News Archive: Health Economics
Return to present year
2004 and Prior
Antiretroviral Therapy for HIV and Employment. A new RAND study shows that HIV-positive patients who are treated with Highly Active Antiretroviral Therapy (HAART) are more likely to remain employed than those who don't receive the treatment. Treating patients in less advanced stages of infection may result in the greatest gain in employment. More on HIV...(Posted 11/04.)
The future of individual health insurance. More than 20 percent of Americans — mostly the self-employed and those working for small businesses — are ineligible for group or public health insurance, yet few choose to purchase individual insurance. A new study shows that the future of individual insurance depends on interventions that increase affordability and limit risk-sharing and adverse selection. More about coverage for the uninsured... (Posted 11/04.)
Satisfaction with dental coverage increases with cost. Patients enrolled in fee-for-service dental plans, which charged higher premiums but set no limits on coverage, expressed far greater satisfaction with their dental care than patients in managed care plans, which cost less but set limits on coverage. (Posted 10/04.)
Predicting the costs of health care for children. A small study conducted in a managed care plan showed that parents' assessment of their children's health-related quality of life strongly predicted the children's health care costs over the ensuing two years. When combined with information about chronic health conditions, these parental assessments can be used to identify children likely to need proactive care coordination... (Posted 10/04.)
A snapshot of small business employees in CA and their health insurance status. Pending legislation in the state of California will require small businesses to enroll their employees in a state-sponsored health insurance fund or show evidence of coverage. A new report provides a look at employers and employees who will be affected by this law, SB2. More on employer-based health insurance... (Posted 10/04.)
Subsidies aren't going to solve the problem of the uninsured. Lower premiums don't convince individuals without access to group insurance to purchase individual insurance. More on state efforts to insure the uninsured... (Posted 9/04.)
Parity legislation shows no effect. A comparison of states with parity legislation and those without it found no differences in self-perceived quality of health insurance coverage, access to needed health care, and use of mental health services. More on parity legislation... (Posted 9/04.)
California HMOs reduced inpatient days. Throughout the mid-1990s, Medicare beneficiaries who joined HMOs spent fewer days in the hospital than did beneficiaries in fee-for-service plans. The reduction in use depended on the type of HMO. How HMOs affect the physician workforce... (Posted 9/04.)
Understanding cancer treatment and outcomes. The CanCORS consortium is conducting research to identify important differences in cancer treatment and outcomes and to evaluate the reasons for these differences across a wide range of patients, health care providers, and organizations. (Posted 8/04.)
Primary Care clinics in Veterans' Administration Medical Centers are increasingly relying on nurse practitioners to provide care. Yet the substantial variations among the Centers suggest that more information is needed on successful integration of NPs into the VA primary care setting and the role the NPs play in the VA achieving its restructuring goals. (Posted 7/04.)
California Medical malpractice law cuts payments to lawsuit winners. A landmark California law that caps non-economic awards in medical malpractice lawsuits has cut defendants' payments by 30 percent to plaintiffs who win such lawsuits at trials. Full document; research brief (Posted 7/04.)
Causes of increased Medicare physician services. Volume and intensity of Medicare physician services increased more than 30% between 1993 and 1998. Half the increase is due to general increase in use of care. More on health economics. (Posted 6/04.)
Medicare risk-adjustment models overestimate HMO-enrollees hospital use. Medicare HMO-enrollees tend to be healthier and use fewer inpatient services than fee-for-service plan enrollees. New risk-adjustment models are needed that provide more accurate predictions of HMO-enrollees use of services. (Posted 5/04.)
Patients cut use of drugs for chronic conditions when copays increase. When the amount patients paid for prescription drugs doubled, patients cut their use of common drugs for diseases such as diabetes, asthma, and gastric acid ailments by as much as 23 percent, raising concerns about adverse health consequences. News release; More on prescription drug copayments...(Posted 5/04.)
How useful are consumer surveys for preferred provider organizations (PPOs)? Concerns have been raised that use of out-of-network providers and other factors unique to PPOs may limit the utility of the CAHPS Survey for rating these health plans. More on CAHPS...(Posted 5/04.)
