RAND Corporation

About: RAND Corporation is a nonprofit organization based out in Santa Monica, California, United States. It is known for research contribution in the topics: Health care & Population. The organization has 9602 authors who have published 18570 publications receiving 744658 citations.

Prescription drug cost sharing: associations with medication and medical utilization and spending and health.

Abstract: ContextPrescription drugs are instrumental to managing and preventing chronic disease. Recent changes in US prescription drug cost sharing could affect access to them.ObjectiveTo synthesize published evidence on the associations among cost-sharing features of prescription drug benefits and use of prescription drugs, use of nonpharmaceutical services, and health outcomes.Data SourcesWe searched PubMed for studies published in English between 1985 and 2006.Study Selection and Data ExtractionAmong 923 articles found in the search, we identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n = 65), pharmacy benefit caps or monthly prescription limits (n = 11), formulary restrictions (n = 41), and reference pricing (n = 16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes.ResultsIncreased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention.ConclusionsPharmacy benefit design represents an important public health tool for improving patient treatment and adherence. While increased cost sharing is highly correlated with reductions in pharmacy use, the long-term consequences of benefit changes on health are still uncertain.

Meta-analysis: Pharmacologic Treatment of Obesity

Abstract: This meta-analysis of studies of pharmacologic treatment of obesity supports the American College of Physicians' clinical guideline in this issue Sibutramine, orlistat, phentermine, bupropion, and

A Comparative Review of Generic Quality-of-Life Instruments

Abstract: The assessment of health-related quality of life (HR-QOL) is an essential element of healthcare evaluation Hundreds of generic and specific HR-QOL instruments have been developed Generic HR-QOL instruments are designed to be applicable across a wide range of populations and interventions Specific HR-QOL measures are designed to be relevant to particular interventions or in certain subpopulations (eg individuals with rheumatoid arthritis) This review examines 7 generic HR-QOL instruments: (i) the Medical Outcomes Study 36-Item Short Form (SF-36) health survey; (ii) the Nottingham Health Profile (NHP); (iii) the Sickness Impact Profile (SIP); (iv) the Dartmouth Primary care Cooperative Information Project (COOP) Charts; (v) the Quality of Well-Being (QWB) Scale; (vi) the Health Utilities Index (HUI); and (vii) the EuroQol Instrument (EQ-5D) These instruments were selected because they are commonly used and/or cited in the English language literature The 6 characteristics of an instrument addressed by this review are: (i) conceptual and measurement model; (ii) reliability; (iii) validity; (iv) respondent and administrative burden; (v) alternative forms; and (vi) cultural and language adaptations Of the instruments reviewed, the SF-36 health survey is the most commonly used HR-QOL measure It was developed as a short-form measure of functioning and well-being in the Medical Outcomes Study The Dartmouth COOP Charts were designed to be used in everyday clinical practice to provide immediate feedback to clinicians about the health status of their patients The NHP was developed to reflect lay rather than professional perceptions of health The SIP was constructed as a measure of sickness in relation to impact on behaviour The QWB, HUI and EQ-5D are preference-based measures designed to summarise HR-QOL in a single number ranging from 0 to 1 We found that there are no uniformly ‘worst’or ‘best’ performing instruments The decision to use one over another, to use a combination of 2 or more, to use a profile and/or a preference-based measure or to use a generic measure along with a targeted measure will be driven by the purpose of the measurment In addition, the choice will depend on a variety of factors including the characteristics of the population (eg age, health status, language/culture) and the environment in which the measurement is undertaken (eg clinical trial, routine physician visit) We provide our summary of the level of evidence in the literature regarding each instrument’s characteristics based on the review criteria The potential user of these instruments should base their instrument selection decision on the characteristics that are most relevant to their particular HR-QOL measurment needs

Entry by Spinoffs

Abstract: Entry by spinoffs from incumbent firms is investigated for the laser industry. A model in which spinoffs exploit knowledge from their parents is constructed to explain the market conditions conducive to spinoffs, the types of firms that spawn spinoffs, and the relationship of spinoffs to their parents. The model is tested using detailed data on all laser entrants from the start of the industry through 1994. Our findings support the basic premise of the model that spinoffs inherit knowledge from their parents that shapes their nature at birth. Implications of our findings for organizational behavior, business strategy, entry and industry evolution, and technological change are discussed.

Individual differences in adult decision-making competence.

Abstract: The authors evaluated the reliability and validity of a set of 7 behavioral decision-making tasks, measuring different aspects of the decision-making process The tasks were administered to individuals from diverse populations Participants showed relatively consistent performance within and across the 7 tasks, which were then aggregated into an Adult Decision-Making Competence (A-DMC) index that showed good reliability The validity of the 7 tasks and of overall A-DMC emerges in significant relationships with measures of socioeconomic status, cognitive ability, and decision-making styles Participants who performed better on the A-DMC were less likely to report negative life events indicative of poor decision making, as measured by the Decision Outcomes Inventory Significant predictive validity remains when controlling for demographic measures, measures of cognitive ability, and constructive decision-making styles Thus, A-DMC appears to be a distinct construct relevant to adults' real-world decisions