2010
Research Brief

Are Performance-Based Accountability Systems Effective? Evidence from Five Sectors

Creating an effective Performance-Based Accountability System (PBAS) requires careful attention to selecting an appropriate design for the PBAS, given the context in which it is to operate, and to monitor, evaluate, and adjust the system, as appropriate.

Jul 28, 2010
Report

Performance-Based Accountability Systems for Public Services

Evidence supports continued experimentation with and adoption of performance-based accountability systems (PBAS) in various sectors: child care, education, health care, public health emergency preparedness, and transportation. However, PBAS design and its prospects for success depend on the context in which it will operate.

Jul 21, 2010
Report

Analyzing the Operation of Performance-Based Accountability Systems for Public Services

Empirical evidence of the effects of performance-based public management is scarce. But a framework for organizing the empirical information we do have could identify individuals or organizations that must change to improve performance, select an effective incentive structure, and choose performance measures that inform the incentive structure appropriately.

Jul 14, 2010

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