How COMPARE Works

COMPARE (Comprehensive Assessment of Reform Efforts) was developed to provide tools to help decision makers assess the effects of changes in health care policies on health care system performance (such as access, quality and cost). COMPARE gives users a comprehensive framework for examining trade-offs across policies or across different dimensions of performance for a particular policy (e.g., a policy’s effect on spending compared to the effect on insurance coverage or on patient experience).

The COMPARE web site has four main sections:

U.S. Health Care Today

COMPARE provides facts and figures about the current U. S. health care system and describes health system performance on each of nine performance dimensions, in the absence of policy changes:

• Spending: aggregate U.S. health care spending, shown by source and type of payment
• Consumer financial risk: the amount of disposable income spent on health care
• Waste: administrative, clinical, and operational spending that does not produce value
• Reliability: the consistency with which the health care system delivers the right care at the right time to everyone
• Patient experience: aggregate assessments of how consumers evaluate their interactions with health care providers and institutions
• Health: the physical, mental, and social well-being of individuals or groups
• Coverage: the number of people who have insurance or who are enrolled in public programs, as well as the generosity of the benefit package
• Capacity: the availability of resources for delivering health care services, including labor, equipment, and facilities
• Operational feasibility: the ease or difficulty of implementing a change in the health care system

Policy Options

COMPARE provides a description of options for changing the health care system. We describe what the option is, how it would work and whether it has been tried before.

We consider policy options in five broad categories:

• Coverage: who has what type of insurance
• Benefit design: what is covered, under what conditions, with what requirements; can include an examination of mandated benefits
• Payment rules: modifications to the current methods by which doctors, hospitals, and other health providers are paid for delivering services
• Health services delivery: the use of technology, organizations, or programs to alter the way in which health services are provided
• The legal environment: tort reform for medical malpractice

Current Proposals

Users can see how policy options have been incorporated into health care policy proposals that have been developed by the Congress, state lawmakers, Governors and non-governmental organizations or coalitions and review the current status of legislative proposals. Users can also customize a search for proposals or visit the HOT legislation page for real time access to key health reform documents released by the White House, Congress, and the CBO.

Analysis of Options

We analyzed the effects of different policy options on each of the nine performance dimensions and summarize the results in a performance Dashboard. The Dashboard allows users to compare the effects of different policy options (e.g., individual mandate versus tax credit) along the full range of performance dimensions (e.g., coverage, spending, health). Users can choose which options or combination of options to consider and which performance dimensions to focus on.

We used a microsimulation model to derive results on the Dashboard for four options in the coverage category (individual mandate, employer mandate, Medicaid/SCHIP expansion, tax credits) for four performance dimensions (spending, consumer financial risk, coverage, and health).  For a description of the methods used in the RAND COMPARE microsimulation model including a discussion of the parameters and assumptions used in the modeling, see Overview of the COMPARE Microsimulation Model (PDF).

In some cases, we found no valid and reliable information on which to base an assessment. Those cells on the Dashboard are labeled "no evidence." Identifying such knowledge gaps can help to develop an effective research agenda going forward.