Current and Future Research Projects

HCCI's Health Care Cost and Utilization Reports are just the starting point for many independent research studies focused on health care costs in the United States. The following are some of the studies currently underway, by independent researchers, using the Institute's claims-based data, and by HCCI:

THE PRICE AIN'T RIGHT? HOSPITAL PRICES AND HEALTH SPENDING ON THE PRIVATELY INSURED. This study by researchers at Carnegie Mellon University (Martin Gaynor), Yale University (Zack Cooper), and the London School of Economics (John Van Reenen) examines the variation in health spending and in hospitals’ transaction prices.

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OVERCOMING BARRIERS TO A RESEARCH-READY NATIONAL COMMERCIAL CLAIMS DATABASE. This study reviews some of the barriers to making health care data accessible to researchers and policy makers, including issues of data security and data sharing. The article, by David Newman, Carolina-Nicole Herrera, and Stephen T. Parente, was published in the American Journal of Managed Care.

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HEALTH SPENDING SLOWDOWN AND THE ECONOMIC DOWNTURN. This study by Northwestern University researchers, David Dranove, Craig Garthwaite, and Chris Ody, examines the effect of the economic slowdown on health care spending for the privately-insured, working-age population. The study was published in the August 2014 issue of Health Affairs.

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HEALTH CARE COSTS FROM BIRTH TO DEATH. This study examines the impact of age and gender on overall and retiree health costs, Medicare spending, and spending on disease over 2002-2010. The study, by Dale Yamamoto, is supported by the Society of Actuaries.

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TRENDS UNDERLYING EMPLOYER-SPONSORED HEALTH INSURANCE GROWTH. This study, published in the October 2013 issue of Health Affairs, examines the change in health care spending trends during and immediately after the recession for people under age sixty-five and enrolled in employer-sponsored health insurance. The study, by Carolina-Nicole Herrera, Martin Gaynor, David Newman, Stephen T. Parente, and Robert J. Town, was performed using the Health Care Cost Institute’s Aggregated ESI Cost and Utilization Dataset (2007-2011).

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AN ANALYSIS OF HEALTH CARE SPENDING BROKEN DOWN BY CLINICAL EPISODES. Zack Cooper (Yale University) and Michael Chernew (Harvard University) are grouping the HCCI claims data by disease and analyzing the levels and growth in health care spending across diseases. The project is aimed at determining whether health care spending is growing uniformly across different disease groups or whether spending growth is concentrated around a subset of conditions. Their project is sponsored by the Commonwealth Fund.

INFLUENCE OF NEIGHBORHOOD ENVIRONMENTS ON HEALTH UTILIZATION AND COSTS. This multi-disciplinary team led by Jeannette Ickovics (Yale University) is determining the influence of residential environments on health utilization and costs. Her team is focusing on health conditions that are driving health care costs in three domains: (1) prenatal care and adverse birth outcomes; (2) chronic disease tied to obesity including cardiovascular disease, diabetes, and cancer; and (3) depression, substance use, and other mental health conditions.

THE EFFECT OF HEALTH CARE DELIVERY SYSTEMS ON PRICES, SPENDING, AND QUALITY. Kate Bundorf, Laurence Baker, and Dan Kessler of Stanford University are estimating the effects of hospital-physician integration on prices, quality, and spending. The team will identify how different ways of organizing physician groups affect medical productivity. They will test whether the effects of integration vary in different types of markets and for different types of patients.

IMPACT OF PARITY LEGISLATION ON USE AND COSTS OF ORAL CANCER MEDICATIONS. Stacie Dusetzina (University of North Carolina) and Nancy Keating (Harvard), along with collaborators from both institutions, are quantifying the impact of state-level oral cancer parity legislation on medication use and health care spending. Their project will provide valuable information to states regarding the impact of parity to date and could be used to inform the development of new state and federal health insurance coverage policies that increase patient access to clinically-appropriate cancer therapies.

DETERMINANTS OF VARIATION IN HOSPITAL PRICING. Researchers at Carnegie Mellon University (Martin Gaynor) and the London School of Economics (Zack Cooper and John Van Reenen) are studying: 1) variation in hospital pricing and the extent to which more expensive hospitals provide better care, 2) the relative contribution of rising prices to rising hospital spending, 3) the influence of hospital market structure on the prices hospitals charge for care, and 4) whether hospitals cost shift, i.e., raise the prices they charge to private patients as publicly funded patients' reimbursement rates fall. This study will be the first to examine these questions using national data on actual payments.

MEDICAL PRODUCTIVITY INDEX. Stephen T. Parente of the University of Minnesota is investigating whether price or quantity is the greater factor driving costs for the privately insured. Economists have stated for decades that the increase in US health insurance expenditures has been driven by an aging population and new medical technologies. However, there has been little research to show what is driving health care costs at a procedural level. His team is studying (1) whether increases in the reimbursement or quantity delivered per procedure are the leading factors explaining health care cost growth, (2) whether reimbursement and quantity differ between payment models, and (3) whether there are specific technologies or medical conditions where price differences consistently dominate quantity differences, regardless of payment model.

CONSUMER RESPONSES TO COST SHARING. Jon Gruber of the Massachusetts Institute of Technology and colleagues at the National Bureau of Economic Research are conducting a study on insured responses to changes in health insurance cost-sharing requirements. They will be examining how different cost sharing structures impact health care utilization as well as the tradeoffs made by consumers between care and cost.

PROVIDER PRACTICE PATTERNS. A team led by Amy Finkelstein of the Massachusetts Institute of Technology is studying the determinants of high spending practice patterns from a new perspective, focusing on the way providers and patients affect health care spending decisions.

DETERMINANTS OF AND VARIATION IN HEALTH CARE PROVIDERS' PRICING. Researchers at Yale University (Zack Cooper), Carnegie Mellon University (Martin Gaynor), and the London School of Economics (John Van Reenen) are studying a number of questions around relationships between health care providers' pricing, spending, and quality of care. This study will be among the first to examine these questions using national, multi-payer claims data.

DIALYSIS MARKET CONSOLIDATION. Leemore Dafny and Christopher Ody of the Kellogg School of Management, together with David Cutler of Harvard University, are investigating the growth and consolidation of the dialysis industry. Although the vast majority of dialysis patients are insured by Medicare, privately-insured dialysis patients generate a disproportionate share of profits. Her team is exploring whether dialysis provider consolidation has led to price increases for privately-insured patients.

PROVIDER INTEGRATION. This project will be completed as a doctoral dissertation by Michael Punzalan and advised by Robert Town, both of the University of Pennsylvania.

BETTER UNDERSTAND CHANGES IN THE UTILIZATION OF, AND SPENDING ON, PHYSICIAN SERVICES. A team of researchers from the Office of the Actuary led by Devin Stone and Hudson Osgood are using HCCI data to gain a deeper understanding of the trends that drive use and spending on physician services. This study will explore trends in physician spending by exploring changes in price and utilization, including quantifying how much recent trends in physician spending can be explained through a variety of factors.

For more information on research projects affiliated with HCCI's Academic Research Partnership Program, please visit our academic research partnerships page.

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