News Archive: Health Economics
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2006
Immigrant health care costs are disproportionately low — Dec. 2006
Foreign-born residents and undocumented workers in the U.S. use fewer medical services (according to their population share), possibly because of better health. Growing evidence suggests that immigrants are healthier than their native-born counterparts.
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Health systems seeking quality-of-care redesigns provide lessons — Dec. 2006
Five years after the Institute of Medicine report, Crossing the Quality Chasm, many promising examples of redesign have been identified. However, pursuing the six Institute of Medicine aims presents challenges. For example, a successful system redesign requires coordination and shared management as opposed to isolated attempts at redesign projects.
Unique foresight framework helps health care managers with long-term planning — Dec. 2006
This method uses scenario-building and business-model-specific load-bearing assumptions to assist health care managers in longer-term planning. The framework is illustrated using a case of disease management.
Price increases can occur faster in multi-hospital systems — Dec. 2006
An analysis of trends in hospital prices between 1999 and 2003 reveals more price mobility for multi-hospital system members than non-system hospitals. Member hospitals were able to increase their prices more than comparable non-system hospitals, regardless of other system or non-system populations in the local market.
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Reactions from physicians on pay-for-performance measures as stimulant to quality of care
Physicians respond to pay-for-performance incentives as a means of stimulating quality improvement. Possible barriers to the successful application of such a program were explored during interviews with physicians experienced with similar programs.
Nearly half of children with high health care costs repeat high costs the following year
In this two-year study of health care costs in children, the top 10% of children with the highest health care costs accounted for over half of all costs. Nearly half of these children remained in the top 10% again the following year, while a modest number dropped to the bottom half. These findings have implications that could help save health care dollars.
Cataract surgery is found to be cost-effective for low-probability patients
Patients who have a low predicted probability for improvement may still find cost-effective benefits from cataract surgery when compared against watchful waiting. This study monitored 250 patients who had a less than 30% probability of reporting improvements in post-operative visual function.
Cost-effectiveness of palivizumab as prophylaxis for infants studied
This study involved hypothetical cohorts of infants who did not have chronic lung disease. Conclusions support more restrictive guidelines for palivizumab prophylaxis. Palivizumab was cost-effective for some infants under certain circumstances.
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Undocumented immigrants use only a small fraction of U.S. public health care dollars — Nov. 2006
According to new research from RAND Labor and Population, health care costs for undocumented immigrants averages about $11 in annual taxes per U.S. household. Immigrants in general, documented and undocumented, appear to be healthier than their native-born counterparts and therefore spend less on treatment.
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Use of Prospective Payment System for inpatient rehabilitation facilities leads to reduction in costs — Nov. 2006
An investigation into the use of a new payment system for inpatient rehabilitation facilities reveals savings. Prospective Payment System use can result in significant declines of both cost and duration of stay in an inpatient rehabilitation facility.
Effects of consumer-directed health care are emerging — Oct. 2006
Consumer-directed health care appears to be associated with lower costs, as predicted, but the results of its effects on quality and appropriateness of care are mixed and will require further study.
Reliving history and renewing the health care reform debate — Oct. 2006
This editorial in the Annals of Family Medicine discusses the importance of renewing the health care reform debate, particularly as the 2008 presidential elections approach. Increasing numbers of uninsured patients, skyrocketing health care costs, and poor-quality health care all have significant long term consequences for our nation's health and our economy.
Lessons learned from health care reform effort in Massachusetts — Oct. 2006
Several lessons can be learned from Massachusetts' effort to reform its health care system to offer insurance coverage for nearly all of its residents: bipartisan cooperation is possible, a variety of policy options are needed, and the initial rates of uninsurance and degree of regulation in the insurance market are important considerations.
Increased co-payments for expensive drugs won't cut health care costs — Sep. 2006
Patients continue to take expensive specialty drugs even when their co-payments rise. The best way to hold down costs for employers and health insurance plans is to make sure the medications are prescribed only to the patients who can truly benefit from them.
