{
  "version": 1,
  "generatedAt": "2026-09-07T04:32:07.308636+00:00",
  "data": {
    "decision": "The Almanac covers every requested analytical domain with public, no-account sources. Paid data remain optional sensitivity analyses or later enhancements that require separate approval.",
    "domains": [
      {
        "domain": "Finance, supply, capacity, utilization",
        "status": "implemented",
        "source": "HCAI annual selected + complete files; 2026 Q1 report",
        "accountRequired": false,
        "cost": "$0",
        "limitation": "Hospital-submitted financial periods and definitions require reconciliation."
      },
      {
        "domain": "Market concentration",
        "status": "implemented",
        "source": "HCAI 2024 Patient Origin and Market Share + HCAI CCN link + AHRQ 2023 system linkage",
        "accountRequired": false,
        "cost": "$0",
        "limitation": "County patient flows are a descriptive screen, not an antitrust market definition; unmatched facilities remain independently identified."
      },
      {
        "domain": "Hospital spending / pricing",
        "status": "implemented_with_evidence_boundary",
        "source": "OHCA Hospital Measurement 2022\u20132023 + RAND Round 5.1 + five free peer-reviewed California studies",
        "accountRequired": false,
        "cost": "$0",
        "limitation": "OHCA net patient revenue measures are spending proxies. Peer-reviewed studies use different payers, periods, services, and designs and are not pooled into a current price index."
      },
      {
        "domain": "Quality outcomes",
        "status": "implemented",
        "source": "HCAI IMI 2016\u20132024 + CMS Care Compare HCAHPS, Timely and Effective Care, and HRRP",
        "accountRequired": false,
        "cost": "$0",
        "limitation": "CMS quality linkage is CCN-only. HCAHPS, SEP-1, ED time, and condition-specific HRRP ratios remain separate; no composite is invented."
      },
      {
        "domain": "Health equity",
        "status": "implemented",
        "source": "HCAI 2024 Hospital Equity Measures",
        "accountRequired": false,
        "cost": "$0",
        "limitation": "First-year hospital-reported fields contain substantial missingness and varying denominators."
      },
      {
        "domain": "California vs. national",
        "status": "implemented_with_denominators",
        "source": "CMS quality files + AHA Fast Facts 2026 + CMS National Health Expenditure Accounts",
        "accountRequired": false,
        "cost": "$0",
        "limitation": "Five CMS quality rows use matched definitions where available. Seven capacity, utilization, ownership, system, and spending rows retain separate denominators and are explicitly classified as aligned-with-caveats or contextual."
      },
      {
        "domain": "Policy and subsidies",
        "status": "implemented_with_scenario_boundary",
        "source": "HCAI awards; DHCS/LAO financing evidence; P.L. 119-21; current CMS rulemaking",
        "accountRequired": false,
        "cost": "$0",
        "limitation": "Awards and loans are program evidence, not net benefit. Federal facility rows are payer-revenue sensitivities, not predictions or official allocations."
      }
    ],
    "optionalPaid": [
      {
        "source": "RAND Hospital Data",
        "listedCost": "$499/year per user; a limited latest-year file is free after registration",
        "accountRequired": true,
        "neededForCore": false,
        "value": "About 1,900 standardized CMS cost-report variables, panel data from 1996 forward, multiple standardized time periods, and outlier options. Raw CMS HCRIS remains free.",
        "url": "https://www.hospitaldatasets.org/pricing-and-plans"
      },
      {
        "source": "HCAI Health Care Payments Data \u2014 secure enclave",
        "listedCost": "$100 application; $5,000 project space + $5,000 per analyst or $6,000 per researcher each year; custom dataset adds $9,000",
        "accountRequired": true,
        "neededForCore": false,
        "value": "Claims-level payer and service analyses inside HCAI's secure environment. A basic one-analyst project is $10,000/year before optional tools, storage, compute, or custom data.",
        "url": "https://hcai.ca.gov/data/request-data/hpd-data-access-and-release/"
      },
      {
        "source": "HCAI Health Care Payments Data \u2014 direct transmission",
        "listedCost": "$100 application; standard commercial $20,000 per data year or commercial + Medi-Cal $22,000 per data year",
        "accountRequired": true,
        "neededForCore": false,
        "value": "Approved direct delivery. Custom/research-identifiable requests add a $9,000 custom-dataset charge plus table/year charges; application, privacy, and release review still apply.",
        "url": "https://hcai.ca.gov/data/request-data/hpd-data-access-and-release/"
      },
      {
        "source": "AHA Annual Survey Database",
        "listedCost": "Quote required; no public list price",
        "accountRequired": true,
        "neededForCore": false,
        "value": "Complete hospital-level database with 1,300+ fields. AHA directs buyers to request licensing from AHA Data & Insights.",
        "url": "https://www.ahadata.com/aha-annual-survey-database"
      },
      {
        "source": "AHA Hospital Statistics 2026 PDF + Excel bundle",
        "listedCost": "$275 member / $349 nonmember",
        "accountRequired": true,
        "neededForCore": false,
        "value": "Aggregate national, census-division, state, bed-size, utilization, personnel, and finance tables through 2024; not the complete hospital-level Annual Survey Database.",
        "url": "https://ams.aha.org/eweb/dynamicpage.aspx?ptc_code=Data+Products&webcode=ListProduct"
      },
      {
        "source": "HCAI confidential patient data",
        "listedCost": "$500 per data product per year for eligible university researchers",
        "accountRequired": true,
        "neededForCore": false,
        "value": "Patient-level discharge, emergency, or ambulatory surgery research; for-profit eligibility and long approval timelines make it unsuitable for this public-data Almanac.",
        "url": "https://hcai.ca.gov/data/request-data/"
      }
    ],
    "accountAction": "No account was created and no paid license was purchased. Any paid acquisition should occur only after CHCF approves the methodology, license terms, budget, and intended publication rights."
  }
}