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Open research questions in Healthcare Policy and Management

115 unresolved questions extracted from the limitations and future-work sections of 3,806 Healthcare Policy and Management papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • The authors acknowledge this analysis has limitations. First, research suggests that perhaps only one or two of every 10 RDs actually has a specific ICD-10 code.15 Thus, this analysis can be most accurately described as examining characteristics of Medicaid enrollees with a diagnosed and known RD. In reality, the number of Americans with Medicaid coverage who have a RD is likely to be higher than reported in the dataset. Second, claims are used as a proxy for the presence of a RD without any further clinical diagnostic validation, such as cross-referencing claims against patient electronic health record (EHR) data to confirm the diagnosis. By relying only on claims data, we are unable to discern a differential (i.e., unconfirmed) diagnosis from a confirmed diagnosis.16 Third, the relationship between a disease concept and a single ICD-10 code is not always one-to-one. This relationship can vary because of overlapping symptoms, varying disease stages, or coding conventions. Finally, the state of Medicaid data is imperfect and constantly evolving. Most importantly, the COVID-19 public health emergency and Medicaid-related provisions did not expire until spring 2023, and Medicaid enrollment during that period was consequently higher.17 And additional changes are on the horizon as OBBBA ushers in sweeping and novel changes to state Medicaid programs.

    Medicaid Service Utilization by Beneficiaries with Rare Diseases · 2026 · DOI

  • This report has limitations. Some are particular to our analysis, while some are inherent in any effort to assess overall health system performance. No international comparative report can encapsulate every aspect of a complex health care system. As described above, our sensitivity analyses suggests that comparative country rankings in the middle of the distribution (but not the extremes) are somewhat sensitive to small changes in the data or indicators included in the analysis, but these changes do not move these countries out of the middle group of the distribution. Second, despite improvements in recent years, standardized cross-national data on health system performance are limited. The Commonwealth Fund surveys offer unique and detailed data on the experiences of patients and primary care physicians but do not capture important dimensions that might be obtained from medical records or administrative data. Furthermore, patients’ and physicians’ assessments might be affected by their expectations, which could differ by country and culture. Augmenting the survey data with standardized data from other international sources adds to our ability to evaluate population health and disease-specific outcomes, particularly regarding the impact of the COVID-19 pandemic. Some topics, such as hospital care and mental health care, are not well covered by currently available international data. Furthermore, it is very difficult to characterize performance of such institutions through surveys because no single individual has a full perspective on that performance, and surveying multiple respondents from representative samples of institutions is logistically challenging and extremely costly. Third, we base our assessment of overall health system performance on five domains — access to care, care process, administrative efficiency, equity, and health outcomes — which we weight equally in order to calculate each country’s overall performance score. We recognize that there is a limitation around care process in that we do not measure quality for acute care conditions, especially in hospitals. Work related to this is underway but would always suffer from limits of generalizability because of limits of studying every conceivable diagnosis. We also recognize that other elements of system performance, such as innovative potential or public health preparedness, are important. We continue to seek feasible standardized indicators to measure other domains. COVID results, included for the first time in this report, capture some aspects of public health preparedness and system resilience, but are also limited in many respects. Fourth, in defining the five domains, we recognize that some measures could plausibly fit within several domains. The assignment of measures to domains was reviewed extensively internally and externally with an expert advisory panel.

    Sufficient and Efficient Spending on Primary Care Benefits National Health and Health Systems · 2026 · DOI

  • Several limitations must be considered First, the cross-sectional design allows only the identifi- cation of associations and perceptions; no causal infer- ence can be made regarding whether DRG incentives directly produce moral distress. Second, the response rate of 19% raises the possibility of self-selection and non-response bias, although this range is comparable to many physician surveys. Respondents with particularly strong views regarding the DRG system may have been more likely to participate. However, this response rate is comparable to many surveys among hospital physicians and managers. Third, ethical tension may arise not only from DRG incentives but also from the broader reality of scarce resources and increasing demands on hospi- tal systems. Therefore, our findings should not be inter- preted as evidence that DRG-based reimbursement is inherently unethical or directly causes reduced quality of care. Rather, they reflect perceived ethical pressure under DRG conditions, which may also be shaped by staffing constraints, leadership culture, regional structures, and broader resource scarcity. Fourth, although the survey included both physicians and managerial stakeholders, other professional groups were either underrepresented or excluded from subgroup analysis in the final models. This limits the ability to characterize the full ethical eco- system of hospital care delivery. Fifth, all measures are self-reported. Social desirability bias cannot be ruled out, especially in domains touching on “gaming,” early dis- charge, or risk selection. We did not independently ver- ify reported practices against administrative data. Sixth, while missingness in key variables was low (each < 5%), we relied on pairwise deletion and complete-case analy- sis. This may introduce minor analytic bias, especially in subgroup comparisons. The ethical tensions observed in this study may not arise exclusively from DRG reim- bursement but also from the broader reality of scarce resources in modern hospital systems. Because most respondents had not worked under the pre-2003 reim- bursement system, findings reflect current perceptions of DRG-related incentives rather than direct comparisons between pre-DRG and post-DRG condition. The word- ing of some survey items may have emphasized economic pressure associated with DRGs and could therefore have influenced responses. Although the questionnaire was pilot-tested, framing effects and acquiescence bias can- not be excluded. The predominance of male respondents reflects the current gender distribution in senior hospital leadership positions in Germany and may limit generaliz- ability to more gender-balanced healthcare settings.

    Ethical perceptions of DRG-based hospital financing among physicians and hospital managers in Germany: a cross-sectional survey · 2026 · DOI

  • Future research should examine how emerging technologies, including artificial intelligence in clinical decision- making, interact with these cultural mechanisms, amplifying or trans- forming classificatory hierarchies depending on the institutional cultures in which they are embedded (31).