Providing health insurance to low-income children improves quality of life — Sep. 2006
Children newly enrolled in a public health insurance program in California reported improvements such as doing better in school, feeling better physically, and getting along better with their peers.
Higher quality of care found in competitive hospitals and in areas with more HMO coverage — Sep. 2006
Hospitals that faced more competition and hospitals in market areas with higher HMO penetration were associated with lower rates of mortality for adult patients with various medical conditions in California.
Adoption of information technology in the U.S. health care system could save billions of dollars — Aug. 2006
Health care information technology could save U.S. hospitals and health services $162 billion. This article outlines the major barriers to success and possible solutions to these difficulties, including the need for government intervention in implementing health care IT on a broad scale.
RAND Health Insurance Experiment continues to influence health services and policy — Aug. 2006
The RAND Health Insurance Experiment (HIE), originally begun in 1971, encouraged the restructuring of private health insurance and helped increase the stature of managed care in the U.S. This influential study continues to impact health policy, and most recently was referenced in the Journal of Health Services Research and Policy in the article "Books that Have Changed Health Services and Health Care Policy." The book is titled Free for All? Lessons from the RAND Health Insurance Experiment.
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Bing Center for Health Economics launches new website — Aug. 2006
Thanks to a generous donation from former RAND trustee Peter Bing, RAND Health has established a new Bing Center for Health Economics. The new Center will be the home for research, training, and recruiting for health economics activities at RAND. The Center's new website provides information about staff, research projects, and publications.Health care markets, the safety net, and utilization of care among the uninsured — Aug. 2006
Health care use among uninsured patients is related to the percentage of patients in urban areas who are uninsured, the number of available physicians, the safety net capacity, and the competitiveness of managed care.
Assessing the economic impacts of alcohol policies in the European Union — Aug. 2006
Presents an evidence-based assessment of a proposed communication on alcohol policy in the European Union, with a focus on the economic impacts. The proposed policy aims to reduce the harmful impacts of alcohol use, especially in youth, while preserving its beneficial economic and social value.
Effects of Medicaid policies on mental health service use among children — July 2006
Children who live in areas with behavioral carve-outs under Medicaid managed care were less likely to use inpatient mental health services, possibly due to restrictions within these types of plans. Children who were older or had a greater need for mental health care were more likely to use these services, as were children whose caregivers had higher levels of education.
Productivity analysis among Health Maintenance Organizations — July 2006
For HMOs with and without Independent Practice Associations (IPAs), HMO productivity increased from 1990 to 1996 and rapidly decreased from 1997 to 2001. However, non-profit HMOs and HMOs without IPAs are more productive than HMOs that are for-profit or have IPAs.
DUI court intervention may be cost-effective for repeat offenders — July 2006
This study analyzed the cost-effectiveness of a therapeutic court intervention for repeat drunk driving offenders and found that all program participants showed behavioral improvements. For third-time offenders, the DUI court produced a cost savings compared to traditional court expenditures.
National survey of Medicaid mental health care arrangements — July 2006
Medicaid has been the primary payer for public mental health systems, but little is known about managed care arrangements at the health plan level. This study confirmed that most states were contracting to serve a broad range of Medicaid enrollees, with a wide array of covered benefits. Most plans were HMO-type arrangements, and a large percentage of states used government entities as vendors.
One-third of children eligible for the State Children's Health Insurance Program (SCHIP) are uninsured — July 2006
A national survey reveals that about 6% of children (4.3 million) were eligible for SCHIP in 2000, and over one-third of eligible children were uninsured. Results showed variation across states, and also suggested a lower uninsurance rate in the 17 states that expanded Medicaid eligibility.
Structural interventions can prevent HIV in low-prevalence populations — July 2006
This study used the cost-effectiveness estimator "Maximizing the Benefit" to determine the relative cost effectiveness of several structural HIV prevention interventions. Results suggest that structural interventions hold the greatest promise in reducing HIV transmission among low-prevalence populations.