Resident satisfaction surveys are used by a high proportion of nursing homes and assisted living facilities Administrators report that the information these surveys provide is quite useful, but these surveys show little consistency, and evidence that the information they gather is used to improve the quality of care is scarce. More on the elderly... (Posted 5/04.)
Fewer disparities in the use of preventive health care. Elderly men enrolled in Medicare managed care plans showed few ethnicity/race-associated differences in their use of preventive services compared to those of earlier studies. (Posted 5/04.)
Unmet needs for health care persist among users of a safety net system. In spite of reorganization of the Los Angeles County health care system, users of the safety net continue to experience barriers to receiving needed care. Competing priorities for basic necessities and lack of insurance contribute importantly to these unmet health care needs. (Posted 5/04.)
Med Schools get 45 percent of federal higher education. Medical schools received 45 percent of all federal research and development funds provided to U.S. colleges and universities in 2002, according to the most complete profile ever of how such funds are distributed. Read the report...(Posted 4/04.)
The stability of the safety net. A study of the health care safety net in all U.S. urban areas during the 1990s found that the stability and level of financing show substantial regional variation. While erosion was not observed during the study period, future economic downtowns and budget pressures could lead to future problems. More on health care financing... (Posted 4/04.)
Benefits of athletic activities — March 2004
In a group of about 5500 public high school students, more than 40% were obese or overweight. But students who participated in athletic activities were more likely to have a lower body mass index, the usual measure of obesity.
Read abstract
A practical guide to HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule is fundamentally changing the way that healthcare providers, health plans, and others use, maintain, and disclose health information. This article offers practical advice for researchers who require access to health care information. (Posted 3/04.)
Regulating insurance premiums in California. California Senate Bill 26 was introduced in 2003 to curtail growth in health insurance premiums. This analysis concludes that the bill would limit premium growth in the short term. However, it would do little to cure the root causes of health care inflation, including new technology, more prescription drugs, expansion of insurance coverage, and demographic changes. (Posted 3/04.)
Cost for obesity growing dramatically. If obesity continues rising at its current rate in the U.S., by 2020 about one in five health care dollars spent on people ages 50-69 could be consumed by obesity-related medical problems. More on obesity...(Posted 3/04.)
Health care spending differences related to race and gender. Health care spending on minorities, poor people and men is often lower than spending on whites, higher-income people and women. But the spending gap narrows or disappears in the last year of life for Medicare patients. More on socioeconomic determinants of health...(Posted 3/04.)
Racial/ethnic differences in consumers' assessment of Medicaid managed care. There are racial/ethnic differences in consumers' ratings of care because different people enrolled in the same plan have different experiences rather than because racial/ethnic minorities are enrolled in plans with worse experiences. More on consumer assessments of health plan quality...(Posted 3/04.)
Disagreement over what constitutes a health emergency, even among the experts. (PDF) Disputes over coverage for emergency department services can account for more than half of appeals . The prevalence of disputes over ED care as well as the high rate at which enrollees win these appeals - over 90% - seems to reflect disagreement over what constitutes a health emergency, not only between enrollees and experts but among the experts themselves. (Posted 1/04.)
Consequences of rising insurance costs. When the cost of insurance premiums rises, many employees choose less expensive coverage, and single employees are likely to drop coverage. Sustained cost escalations could result in increasing numbers of uninsured. More on the effects of increasing insurance costs...(Posted 1/04.)
Providing public insurance to HIV/AIDS patients could greatly increase survival rates. A joint RAND/Stanford University study found that expanding pubic insurance, such as Medicaid, to uninsured patients could reduce HIV/AIDS-related deaths by up to 66%. The study also found that private insurance prevents deaths even more effectively. More on HIV/AIDS... (Posted 1/04.)
The disabling effects of obesity. Americans younger than 60 are becoming more disabled, and the major culprit is obesity. More on obesity... (Posted 1/04.)
Steering consumers to low-cost drugs. Pharmacy benefit packages that require different patient copayments depending on the drug are going to become more common. These kinds of packages are intended to steer consumers toward low-cost substitutes for more costly drugs. More on design of pharmacy benefit packages... (Posted 1/04.)
