Report

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Health Care Costs - Solutions from HCFO Research.pdf

As policymakers seek to address the nation’s burgeoning deficit, they are ultimately confronted with how to rein in rising health care costs.  Complicating the problem is the fact that policymakers, hospital executives, employers, consumers and others may use the single phrase “health care costs” to refer to several very different ideas, including the costs of health care services, their prices, reimbursements to providers, health insurance premiums, and patients’ out-of-pocket spending.  Distinguishing among trends in costs, prices and overall health care

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definedcontribution.pdf

In the current health care marketplace – which is dominated by employer-sponsored insurance – striking a balance between what employees want and what employers can give them is difficult. The managed care backlash has spurred an increasing demand for choice from consumers, while employers, faced with rising health care costs each year, try to balance the satisfaction of workers with their own bottom line.

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monograph0308.pdf

Ever since 2001, when the Institute of Medicine recommended that public and private purchasers of health care build stronger incentives to enhance quality, there has been a proliferation of pay-for-performance (P4P) demonstrations.1 But despite this growth in new initiatives for quality-based incentive programs for hospitals, physicians, nursing homes and home health providers, there is limited evidence of the effectiveness of early private-sector demonstration projects.2 As efforts to link reimbursement and performance continue to increase, a careful review of the lessons learned from earl

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managedcare.pdf

For some time, states have regulated managed care organizations to ensure their financial solvency, including their ability to cover the risk of enrollees. Over the past decade, the nature of states’ regulation of the managed care industry has shifted to focus on preserving quality and patient and provider satisfaction. For example, states have passed legislation or established regulations to ensure that adequate provider networks are maintained and patients have adequate access to specialists through referrals.

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synthesis0508.pdf

This synthesis focuses on a group of projects exploring various aspects of the individual insurance market funded by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) initiative throughout the past decade. These projects vary broadly in scope and method.

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fortune500.pdf

This report presents the results of the first academic study of health purchasing practices used by large companies to address the ongoing challenge of managed care.

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crowdout.pdf

Crowd-out—the substitution of public for private insurance—is a complicated issue that in recent years has become increasingly relevant to state and federal policymakers. The policy and politics of crowd-out entered the spotlight during the Medicaid expansions of the 1980s, and the 1997 enactment of the State Children’s Health Insurance Program (SCHIP) focused renewed attention on the issue.

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research0701.pdf

Although Hispanics generally receive less than average medical care, they commonly underreport barriers to needed care. Researchers at the Center for Health Affairs at Project HOPE found this contradictory reporting may demonstrate inadequacies in the measure being used for this population. The commonly used difficulty-in-obtaining-needed-care measuremay be inappropriate for non-English-speaking Hispanics due to a cultural bias in how this population reports access to care. Specifically, many of them do not interpret “need” in the same way as non-Hispanic whites.

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healthplan.pdf

In working with health plan data, researchers have discovered an array of challenges, ranging from convincing the plans to cooperate to addressing the difficulties of generalizing findings based on a single plan’s data. Despite the limitations and complications, most researchers remain convinced that plan data is an irreplaceable resource. The need, therefore, is to work through the challenges of