Selected Publications


Covered California: A Progress Report

by Richard M. Scheffler and Jessica Foster, January 31, 2014

In its first several months of open enrollment, Covered California despite its challenges has been a bright spot among state health insurance Exchanges created under the Affordable Care Act. About 23% of national enrollments in 2013 came from California. More than 1.4 million California residents have completed Covered California applications, more than 625,000 people have enrolled in subsidized or unsubsidized health plans, and more than 1.2 million are expected to be newly enrolled in Medi-Cal. Though it experienced a slow start in October, Covered California by the end of the year had surpassed its enrollment goal for the first half of open enrollment. This report provides a summary of the Covered California rollout, including a breakdown of application and enrollment trends, plan affordability and cost estimations, and questions and concerns for future analysis.


The Labor Market for Health Workers in Africa

by Agnes Soucat, Richard M. Scheffler, with Tedros Adhanom Ghebreyesus, Editors April 2013

Addressing the challenge of decent healthcare and education for lowincome families is critical to building the human capital that African countries need to sustain economic growth in the years ahead. Within this broad goal, specific challenges linked to Human Resources for Health (HRH) in Africa must be addressed to achieve stronger health systems, universal access to health services, and greater improvements in actual health outcomes. Today, it is widely recognized among Ministries of Health and development partners that the overall availability, distribution, and performance of health workers in Africa must be rapidly improved.


Accountable Care Organizations and Antitrust: Restructuring the Health Care Market

by Richard M. Scheffler, Stephen M. Shortell, Gail R. Wilensky, April 2012

On October 20, 2011, The Centers for Medicare & Medicaid Services (CMS) released the final rules for accountable care organizations (ACOs), a highly publicized initiative of the Affordable Care Act. Accountable care organizations are part of the Medicare Shared Savings Program, which is charged with improving quality of care for Medicare patients. The CMS provided incentives for ACOs to deliver high-quality care at reduced rates of spending by providing a more coordinated team approach to health care delivery.


CPAC Health Insurance Premium Rate Review Regulation: Case Studies to Inform California

by Brent D. Fulton, Richard M. Scheffler, April 2012

The objective of this study is to examine health insurance rate review regulation in Minnesota and Massachusetts, to inform California policy-makers regarding evidence on prior approval authority. This evidence is intended to inform California’s proposed change from file-and-use to prior-approval authority, based on AB 52 “Health Care Coverage: Rate Approval.” The methods included reviewing the literature on rate review regulation, interviewing officials from state agencies that approve rates, and interviewing senior actuaries and executives from health insurance carriers. Three interviews were conducted on Minnesota, three interviews were conducted on Massachusetts, and two interviews were conducted on California. Minnesota was selected because it has exercised its prior approval authority for at least 15 years, which provides a long period of time to analyze. Massachusetts was selected because it only began exercising its prior approval authority—technically prior review and disapproval authority—in April 2010, providing an example of a state just starting prior approval rate review


Accountable Care Organizations and Antitrust Conference Briefing Document

by Liora Bowers, Benjamin Handel, Emilio Varanini, Richard Scheffler, November 2011

This briefing paper serves as a background for the discussion that will take place during the “Accountable Care Organizations and Antitrust Conference” to be held on November 11, 2011 at UC Berkeley. With the October 20, 2011 release of the final rule creating the Medicare Shared Savings Program (MSSP), the Center for Medicare & Medicaid Services has paved the way for a national move towards coordinated delivery systems known as Accountable Care Organizations (ACOs). This paper provides background on government policy towards an accountable care delivery system, the balance between integration efficiencies and market power, and the goals and methods of antitrust analysis within healthcare delivery. It provides context for the issues of market definition, anticompetitive effects, antitrust evaluations, and contracting practices among healthcare providers. The paper concludes with a brief discussion of the California ban on the corporate practice of medicine.


California on the Eve of Mental Health Reform

by Tracy L. Finlayson, and the Nicholas C. Petris Center, November 2007

This report summarizes baseline information derived from a survey of county mental health directors about key organizational and budgetary characteristics in California’s county mental health departments.


The Global Market For ADHD Medications

by Richard M. Scheffler, Stephen P. Hinshaw, Sepideh Modrek, and Peter Levine, April 2007

Little is known about the global use and cost of medications for attention deficit hyperactivity disorder (ADHD). Global use of ADHD medications rose threefold from 1993 through 2003, whereas global spending (U.S. $2.4 billion in 2003) rose ninefold, adjusting for inflation. Per capita gross domestic product (GDP) robustly predicted use across countries, but the United States, Canada, and Australia showed significantly higher-than predicted use. Use and spending grew in both developed and developing countries, but spending growth was concentrated in developed countries, which adopted more costly, long-acting formulations.


Consumer-Driven Health Plans: New Developments and the Long Road Ahead

by Richard M. Scheffler and Mistique C. Felton, July 2006

We review new legislation covering such plans, analyze their penetration
in the marketplace, and predict their growth. We also use current information about plans that are compatible with Health Savings Accounts to compare them to traditional Preferred Provider Organization plans.


Hospital Service Changes in California: Trends, Community Impacts and Implications for Policy

by Nicholas C. Petris Center, April 2005

While hospital closures have generated a great deal of media attention and community concern, hospitals have other possible responses to the difficult financial environment. This report focuses on one such response. Are hospitals changing their inpatient service offerings in order to improve their financial health?


Measuring Mental Health in California’s Counties: What Can We Learn?

by Daniel Eisenberg, Nicole Bellows, Timmothy T. Brown, Richard M. Scheffler, January 2005

This report provides data and information on a series of mental health indicators that enable us to draw a picture of the mental health status throughout Califomia. These mental health indicators include the following: ‘doing less overall due to emotional problems,’ ‘doing one’s work less effectively due to depression or anxiety,’ ‘feeling downhearted and sad,’ ‘not feeling calm and peaceful,’ and ‘lacking energy.’


Is There A Doctor in the House? An Examination of the Physician Workforce in California

by Nicholas C. Petris Center, June 2004

This report presents important new findings about long-range trends in physician supply in California, as well as a snapshot of the state’s current physician workforce.


An analysis of the significant variation in psychostimulant use across the U.S.

by Farasat Bokhari, Rick Mayes, and Richard M. Scheffler, May 2004

Our analysis of the DEA’s ARCOS data shows that most of the significant variables correlated with ‘higher’ per-capita use of ADHD drugs serve as a proxy for county affluence. To provide a more complex, multivariate analysis of the area variation in psychostimulant use across the U.S.—which is the logical next step—requires obtaining price data to match the DEA’s quantity data.


California’s Closed Hospitals, 1995-2000

by Nicholas C. Petris Center, April 2001

We identified 23 closures, 11 of which took place at for-profit facilities. The vast majority took place in urban areas, and they were most often in southern California. More than half of the closed hospitals had fewer than 100 licensed beds. Ten of the closed hospitals had changed ownership within three years prior to their closure. All the closed hospitals claimed, and demonstrated, financial distress prior to closing.