Deciding which drug to produce. Business incentives lead pharmaceutical companies to produce lifestyle drugs rather than drugs for chronic or emerging diseases. (Posted 1/04.)
Laboratories of reform. Over the past two decades, the states have been the laboratories for testing new approaches to insuring the uninsured. The results show that states haven't yet solved the problem. But state efforts have produced important lessons that could help federal policymakers in shaping the next wave of national health insurance proposals. Subscribe to RAND Review. (Posted 12/03.)
Nursing home profits can mean poorer care. A RAND study found that overall, for-profit nursing homes provide poorer care than not-for-profit homes. The most profitable nursing homes provide the worst care. More on care of the vulnerable elderly (Posted 12/03.)
Small group health insurance reforms have a small effect on job mobility. State initiatives aimed at reforming small group health coverage to increase job mobility and limit premiums for workers with high health costs appear to increase job mobility slightly, but premium limits may lower costs for the sick at the expense of older workers. (Posted 11/03.)
A design for health care change. The Pittsburgh Regional Healthcare Initiative is an innovative approach to improving clinical practice and patient safety through shared learning. The Initiative is a collaborator of the RAND-University of Pittsburgh Health Institute. (Posted 10/03.)
Financing health care for women with disabilities. An estimated 27 million American women are living with disabilities that frequently prevent them from getting the most routine preventive and primary health care. This study finds that the health care financing system explicitly reimburses for specialty care for a disabling condition, but it ignores the added equipment and staffing needed to provide appropriate general health care. (Posted 10/03.)
Health insurance for low-income children. Subsidized group insurance provides more stable insurance coverage for low-income children than public insurance does. But other programs will be needed to reach the majority of uninsured children. More on providing health insurance for children. Assessment of state efforts to insure the uninsured. (Posted 9/03.)
Motivating consumers to purchase private health insurance. The administration has proposed a $1,000 tax credit to encourage uninsured people to purchase individual coverage. This study found that a $1,000 tax credit would cover only about 40 percent of the average monthly cost for individual coverage in California. Premiums vary by age. A $1,000 credit would cover the premium for about one-fourth of thirty-year-olds but fewer than 5 percent of fifty-year-olds. The tax credits would provide even less premium coverage for sicker enrollees. More on the effects of premium subsidies. (Posted 9/03.)
Few insurance claims for substance abuse treatment. A new study shows that the number of claims filed for substance abuse treatment among the privately insured is much smaller than expected. These findings raise concerns about the extent of undocumented treatment, unmet needs for such treatment, and implications for assessment of the quality of treatment available to the privately insured. (Posted 8/03.)
Satisfaction with eye care in managed care. The study found that many patients with open-angle glaucoma or diabetic retinopathy prefer to be treated by specialists. Patients were less satisfied if they were treated in practices that obtained a large portion of their revenue from capitation, or by providers who derived a large portion of their incomes from bonuses. More on the effects of managed care. (Posted 8/03.)
Psychiatrists worry about effects of managed care on their patients. Although psychiatrists are less dependent than other physicians on managed care, they are more concerned that managed care has a negative impact on patient-provider relationships. Other aspects of managed care, such as pre-authorization and gatekeeping, may be driving their perceptions. Effects of managed care on the physician workforce. (Posted 8/03.)
Even Medicare patients with drug coverage may have limited coverage because of caps on benefits. To continue the same medication use as before exceeding caps, these patients faced potentially high increases in out-of-pocket costs for medications used primarily to treat chronic conditions. Generic options were not available for many of these drugs. (Posted 8/03.)
A framework to reduce emergency department crowding. There's widespread consensus that emergency departments are crowded, but little agreement about what causes crowding and how to fix the problem. As this study shows, what's needed is an integrated approach, not piecemeal solutions. (Posted 8/03.)
Consumer perceptions of mortality and decisions to sell their life insurance. People who are chronically ill may sell their life insurance in exchange for cash that they can use to finance health care and other services. This study found that unhealthy consumers are systematically too optimistic about their risks of dying. As a consequence, they misjudge the value of the insurance they are selling. (Posted 8/03.)