    Knowing equity, doing equity: healthcare cultures and why reforms stall in everyday care · 2026 · DOI

  • Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care.

    Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services · 2025 · DOI

  • Policy Points Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services in Medicaid, little is known about MCO strategies to overcome critical access barriers and the factors influencing these strategies.

    Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services · 2025 · DOI

  • Interest and activity are expanding to Medicaid; however, their experiences and approaches to VBP arrangements for medical products are not well characterized.

    Experiences and Interest in Value‐Based Payment Arrangements for Medical Products Among Medicaid Agencies: An Exploratory Analysis · 2024 · DOI

  • As the COVID-19 pandemic increases the number of critically ill patients flowing into hospitals, hospitals in many countries are facing a growing shortage of vital equipment and supplies, presenting ethical dilemmas to physicians who have to decide which COVID-19 patients to prioritize when resources are scarce.

    Who Gets the Ventilator? Moral Decision Making Regarding Medical Resource Allocation in a Pandemic · 2020 · DOI

  • Importance: US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time.

    US Health Care Spending by Payer and Health Condition, 1996-2016 · 2020 · DOI

  • OBJECTIVE: Medicare's Hospital Readmissions Reduction Program (HRRP) does not account for social risk factors in risk adjustment, and this may lead the program to unfairly penalize safety-net hospitals.

    Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program · 2019 · DOI

  • Although nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known about the prices paid to hospitals by the private insurers that administer such plans.

    How Do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare With Medicare Fee-for-Service Prices? · 2018 · DOI

  • CONTEXT: Expanding Medicaid to previously uninsured adults has been shown to increase detection and reduce the prevalence of depression, but the ways that Medicaid affects mental health care, how effectively it addresses unmet needs, and how those effects differ for those with and without a history of depression remain unclear.

    The Effect of Medicaid on Management of Depression: Evidence From the Oregon Health Insurance Experiment · 2018 · DOI

  • From a strictly legal perspective, Olmstead's impact has been limited by the fact that the ADA does not require fundamental alterations in public programs.

    Using the Courts to Shape Medicaid Policy: <i>Olmstead V. L.c. by Zimring</i> and Its Community Integration Legacy · 2016 · DOI

  • Future changes in rates of inpatient hospitalization and ED use among the newly insured could vary widely, based on descriptive findings and inferences from the quasi-experimental literature.

    How Might the Affordable Care Act's Coverage Expansion Provisions Influence Demand for Medical Care? · 2014 · DOI

  • Policy changes in Medicare that reform the way that beneficiaries are charged for MA plan membership are warranted to move more beneficiaries into MA.

    How Successful Is Medicare Advantage? · 2014 · DOI

  • Rather than complementing social health insurance and helping the country to achieve universal coverage, granting public hospitals greater autonomy that mimics the private sector may indeed undermine the legitimacy and sustainability of social health insurance as health care costs escalate and higher quality of care remains elusive.

    Does Autonomization of Public Hospitals and Exposure to Market Pressure Complement or Debilitate Social Health Insurance Systems? Evidence from a Low-Income Country · 2014 · DOI

  • Yet, little is known about how the reform may have affected the demand for and the financial performance of safety net hospitals (SNH), the primary source of care for such populations before the reform.

    The Health of Safety Net Hospitals following Massachusetts Health Care Reform: Changes in Volume, Revenue, Costs, and Operating Margins from 2006 to 2009 · 2013 · DOI

  • BACKGROUND: The Accountable Care Organization (ACO) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation.

    Accountable Care Organizations in the United States: Market and Demographic Factors Associated with Formation · 2013 · DOI

  • CONCLUSIONS: Although there were confounding variables, and causality could not be determined, these data are consistent with the hypothesis that Colorado's 1992 legislative efforts to reform workers compensation law using the biopsychosocial model worked as intended to provide good care while controlling costs.

    Biopsychosocial law, health care reform, and the control of medical inflation in Colorado. · 2012 · DOI

  • Whether this reporting requirement is merely onerous and costly for those associated with primary payers, or an overzealous requirement that will prove too much for CMS to enforce remains to be seen.

    Want to Avoid Medicare? Fat Chance!: MMSEA Reporting Requirements and Their Impact on the Resolution of the Claims of Medicare Beneficiaries · 2011

  • Though the health insurance mandate does not go into effect until 2014, it has already faced numerous constitutional challenges in district and circuit courts, with entirely inconsistent results.

    Religious Exemptions to the PPACA's Health Insurance Mandate · 2011 · DOI

  • Retiree health plans for teachers vary widely across the country, with some states paying the full premium for the retired teacher while other states require that the retiree pay 100 percent of the premium.

    Retiree Health Plans for Public School Teachers after GASB 43 and 45 · 2010 · DOI

  • States' choices of how much of the uncovered burden of prescription drug costs is left to near-poor elderly and disabled residents continues to vary widely even though Medicare began to provide pharmaceutical coverage beginning January 2006.

    Geography Still Dictates Rx Coverage for Many Near-Poor Seniors and Disabled Persons · 2007 · DOI

  • The next two or three years are critical for the viability of PHI: both families and states will face increasing difficulties in paying the insurance premium; health infrastructure and staff are insufficient to guarantee the health package services; and the private service contracting will further strain state health ministries' ability to strengthen service supply.

    Health System Reform in Mexico: A Critical Review · 2007 · DOI

  • STUDY DESIGN: Health plan choices, including the Medicare+Choice/Fee-for-Service decision and the choice of plan within the M+C sector, were modeled using limited information maximum likelihood nested logit.

    The Effect of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare Program · 2004 · DOI

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115 open questions have been extracted from the limitations and future-work passages of 3,806 Healthcare Policy and Management papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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