RAND Resources for Health Care Reform
Driven by concerns about the escalating cost of health care and large numbers of uninsured Americans, Congress is considering a series of sweeping changes to health care policy. These changes have the potential to transform health and health care in the United States in several ways, including expanding insurance programs to cover millions of the currently uninsured; changing how care is paid for and how costs are shared among insurers, patients, and government sources; improving quality of care through a range of methods, including measurement tools, financial incentives for providers, and information technologies; and promoting healthier lifestyle and behavioral choices.
For the past 40 years, RAND Health, one of the world's largest private health research groups, has conducted research and analysis on topics that are currently at the center of the health care reform debate. The key elements of this work are described below and include COMPARE (Comprehensive Assessment of Reform Efforts). This resource was created to help provide policymakers and interested parties with a unique way of understanding and evaluating the effects and unintended consequences of various health care reform proposals.
'COMPARE' Provides Global Positioning System for Health Care Policy
COMPARE is a first-of-its-kind online resource that provides one-stop shopping for objective analysis of health policy issues. COMPARE presents: facts and figures about the current state of the U.S. health care system, focusing on key dimensions of system performance; a description of policy options for changing the health care system; an inventory and the status of the most prominent federal, state, and private health care reform proposals; and an interactive tool that presents the results of microsimulation analyses of the effects of different health care policy options on multiple dimensions of health system performance, including cost, coverage, and outcomes.
RAND Research: Informing the Health Care Debate
Increasing Access to Health Care
Access to health care usually refers to the ease with which an individual can obtain needed medical services. In addition to policy options that would increase the availability of insurance coverage—which is linked to improved access to needed care—Congress is considering options for addressing socioeconomic and urban/rural disparities in access, including tax incentives and policy options to address primary care workforce issues. RAND research has examined factors that influence access, the effects of changes in access, and the relationship between access and health for specific populations, including racial and ethnic minorities, people with limited English proficiency, immigrants, children, and veterans.
Increasing Health Insurance Coverage
In 2007, about 45.7 million people in the U.S. were uninsured. The uninsured come from every income level, age group, employment status, gender, race, ethnicity, and region of the country. Health care coverage protects individuals against the financial risk that might result from unpredictable and expensive health care needs. Individuals who have health care coverage tend to receive more preventive care, are less likely to avoid or delay needed medical care because of cost, and may have better health outcomes than patients without coverage. Increasing the proportion of people with adequate protection from financial risk due to health care expenses is a cornerstone of many health care reform proposals. The most widely discussed options for expanding coverage to the uninsured include employer mandates, individual mandates, refundable tax credits, and expanding Medicaid/SCHIP eligibility. RAND analysts have used microsimulation modeling methods to predict the effects of specific policy scenarios on health care coverage and health spending.
Decreasing Costs and Increasing Quality
Despite investing $1.7 trillion annually in health care, the U.S. health care system is plagued with inefficiency and poor quality. The need to control costs while also increasing quality of care figures prominently in the health care reform debate. Better information systems could help, as could efforts to pay for quality and outcomes rather than for number of services delivered. RAND analysts have conducted extensive work on quality of care, estimated the costs and benefits of wide-spread adoption of health IT, assessed the effects of pay-for-performance programs, and conducted studies on public reporting of performance information and its effect on performance and patient experience.
Decreasing Health Spending
U.S. health care spending continues to rise rapidly and accounts for an increasing proportion of the gross domestic product. Trends affecting health care spending include price inflation, the number of mix of services used, increases in the population and the aging of the population; the obesity "epidemic," and new technology are significant contributors. Most health care bills are paid by "third party payers" (such as insurance companies, employers, and government programs), and so patients have little incentive to be discerning consumers who will demand high quality services at a lower cost and use less unnecessary care. Increased consumerism is also expected to encourage cost and quality competition among health care providers, resulting in lower prices for services. Drawing on publicly available data, RAND analysts have examined trends in health care spending and have also assessed how policy options such as high deductible health plans and increased cost sharing affect both costs and health outcomes.
Promoting Wellness and Prevention
There is widespread consensus that healthy lifestyle choices including diet, exercise, and preventive screenings are vital to a healthy population. While there is also agreement about the negative impact of poor lifestyle choices, and that changes in these habits—either through organized programs or the efforts of individuals—could improve health, there is no consensus about how these changes would affect health spending. Governments, employers and health insurers have considered the use of incentives in public and private health insurance programs to promote behavior change with the expectation of improving health and saving money. RAND investigators have studied the effects of obesity and disease management programs on health and health spending.
Health Care Organization and Capacity
RAND work in this area has taken a system perspective, examining how organization affects the health system's ability to provide high-quality care and use resources efficiently and effectively. RAND has conducted hundreds of analyses of how changes in health care markets, delivery systems, and financing mechanisms affect patients, providers, insurers, and medical-product manufacturers. For example, this work has extended into such areas as state health care financing initiatives for the uninsured, the impact of prescription drug benefits on health outcomes and costs, and the effect of managed care on utilization and quality of care.