Keeping doctors in medically underserved areas. To convince physicians to practice in medically underserved areas, Medicare pays them 10% more for Medicare services than physicians in other areas. The Centers for Medicare and Medicaid services, the agency that administers the Medicare program, asked RAND to see whether the program was working. RAND's answer: It isn't. More about this study. (Posted 7/03.)
Government health coverage helps erase gaps in care. Findings of a new study on health care expenditures for Medicare beneficiaries suggest that public sources of payment for health care are helping to eliminate racial and ethnic disparities in care. (Posted 6/03.)
Treatment costs for cancer patients in clinical trials. Care for the average patient who enrolls in a clinical trial costs an average of $892 more each year than if that patient had not enrolled in a trial. Lack of insurance coverage should not be an obstacle that prevents cancer patients from enrolling in studies of promising new treatments. Press release» (Posted 6/03.)
Report cards on hospital performance are controversial but here to stay. A recent article compares British and American report cards and recommends ways to improve the quality, consistency, and usability of public reports. More on report cards... (Posted 6/03.)
HMOs help limit out-of-pocket health spending for seniors. A newly released RAND study finds that Medicare HMOs are more effective than other widely available supplemental health insurance plans at helping limit out-of-pocket health care costs for the elderly. More... (Posted 5/03.)
Timely follow-up care after ER discharge: lack of access for all. Lack of health insurance is known to affect access to needed health care. But a new RAND study finds that only half of insured patients who needed follow-up care after an emergency room visit received appointments within a week of discharge. Uninsured patients and those covered by Medicaid were even less likely to receive timely appointments. (Posted 5/03.)
Subsidizing COBRA: Will it decrease the ranks of the uninsured? COBRA, a federal law designed to allow workers to continue group health coverage after leaving a job, applies only to a small number of the uninsured, according to a new RAND study. Thus, subsidies to all low-income people who leave a job would be more effective. (Posted 5/03.)
The unfinished story of state health care reform. Over the past decade, the states have been the laboratories for trying new approaches to insuring the uninsured. A series of studies examined how successful the experiments have been. The results show that states have not yet solved the problem of the uninsured. But the experiments have provided important lessons for policymakers. (Posted 4/03.)
Policies governing the use of public funds for care of the uninsured: who sets them? A newly completed study examines the issue of governance of public funds for health care, focusing on Miami-Dade County FL and recommends that funding be provided to implement innovative approaches to caring for the indigent. (Posted 6/03.)
What do employees do when their health insurance premiums rise? A new study examined how employees who have a flexible benefits plan respond to an increase in the price of their health insurance. Workers lowered their level of insurance coverage but increased their health insurance expenditures. Workers accommodated these increases by reducing both their take-home income and other benefits such as life insurance, disability and dental insurance, and retirement benefits. Thus in the long run, rising health insurance prices may leave consumers vulnerable to health, mortality, disability and other significant risks. (Posted 3/03.)
Expansion of public health insurance programs for low-income people leads many to switch from private coverage according to a new RAND study. Because this switching, called crowd-out, affects health insurance coverage decisions of employers, newer expansion efforts have adopted methods to limit it. (Posted 3/03.)
Variations in Medicare spending and quality of care. A newly released study has found that hospitals with higher Medicare spending do not always provide higher quality care. In an accompanying editorial, Ken Shine, MD, concluded "[The researchers] have convincingly demonstrated that excellent outcomes for patients can be achieved in regions that do less, but do it right. The challenge is to convince the public that this is not about rationing but about better care." (Posted 2/03.)
Medical monitoring for future pharmaceutical injuries? Within the past few years, individuals exposed to a defective drug with potentially harmful long-term effects have begun to demand that the legal system require manufacturers to provide regular medical monitoring, raising fears that the costs resulting from such monitoring could quickly spiral out of control. An analysis of legal cases to date finds that in general, judges' decisions appear to be taking all clinical, economic, and epidemiological factors into account and that such monitoring will allow the courts to address potential harms proactively. (Posted 2/03.)
Most HMO disputes involve coverage, not necessity of care, and patients win half of appeals. Most disputes between patients and their HMOs deal with the amount of coverage for services, rather than their medical necessity, and many of those that do involve necessity are resolved in favor of patients, according to a study by researchers from RAND and the Harvard School of Public Health. More... (Posted 2/03.)
