The National Institute for Health Care Reform (NIHCR) contracted with the Center for Studying Health System Change (HSC) between 2009 and 2013 to conduct health policy research and analyses to improve the organization, financing and delivery of health care in the United States. HSC ceased operations on Dec. 31, 2013, after merging with Mathematica Policy Research, which assumed the HSC contract to complete NIHCR projects. Beginning in 2014, NIHCR has contracted with Altarum Institute’s Center for Sustainable Health Spending and others, with a focus on research to improve health in Detroit.

Chapin White

Documents & Publications

Title	Date
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…	May 12, 2020
Limiting Tax Breaks for Employer-Sponsored Health Insurance: Cadillac Tax vs. Capping the Tax Exclusion NIHCR Research Brief No. 20 Among the most expensive "but nearly invisible" federal expenditures is the roughly $250 billion1 annual tax break for employer-sponsored health insurance. Under current law, the value of both employer and most employee contributions for health insurance are excluded from employee federal income tax and employer and employee payroll taxes. While…	October 8, 2015
Health Reform 2.0: Alternate State Waiver Paths Under the Affordable Care Act 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…	September 24, 2015
Reference Pricing: A Small Piece of the Health Care Price and Quality Puzzle NIHCR Research Brief No. 18 As purchasers seek strategies to reduce high health care provider prices, interest in reference pricing—or capping payment for a particular medical service—has grown significantly. However, potential savings to health plans and purchasers from reference pricing for medical services are modest, according to a new analysis by researchers at the former…	October 9, 2014
Location, Location, Location: Hospital Outpatient Prices Much Higher than Community Settings for Identical Services NIHCR Research Brief No. 16 Average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price for identical services provided in a physician’s office or other community-based setting, according to a study by researchers at the former Center for Studying Health System Change (HSC). Using private insurance claims data…	June 26, 2014
Cutting Medicare Hospital Prices Leads to a Spillover Reduction in Hospital Discharges for the Nonelderly Health Services Research Objective. To measure spillover effects of Medicare inpatient hospital prices on the nonelderly (under age 65). Primary Data Sources. Healthcare Cost and Utilization Project State Inpatient Databases (10 states, 1995-2009) and Medicare Hospital Cost Reports. Study Design. Outcomes include nonelderly discharges, length of stay and case mix, staffed hospital bed-days,…	May 21, 2014
Inpatient Hospital Prices Drive Spending Variation for Episodes of Care for Privately Insured Patients NIHCR Research Brief No. 14 When including all care related to a hospitalization—for example, a knee or hip replacement—the price of the initial inpatient stay explains almost all of the wide variation from hospital to hospital in spending on so-called episodes of care, according to a study by researchers at the former Center for Studying…	February 27, 2014
Understanding Differences Between High- and Low-Price Hospitals: Implications for Efforts to Rein In Costs Health Affairs, Web First Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power. This study used private insurance claims data to identify…	January 29, 2014
How Do Hospitals Cope with Sustained Slow Growth in Medicare Prices? Health Services Research, Early View Objective. To estimate the effects of changes in Medicare inpatient hospital prices on hospitals’ overall revenues, operating expenses, profits, assets, and staffing. Primary Data Source. Medicare hospital cost reports (1996–2009). Study Design. For each hospital, we quantify the year-to-year price impacts from changes in the Medicare payment formula.We use cumulative simulated price impacts as…	October 3, 2013
High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power HSC Research Brief No. 27 Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients are much higher than Medicare payment rates and vary widely across and within markets, according to a study by the Center for Studying Health System Change (HSC) based on claims data for about 590,000 active and retired nonelderly…	September 4, 2013
Contrary to Cost-Shifting Theory, Lower Medicare Hospital Payment Rates for Inpatient Care Lead to Lower Private Payment Rates Health Affairs, Vol. 32, No. 5 Many policy makers believe that when Medicare constrains its payment rates for hospital inpatient care, private insurers end up paying higher rates as a result. I tested this “cost-shifting” theory using a unique new data set that combines MarketScan private claims data with Medicare hospital cost reports. Contrary to the…	May 6, 2013
Addressing Hospital Pricing Leverage through Regulation: State Rate Setting 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…	May 8, 2012
Great Recession Accelerated Long-Term Decline of Employer Health Coverage NIHCR Research Brief No. 8 Between 2007 and 2010, the share of children and working-age adults in the United States with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent, according to a new national study by the Center for Studying Health System Change (HSC). The key factor driving the sharp…	March 15, 2012
State Benefit Mandates and National Health Reform 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…	February 29, 2012
Health Status and Hospital Prices Key to Regional Variation in Private Health Care Spending NIHCR Research Brief No. 7 Differences in health status explain much of the regional variation in spending for privately insured people, but differences in provider prices—especially for hospital care—also play a key role, according to a study by the Center for Studying Health System Change (HSC) based on claims data for active and retired nonelderly…	February 15, 2012
Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-offs NIHCR Policy Analysis No. 6 Under national health reform, new federal rules will govern the nongroup and small-group health insurance markets, including a requirement for state-based health insurance exchanges, or marketplaces, to be operational by Jan. 1, 2014. Between now and then, both the federal government and states must make key decisions about the design…	November 9, 2011
Geographic Variation in Health Care: Changing Policy Directions NIHCR Policy Analysis No. 4 Dating back more than 40 years, a large body of research has identified wide geographic variation in fee-for-service Medicare spending and service utilization. A major early conclusion of geographic variation research was that care is provided much more efficiently in some areas of the United States than in others, with…	April 12, 2011