Publications

Health care costs consume a growing percent of the U.S. gross domestic product, and economic literature has demonstrated that ultimately individuals pay these costs, either through taxes, reduced wages, or direct out-of-pocket and premium payments. In a HCFO-funded study, researchers explored the distribution of the individual family’s financial burden from the combination of public and private health care spending.

An increasing number of patients are visiting retail clinics for simple acute conditions. Physicians worry that visits to retail clinics will interfere with primary care relationships.

Hall, a professor of law and public health in the Division of Public Health Sciences at Wake Forest University Medical School, is completing a qualitative investigation of employers’ use of the Massachusetts Connector in order to inform states and the federal government about best strategies for the design and operation of new small-group health insurance exchanges and market regulations.

Health care costs consume a growing percent of the U.S. gross domestic product and individuals pay all costs, either through taxes, reduced wages, or direct out-of-pocket and premium payments. In a recent HCFO-funded study, researchers explored the distribution of the individual family’s financial burden from the combination of public and private health care spending.

The private health plans that administer the Medicare drug benefit use various tools to encourage the use of generic drugs in order to lower total drug spending. Higher generic drug use also appears to encourage consumers to continue taking their medications.

As policymakers plan for major coverage gains under the Patient Protection and Affordable Care Act, there is increasing awareness of the groups that will be left out of health care reform.  Among these groups are undocumented immigrants, who are excluded from participation in exchanges, enrollment in the expanded Medicaid program, and other initiatives aimed at helping the uninsured gain coverage.

The stylized fact is that while private insurance has tended to innovate on the benefit design side of the insurance contract, Medicare has lead innovation on the payment side. Traditional or Fee-For-Service Medicare has produced many innovations in the payment for health care services, while private insurance has produced a series of benefit design innovations. This story misses one important example of Medicare benefit innovation: the creation of the Medicare hospice benefit.

Pharmaceuticals represent a rapidly growing area of health care expenditures. These rising costs have led many payers to implement prior authorization as one type of cost control policy.

Individuals and businesses across the country received checks from their health insurance companies this summer under a provision in the Patient Protection and Affordable Care Act that targets insurers’ use of premium dollars.  Minimum medical loss ratios (MLRs) require insurers to spend a certain percentage of premium revenue on health care claims and quality improvement activities. 

Effective in 2000, Medicare's Outpatient Prospective Payment System (OPPS) sets pre-determined reimbursement rates for hospital outpatient services, replacing the prior cost-based methods of reimbursement. Using Florida outpatient discharge data, the researchers studied the effect of OPPS on hospital outpatient volume.