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While the current system of care for treating rare but serious infectious diseases—which was developed in response to the 2014–2016 Ebola outbreak—provides an important foundation, a number of issues remain. In particular, a system of care must be able to sustain capacity and capabilities, manage the distribution of needed resources, and meet high demand for services. In this report, RAND researchers consider the need to strengthen the current system of care, discuss potential opportunities, and identify key financial considerations for the sustainability of the system. This research suggests that the United States may benefit from a strengthened or more formalized system of care for rare but serious infectious diseases. The authors identify several opportunities to strengthen the current system of care, including enhancing or building upon the three tiers of acute care facilities that were established during the Ebola outbreak of 2014–2016, developing a brain trust of clinicians and others who can provide advice to health care providers, using mobile teams, and enhancing air and ground systems for safely transferring infected patients. The authors also lay the groundwork for future discussions around key financial considerations to ensure the sustainability of a system of care for rare but serious infectious diseases.

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This report was initially published in 2019; this update was published in 2021 and includes clarification on RAND's definition of clean procedures. In July 2019, as part of a contract with the Centers for Medicare & Medicaid Services (CMS), the RAND Corporation published three complementary reports related to post-operative visits bundled into Medicare payments for many procedures. The reports build on a new CMS requirement that some practitioners report on when bundled post-operative visits occur using a no-pay claim. CMS invited comments on these reports in the calendar year 2020 Physician Fee Schedule Proposed Rule. Although some organizations supported CMS's efforts to collect data on post-operative visits and the related RAND reports, others expressed concerns about CMS's claims-based data collection and the content of the reports. In this follow-up report, RAND researchers respond to those criticisms. The authors remain confident in their main conclusion that fewer post-operative visits were provided than expected, leading to Medicare overpayment for some procedures and underpayment for nonprocedure services, such as office visits. They recommend that CMS consider revaluing procedures with bundled post-operative visits in consideration of the newly available data on the number of post-operative visits actually provided to patients.

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Alzheimer's disease (AD) is a chronic neurodegenerative disorder that leads to cognitive and functional decline, dementia, and premature death. Similar to other aging societies, Canada faces an increasing burden of this disease on patients and their caregivers, as well as on health care and long-term care resources. The majority of disease-modifying therapies being studied in current trials target early stages of the disease — when there are symptoms of memory loss and cognitive but not functional decline, also described as mild cognitive impairment (MCI) — or even earlier, before symptoms manifest. The aim of these therapies is to delay or prevent progression of early-stage AD to Alzheimer's dementia. The possibility of a future AD–modifying therapy for early stages of the disease has significant implications for health care delivery systems in terms of diagnosing and treating a large population. Following the authors' earlier work in the United States and Europe, they draw on publicly available data and expert insights to refine a simulation model that quantifies the capacity of the Canadian health care system to diagnose and treat people with early-stage AD. The report presents the authors' conceptual framework, simulation model, and projections. They discuss the design of the model and show historical and projected capacity trends that affect diagnosis and treatment and show the impact of capacity constraints on wait lists, waiting times, and the number of people progressing from MCI due to AD to Alzheimer's dementia.

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This report presents the results of a congressionally mandated, independent assessment of federally funded health services research (HSR) and primary care research (PCR) spanning the U.S. Department of Health and Human Services (HHS) and U.S. Department of Veterans Affairs (VA) from FYs 2012 to 2018. Through technical expert panels, stakeholder interviews, and a systematic environmental scan of research grants and contracts funded by HHS and the VA, the authors characterize the distinct contributions of agencies in these departments to the federal HSR and PCR enterprise. The authors also identify opportunities to improve detection and coordination of overlap in agency research portfolios, the impacts of HSR and PCR and how they cumulate across research portfolios, and gaps in research funding, methods, and dissemination. The authors offer recommendations to maximize the outcomes and value of future investments in federal HSR and PCR to better guide and serve the needs of a complex and rapidly changing U.S. health care system.