Understanding patients' choices at the point of referral — June 2006
This report details joint research by RAND Europe, City University and the Kings Fund to investigate which factors might drive patients' health care choices at the point of referral in the United Kingdom. The research team explored patients' priorities to gain insight into the types of information patients require and the value patients place on hospital performance and characteristics.
Effects of state parity laws on use of mental health care — June 2006
Results suggest that state parity laws succeeded in expanding access to mental health care for those with relatively mild mental health problems.
Increasing costs of urinary incontinence among female Medicare beneficiaries — June 2006
Costs of urinary incontinence among older women nearly doubled between 1992 and 1998, from $128 million to $234 million, primarily due to increases in doctor visits and outpatient surgeries. The increase in total spending was due almost exclusively to the increase in the number of women treated for incontinence.
Coverage for substance abuse treatment under Medicaid managed care — June 2006
This study reports on a survey of state Medicaid managed care programs conducted in the year 2000, which were examined to determine whether coverage for substance abuse treatment is poor under Medicaid managed care.
Consumer decision making in the individual health insurance market — May 2006
Tax credits and subsidies are unlikely to have a large impact on the number of people without individual health insurance. Simplifying the application process and making information easier to find may be more effective.
Public health insurance can improve access and health for vulnerable children — Apr. 2006
Uninsured children in California who are eligible for public health insurance have poorer access to care than enrolled children, and those with the highest levels of risk have poorer health status. Providing insurance to these children may lead to improved access and health.
RAND announces new Bing Center for Health Economics — Mar. 2006
Thanks to a generous donation from former RAND trustee Peter Bing, RAND Health is establishing a new Bing Center for Health Economics. The new center will be the home for research, training, and recruiting for health economics activities. More information will be posted here as it becomes available.
Combined behavioral and drug therapy improves treatment for panic disorder — Mar. 2006
Patients with panic disorder experienced more improvement when treated with a combination of cognitive behavioral therapy and pharmacotherapy than with usual primary care treatment, with only a moderate increase in cost.
Substance abuse treatment doesn't solve national drug problems — Mar. 2006
Treatment of drug addiction is effective for individuals and communities, but even well-funded programs have not reduced the number of drug abusers on a nationwide level. Complementary programs are needed to make drug policies more effective.
Medical safety net plays key role in care for uninsured children — Mar. 2006
Uninsured rural children are more likely to receive some type of medical services if they live closer to "safety net" providers or if there are more primary care physicians nearby.
Staff turnover in nursing homes associated with organizational characteristics — Feb. 2006
Findings suggest that staff turnover in nursing homes is higher for those facilities that are lower quality, owned for-profit, have lower staffing levels, and higher bed sizes.
Evidence of cost shifting in California hospitals — Jan. 2006
Findings from a study of California hospitals suggest that decreases in Medicare and Medicaid prices were associated with increases in prices for privately insured patients. This shift in costs accounted for over 12% of the total increase in private payer's prices from 1997 to 2001.
Cutting drug copayments can reduce hospitalizations and save money — Jan. 2006
Cutting drug copayments on cholesterol-lowering medication for the sickest patients would avert nearly 80,000 hospitalizations and more than 31,000 emergency room visits each year — accounting for the more than $1 billion in savings.
Costs of patient care reduced using alternative approach to care management — Jan. 2006
This study examined the cost savings from care managed by teams of physicians and nurse practitioners, along with reductions in postdischarge services. This approach was found to be cost-effective while maintaining a high quality of medical care.
Pricing of health insurance affects financial risk behavior of the elderly — Jan. 2006
As health care costs continue to rise, medical expenses have become an increasingly important contributor to financial risk. This study explores the connection between the availability and pricing of health insurance and the financial risk-taking behavior of the elderly.
RAND Health HIT study in Health Affairs Top 25 Papers for 2005 — Jan. 2006
RAND Health article "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs" made the "Top 25 Papers for 2005" list at Health Affairs.
Relationship between high school marijuana use and future annual earnings — Jan. 2006
Using a unique data analysis approach, this study finds an association between early marijuana use and future earnings. Findings reflect the cumulative effect of marijuana use on cognitive ability and motivation.
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