Mission Statement
The mission of the National Institute for Health Care Reform (NIHCR) is to conduct high-quality, objective research and policy analyses of the organization, financing and delivery of health care in the United States. The Institute works to identify key health policy issues, identify policy options, and assess the advantages and disadvantages of policy options to help inform policy makers and other decision makers about how to expand access to high-quality, affordable health care to all Americans.
What's New
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Upcoding Linked to up to Two-Thirds of Growth in Highest-Intensity Hospital Discharges in Five States, 2011–19
Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code patients to a higher complexity than is appropriate, whereas in other instances, upcoding can accurately reflect patient acuity. We… -
Improving Access to Primary Care for Underserved Populations: A Review of Findings from Five Case Studies and Recommendations
Strong, accessible primary care improves population health outcomes. It preventsillness and death, and is associated with a reduction in health disparities. TheUnited States falls short on many indicators that demonstrate the strength of anation’s primary care system, and underserved populations in the country experiencesignificant barriers to accessing primary care. In… -
Household Health Care Payments Under Rate Setting, Spending Growth Target, and Single-Payer Policies
Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households. The objective of this study is to estimate the distribution of household health care payments across income under health care reform policies. Cross-sectional study with microsimulation used nationally representative data of the… -
Patterns and Drivers of Medicare Advantage Enrollment Growth, 2017–2023
In 2024, over half of Medicare enrollees received coverage through MedicareAdvantage (MA) plans (Freed et al 2024a). MA has grown rapidly in the past decade,from about a third of Medicare enrollment in 2015 to over half in 2024. The growth ofMA has important implications for the financial sustainability of the… -
Assessing the Feasibility and Likelihood of Policy Options to Lower Specialty Drug Costs
Specialty drugs are high-cost medications often used to treat complex chronic conditions. Even with insurance coverage, patients may face very high out-of-pocket costs, which in turn may restrict access. While the Inflation Reduction Act of 2022 included policies designed to reduce specialty drug costs, relatively few policies have been enacted… -
The Effectiveness of Policies to Improve Primary Care Access for Underserved Populations: An Assessment of the Literature
Primary care is a critical tool to prevent illness and death and to improve equitable distribution of health in populations. However, access to this important source of care is lacking, especially for many underresourced groups, such as communities of color and in rural areas. In 1981, researchers Roy Penchansky and… -
The Effects of Medicare Buy-In Policies for Older Adults on Health Insurance Coverage and Health Care Spending
A Medicare buy-in program would allow qualifying individuals currently ineligible for Medicare to purchase a Medicare-like health insurance plan. The buy-in would be administered as a distinct program but could take advantage of Medicare's premium structure, benefit design, or provider payment rates (NASI 2020). After comprehensive health reform failed to… -
Sine Qua Non: A Healthy Nation Requires Real Budget Constraints in All Government Health Programs
Every government health program should operate under the same budget constraint that applies to other government programs. Failure to do so represents bad budgeting and economic, social, and health policy; redistributes income in perverse ways; and makes health care allocation extremely inefficient. No excuses for this failure to act—largely centered… -
Strategies to Advance Insulin Affordability in the United States
How did insulin become unaffordable for millions of Americans and what can policymakers do about it? Altarum's new report, Strategies to Advance Insulin Affordability in the United States, answers this question and provides a detailed set of policy proposals to make insulins affordable to patients and payers through federal regulation, market… -
Private Health Plans Pay Hospitals Much Higher Prices in Indiana than in Michigan: Explanations and Implications
Premiums for employer-sponsored health insurance have been growing at a rate well above growth in wages or overall inflation. Excess premium growth, in turn, suppresses wage growth and creates financial hardship for the middle class while, at the same time, reducing government tax revenues and employment. Spending on hospital care…