Future trends in nursing home residence... The nursing home population has declined in recent years. However, new forecasts predict that this trend will reverse itself within the next 10 years, largely due to the expected increase in disability among the aging population. (Posted 1/03.)
It's time to add a flexible drug benefit to Medicare. Congress should add a prescription drug benefit to Medicare and assist state Medicaid programs overwhelmed by rising pharmacy costs. In doing so it should look to the experiences of pharmacy benefit managers, write Dana P. Goldman and Geoffrey F. Joyce in a recent Los Angeles Times op-ed. Summary of RAND work on drug benefits... (Posted 12/02.)
Should we redesign our public health infrastructure? The events of September 11, 2001 revealed our public health system's state of disarray. Yet the public still lacks an understanding of what the public health infrastructure is intended to do. A recent commentary explores the question of whether our decaying public health system can simply be rebuilt or whether a paradigm shift is needed to design a system that serves the needs of the 21st century. (Posted 11/02)
Health disparities among Medicare+Choice recipients. A newly released RAND study used individual-level measures from the Health Plan Employer Data and Information Set (HEDIS) to compare quality of health care and access to care among Medicare+Choice (the Medicare managed care option) enrollees. The study finds that African Americans enrolled in Medicare+Choice receive poorer quality health care than do Caucasian, Hispanic, Asian-American, and Native American enrollees. (Posted 11/02)
Referring patients using emergency rooms to next-day care. Facing overcrowding and budget cuts, emergency departments are under pressure to refer patients with nonacute conditions to other settings. But can it be done without harming patients? A recent study concluded that detailed standardized screening criteria can safely identify patients at public hospital emergency departments for referral to next-day care. However, larger studies are needed to assess the possibility of adverse effects. (Posted 11/02)
Cost Sharing Cuts Employers' Drug Spending—But Employees Don't Get the Savings. Increasing co-payments for prescription drugs causes patients to reduce their use of medication and switch to lower-cost drugs. The higher co-payments do cut costs, but almost all of the cost savings accrue to the health plan and not to the patient. More on prescription drug benefits... (Posted 11/02)
Does Medicare benefit the poor? Previous studies found that Medicare benefits flow primarily to the economically advantaged. This study took a new approach. Measuring socioeconomic status at the individual level, rather than in the aggregate, they found that the poorest groups receive the most Medicare benefits at any age. (Posted 10/02)
Rising cost of prescription drugs is changing patients' behavior. Increasing co-payments for prescription drugs causes patients to reduce their use of medication and switch to lower-cost drugs. Lower income groups could be most at risk. (Posted 10/02)
Limited insurance deprives deaf population from hearing-restoring technology. Because many health insurers fail to pay the full cost of cochlear implant procedures, the technology was not used more widely by the several hundred thousand deaf people around the United States. RAND researchers estimate that only only a small fraction received cochlear implants in 1999, the year that was the focus of their study. Read the press release and the research brief. (Posted 10/02)
The economic impetus for obesity in the United States. A recently completed analysis of labor statistics by two RAND researchers shows that the health of young Americans is deteriorating as the elderly are becoming healthier. This deterioration in health and increase in disability among the young is due to the rise in overweight and obesity, particularly over the past 10 years. The researchers go on to show that the rise in overweight can be attributed at least in part to economic factors: the rise in incomes, the increased availability of inexpensive food, and the increasingly sedentary nature of work. (Posted 10/02.)
