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Introduction Since its passage in 2010, the Affordable Care Act (ACA) has introduced a series of health care financing and delivery reforms to expand coverage, invest in health care infrastructure, and implement changes to improve quality and costs. In 2014, the ACA’s coverage expansion began in Michigan through the launches…

NIHCR Research Brief No. 19

State leaders interested in reforming their health care systems face a dilemma. Every state’s health care system is utterly dependent on funding flows from federal health programs and subsidies in the federal tax system, but federal programs, in some cases, run counter to state political cultures and priorities. Section 1332…

JAMA Internal Medicine

There is broad consensus among physicians, hospital and health insurance leaders, and policy makers to reform payment to health care providers so as to reduce the role of fee for service, which encourages high volume, and instead to use systems that reward better patient outcomes, such as bundled payments for…

NIHCR Research Brief No. 13

Amid concerns about primary care provider shortages, especially in light of health reform coverage expansions in 2014, some believe that revising state laws governing nurse practitioners’ (NP) scope of practice is a way to increase primary care capacity. State laws vary widely in the level of physician oversight required for…

NIHCR Research Brief No. 11

Almost 60 percent of Americans younger than 65 obtain health insurance through an employer, but the proportion is steadily declining, largely because of rising health care costs. The decline in employer coverage has disproportionately affected low-wage workers and those in small firms. Amid concerns that national health reform will hasten…

NIHCR Policy Analysis No. 8

From requirements that insurers cover prescription drugs to services of chiropractors, state health benefit mandates have a long and controversial history. Critics contend mandates drive up health insurance costs, while advocates assert they ensure access to important care. The 2010 national health reform law requires states to pay for mandated…

NIHCR Policy Analysis No. 7

While there is little debate about a growing primary care workforce shortage in the United States, precise estimates of current and projected need vary. A secondary problem contributing to addressing capacity shortfalls is that the distribution of primary care practitioners often is mismatched with patient needs. For example, patients in…

Congressional Testimony

Statement of Paul B. Ginsburg, Ph.D. President,Center for Studying Health System Change Research Director, National Institute for Health Care Reform (NIHCR) Before the U.S. House of Representatives Ways and Means Committee, Subcommittee on Health Hearing on "Health Care Industry Consolidation" Chairman Herger, Congressman Stark and members of the Subcommittee, thank…

Community Report No. 9

In October 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Syracuse metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care leaders,…

Community Report No. 8

In July 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Phoenix metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders,…

NIHCR Research Brief No. 5

As policy makers try to jumpstart health information technology (HIT) adoption and use in small physician practices, lessons from independent practice associations (IPAs)—networks of small medical practices—can offer guidance about overcoming barriers to HIT adoption and use, according to a new qualitative study by the Center for Studying Health System…

NIHCR Research Brief No. 4

Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, according to a new qualitative research study from the Center…

Community Report No. 5

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Little Rock metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care…

Community Report No. 4

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the northern New Jersey metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health…

Community Report No. 1

WASHINGTON , DC—Massachusetts’ 2006 landmark health reform law has reverberated throughout the Boston health care market as providers, insurers, employers and consumers adjust and adapt to a post-reform world of nearly universal health insurance coverage, according to a new Community Report released today by the Center for Studying Health System…

NIHCR Policy Analysis No. 1

As consensus grows that true reform of the U.S. health care system requires a move away from fee-for-service payments, designing alternative payment methods, including episode-based payments, has emerged as a high priority for policy makers. An episode-based payment approach would essentially bundle payment for some or all services delivered to…

HSC Policy Analysis No. 2

Adequate and affordable insurance coverage is a particular concern for near-elderly Americans—those aged 55 to 64—because this group is at greater risk for serious health problems and high health care costs than younger adults. Moreover, because of their age and increased likelihood of health problems, the near elderly without access…

NIHCR Policy Analysis No. 10

Outpatient prescription drugs account for about 10 percent—$259 billion in 2010—of total U.S. health spending. Expiring patents on many of the most commonly prescribed drugs have helped slow the rate of spending growth in recent years, but drug spending is likely to accelerate again as new drugs come to market.…

NIHCR Policy Analysis No. 9

Although U.S. health care spending growth has slowed in recent years, health spending continues to outpace growth of the overall economy and workers’ wages. There are clear signs that rising prices paid to medical providers—especially for hospital care—play a significant role in rising premiums for privately insured people. Over the…

NIHCR Policy Analysis No. 3

Many believe the renewed U.S. public investment in determining what treatments work best for which patients in real-world settings—known as comparative effectiveness research (CER)—will improve patient care by strengthening the evidence base for medical decisions. A major goal of CER is to encourage the use of effective therapies and discourage…

NIHCR Policy Analysis No. 3

WASHINGTON, D.C. –– Determining what treatments work best for which patients in real–world settings—known as comparative effectiveness research (CER)—can help foster beneficial medical innovation, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR). Written by researchers at the Center for Studying Health…

Community Report No. 2

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Cleveland metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…