Topics for Study

The Coverage Team at the Robert Wood Johnson Foundation seeks to reduce the number of uninsured Americans. Through this special solicitation, we are looking for proposals that would improve our understanding of the complex effects of rising health care costs.

To provide a clear focus for applicants to The New Connections Initiative, each programming team was asked to develop specific research projects or questions that would help inform their strategies and grant making. These specific questions are described below. Applicants are asked to submit proposals for one of the topics described below.

Please note that not all teams have research questions at this time and the detail provided below by each team varies according to each team's needs and interests. Finally, some of the research questions will be more suitable for Junior Investigators and other questions will be more suitable for Senior Consultants. Thus, applicants should consider the following guidelines.

Senior Consultants
Projects that are more qualitative and can yield recommendations and products for the team should be answered by a Senior Consultant. Senior Consultants should refer to the examples of activities, potential products and deliverables that could be conducted included on page 2 of the Letter of Invitation.

Junior Investigators
Questions that would be more suitable for secondary analysis should be answered by a Junior Investigator. When responding to this solicitation, Junior Investigators must indicate how they will incorporate the secondary datasets when responding to research questions. Junior Investigators should provide a description of the data and rationale for its appropriateness given the research question.  Junior Investigators are responsible for identifying and acquiring the dataset.

Research Questions:

Rising health care cost growth affects individuals, families, employers, providers, private insurers, public programs, and a host of other stakeholders.  Unrestrained cost growth makes the search for new insurance products and benefit packages more difficult, and ultimately contributes to the increasing number of the uninsured.  Rising costs can also have a significant impact on household finances, even for those with insurance.

This solicitation focuses on two important categories of health care cost growth: affordability and financial distress. Please note that the questions below are not an exhaustive list, but rather as suggestions that are meant to stimulate researchers to develop creative, policy-relevant projects, related to affordability and financial distress.

1. Affordability

Affordability touches on many issues, for example the cost of insurance (e.g., premiums), out-of-pocket (OOP) costs, and the cost of health care relative to income or assets.  In order for policy-makers to develop the most effective policies for controlling costs, while maintaining affordability of health care, we must consider how individuals and families from different racial and ethnic groups define affordability and cope with rising health care costs. 

Critical questions include:

• At what income threshold do individuals typically find a health insurance premium to be affordable?
• Should affordability measures be different for chronic versus acute conditions?
• What percentages of people have high OOP expenses persistently versus episodically?
• Should affordability be measured differently for those with persistently high costs?
• How does spending on premiums and OOP costs vary by health status and the presence of chronic conditions at different income levels?
• What motivates some people to purchase insurance coverage, while others at the same income level and age do not?
  
  
  

2. Financial distress

In addition to affordability, it is also important to better understand financial distress that stems from high health care costs.  The impact of high costs can be particularly acute following a significant medical event, even for those who are insured.  Of particular interest is whether the financial distress related to health care differs across racial and ethnic groups. 

Critical questions include:

• What financial or quality of life tradeoffs are individuals or families willing to make when considering the purchase of health insurance?
• What measures can be used to monitor financial distress (e.g., credit card debt, foregone purchases)?
• Is it possible to track distress longitudinally?
• Are there recurring patterns?
• Is financial distress caused by chronic illness or catastrophic events?