Co-payments affect patients' use of medication. Co-payments for prescription drugs affect patients' use of medication. Increasing co-payments for prescription drugs causes patients to reduce their use of medication and switch to lower-cost drugs. Different levels of co-payments cut costs by different amounts, but in all cases, nearly all of the savings go to the insurance plans, not to consumers. Read press release... See additional coverage by Reuters, Washington Post, and U.S. News & World Report. (Posted 10/02)
Bioterrorism research needed. Ken Shine, director for the RAND Center for Domestic and International Health Security, has written a Memorandum to the President detailing the medical research needed to combat bioterrorism. Shine wrote the memorandum for the Aspen Strategy Group, a meeting of national and international leaders and experts convened by The Aspen Institute to address complex policy issues. The August 4-8, 2002 meeting of the Aspen Strategy Group focused exclusively on ways to improve health-related security. (Posted 9/02)
Don't count on insurance coverge for emergency room services. Many consumers assume that their health plan covers emergency room services. They may be wrong. A recent RAND study identified payment for emergency room care as a major point of contention between consumers and two large HMOs. More about this study... (Posted 10/02)
How do physicians feel about managed care? A survey of more than 7,000 physicians indicates that gatekeeping arrangements in primary care affect physicians' satisfaction with their career. Physicians in solo and 2-physician practices are least satisfied with their careers and reported more constraints on their clinical freedom and income than physicians in other settings.
More: Managed care affects where physicians practice and when they retire. (Posted 10/02)
An economic justification for subsidizing terrorism insurance. Calls for government intervention are common after major catastrophes, but they seldom correct fundamental deficiencies in the private market for insurance. However, the case of terrorism is significantly different. When one target protects itself against terrorism, alternative targets become more attractive to terrorists. Therefore, protection can have negative effects on society at large that are not considered by an individual target. The result can be too much protection by individuals. The government could solve this problem by subsidizing terror insurance—more insurance would lessen the incentives for individuals to protect themselves—and by spending on collective law enforcement, which does not make any single individual more vulnerable. (Posted 10/02)
Most disputes with HMOs are not about denial of coverage for medically necessary or life-saving care. Contrary to popular belief, most appeals of HMO coverage denials do not involve failure to cover medically necessary or life-saving care, according to a newly released study by RAND Health researchers. About half of all appeals to two of the nations largest HMOs dealt with services the patient had already received, usually in a hospital emergency room, and more than three-fourths of the appeals were successful. More... (Posted 9/02)
Do HMOs compromise quality to lower costs? A study just released by RAND Health researchers examined the association between hospitals' quality, geographic convenience, and costliness for coronary bypass (CABG) surgery and the likelihood of their being selectively contracted by HMOs to provide that surgery. The findings suggested that HMOs value quality, geographic convenience, and costliness, but that the importance of quality and costliness varies with HMOs. Greater hospital competition decreased the likelihood of contracts, whereas greater HMO competition increased that likelihood. (Posted 9/02)
The challenge of educating potential beneficiaries about their health care options extends to the military. Prior to 2001, Medicare-eligible military retirees and their dependents had only limited entitlement to military-sponsored health care. A recently released RAND report evaluated the results of the military's Tricare Senior Supplement Demonstration project, in which Medicare-eligible military retirees in two geographical areas were offered access to military-sponsored health care. Although the Tricare Senior Supplement program has since been superceded by a nationwide program called Tricare for Life, the report's findings demonstrate the need to provide potential beneficiaries with adequate information about their options for health care coverage. (Posted 9/02)
How do "Disability Ratings" match losses of income due to work-related injuries? "Disability ratings," which are used to set workers compensation rates for work-related injuries in the state of CA, are a poor predictor of earnings losses for workers who become permanently disabled due to upper-extremity injuries, according to a newly released RAND study. (Posted 9/02.)
Analyzing the costs of graduate medical education in childrens' hospitals. Medical student and resident training programs increase the costs of hospital care relative to those of non-teaching hospitals. Graduate medical education has been funded largely by patient care income, and the federal government, through Medicare, pays the largest share. However the calculation of direct and indirect cost differences attributable to teaching is not straightforward. A report just released by RAND Health researchers provides an analysis of the methods mandated by the new federal Childrens' Hospital Graduate Medical Education Fund to assess the indirect costs of medical education in childrens' hospitals. (Posted 5/02)
Development of a prospective payment system for inpatient rehabilitation services under Medicare. The Balanced Budget Act of 1997 mandated that the Center for Medicare and Medicaid Services (then the Health Care Finance Administration) design, develop, and implement a prospective payment system for inpatient rehabilitation services, similar to those for other Medicare-covered services. The previous payment system, mandated by the Tax Equity and Fiscal Responsibility Act (TEFRA), had a number of inherent problems, including lack of adjustment for the types and severity of illnesses treated and was perceived to be unfair to older hospitals. In a just-released report, RAND researchers describe the work they did to support the establishment of this prospective payment system and provide recommendations for refinement of the system. Executive summary... (Posted 5/02)
A look at Korea's health insurance system for the elderly. This study examined the prevalence of disease, health care use, and costs for the health insurance provided by Korea to the elderly. The study suggests that simultaneously analyzing these dimensions may help avert a financing crisis. More information about RAND Health's work in international health... (Posted 5/02)
Managed care experts who are physicians have a strong distaste for HMOs. In a new RAND study, managed care experts were surveyed to determine what kind of health plan they chose. Experts who were physicians were half as likely as nonphysician experts or academics from other institutions to enroll in HMO plans. (Posted 5/02)
Surgeons in small practices express career dissatisfaction - The growing presence of managed care has been linked to an increase in career dissatisfaction among physicians. However a new study by RAND researchers that analyzes the results of the Community Tracking Study physicians' survey finds that among surgeons, at least, career dissatisfaction is linked more strongly to small practice size. (Posted 5/02)
Small Group Health Insurance Reforms Do Not Result in Expanded Coverage. In the mid-1990s, several states legislated reforms to the laws governing health insurance coverage offered by small businesses to their employees. The goal of these reforms was to improve low coverage rates; however, many analysts feared that the reforms would have negative consequences for the market. A new study by RAND researchers shows that while the feared changes have not come to pass, neither have the intended benefits been realized. (Posted 4/02)
Adding a prescription drug benefit to Medicare - Medicare is the only major health insurance carrier that does not provide prescription drug benefits. Interest in adding a prescription drug benefit to Medicare has recently been renewed, but the primary concern is the potential cost of such a benefit. A group of RAND researchers has created a model to estimate the annual costs of providing prescription drugs to elderly beneficiaries under various proposed reimbursement strategies. The full text of this study is available online. Highlights of this work may also be viewed on our website. (Posted 4/02)
Do Health Care Report Cards Present Information Effectively? Report cards that rate the performance of health care plans are being issued with increasing frequency as a way to provide consumers with information to facilitate their choices. Efforts are underway to develop new performance measures and improve the validity of reporting, yet few attempts have been made to assess the usability of the reports. A new RAND study applies principles of cognitive science to health plan report card design and assesses the usability of three websites that provide health plan performance data.
Highlights of additional research in this area: Report Cards for Health Care: Is Anyone Checking Them? (Posted 3/02)
Assessing consumer health care experiences. The Group-level CAHPS® survey instrument represents CAHPS® efforts to date to develop and refine a CAHPS instrument designed to assess consumer health care experience at the level of the provider group (such as a clinic or group medical practice). The beta-version survey was developed in collaboration by CAHPS® grantees (Harvard, RAND, the Research Triangle Institute) and the Pacific Business Group on Health (PBGH). Translations of beta-version of GCAHPS® are available in Armenian, Chinese, Khmer, Korean, Spanish, Tagalog, and Vietnamese.
PDF files of surveys Updated CAHPS publications (Posted 3/02)
The health insurance benefits employers offer to prospective employees are tied to economic conditions and the rate of unemployment. When unemployment rates are high, employers are likely to exclude health coverage from the benefits packages they offer to new employees, suggesting that if the recession continues, the number of uninsured individuals is likely to continue to grow.
For more information: Highlights of other research in this area can be found at http://www.rand.org/publications/RB/RB4527/, http://www.rand.org/publications/RB/RB4529/. (Posted 3/02)
The Internet holds the promise of making health-related information only a click away. But can it deliver? A recent study suggests there's much to be done before the Internet can achieve its potential as an information resource for both consumers and health care providers. Full text of this study... (Posted 2/02)
Employees of low-wage businesses are much less likely to have access to employment-based health insurance than are employees of other businesses. Policy initiatives targeted at increasing health insurance benefits to these low-wage employees must ensure that the minimum standards for employer eligibility in assistance programs are set in such a way that low-wage workers and their dependents are identified and targeted effectively. (Posted 1/02)
Top