National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (5)
- Cancer (1)
- Cardiovascular Conditions (2)
- COVID-19 (1)
- Disparities (1)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
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- (-) Uninsured (18)
- Vulnerable Populations (3)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedZachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Smith K, Padmanabhan P, Chen A
The impacts of the 340B Program on health care quality for low-income patients.
This study’s objective was to assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients. HCUP State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and the American Hospital Association Annual Survey were all used to extract inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data was linked on hospital 340B eligibility and participation. The authors did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality, 30-day readmission rates, or other measures. Among insured and non-Medicaid patients, they found discontinuities for acute myocardial infarction and postoperative sepsis mortality.
AHRQ-funded; HS026980.
Citation: Smith K, Padmanabhan P, Chen A .
The impacts of the 340B Program on health care quality for low-income patients.
Health Serv Res 2023 Oct; 58(5):1089-97. doi: 10.1111/1475-6773.14204..
Keywords: Low-Income, Hospitals, Vulnerable Populations, Medicaid, Uninsured, Inpatient Care, Quality of Care
Eliason E, Admon LK, Steenland MW
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
The purpose of this study was to explore the loss of Medicaid coverage in toward the end of the postpartum period prior to COVID-19 and describe the implications for Medicaid unwinding. The researchers utilized unique Pregnancy Risk Assessment Monitoring System follow-up data from prior to the COVID-19 pandemic. The study found that only 68% of enrollees in prenatal Medicaid maintained continuous Medicaid coverage through 9 or 10 months postpartum. Of the total prenatal Medicaid enrollees who lost their coverage in the early postpartum period, two-thirds continued to be uninsured 9 to 10 months postpartum. The researchers concluded that extensions to state postpartum Medicaid could prevent a return to postpartum coverage loss rates similar to the level in the prepandemic period.
AHRQ-funded; HS027464; HS000011.
Citation: Eliason E, Admon LK, Steenland MW .
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
Health Aff 2023 Jul; 42(7):966-72. doi: 10.1377/hlthaff.2022.01659..
Keywords: COVID-19, Maternal Care, Medicaid, Women, Access to Care, Uninsured, Health Insurance
Frenier C, McIntyre A
Insurance coverage transitions after disenrollment from Medicaid in Minnesota.
The transition of health insurance following withdrawal from Medicaid is an under-explored area of study. This is particularly significant with the impending cessation of Medicaid's continuous coverage policy due to pandemic relief measures, a shift that is predicted to affect about 18 million individuals. The purpose of this study was to analyze the pattern of insurance transition post-Medicaid disenrollment, specifically in a state where Medicaid expansion was adopted and continuous coverage and eligibility policies were relatively liberal. The study cohort was derived from the Minnesota All Payer Claims Database (MN APCD), with a focus on residents aged 64 or less, who had experienced Medicaid enrollment cessation between January 2018 and February 2019. The final sample included 346,734 cases of Medicaid disenrollment. The study found that approximately 50% of individuals who disenrolled from Medicaid in Minnesota were without observable coverage six months later, with a significant percentage returning to Medicaid within a year. It was also observed that many enrollees didn't transition seamlessly to new coverage, indicating that a meaningful proportion of disenrollment may have occurred among those who were still eligible for Medicaid or experienced short-term changes in eligibility that didn't last for an entire year.
AHRQ-funded; HS017589.
Citation: Frenier C, McIntyre A .
Insurance coverage transitions after disenrollment from Medicaid in Minnesota.
JAMA Netw Open 2023 Apr 3; 6(4):e239379. doi: 10.1001/jamanetworkopen.2023.9379..
Keywords: Health Insurance, Medicaid, Uninsured
Meille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Jacobs PD
AHRQ Author: Jacobs PD
Mandating health insurance coverage for high-income individuals.
In this study, the author describes the effect of the Affordable Care Act’s (ACA’s) individual mandate for health coverage by focusing on higher-income non-elderly adults and exploiting state differences in the rules governing premium setting and coverage issuance in the non-group market prior to 2014.
AHRQ-authored.
Citation: Jacobs PD .
Mandating health insurance coverage for high-income individuals.
National Tax Journal 2018 Dec;71(4):807-28. doi: 10.17310/ntj.2018.4.10..
Keywords: Health Insurance, Policy, Uninsured
Bradley CJ, Neumark D, Walker LS
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
Investigators recruited low-income uninsured adults in Virginia to determine whether cash incentives would encourage primary care provider (PCP) visits as opposed to going to the hospital emergency room. This randomized, controlled trial determined that PCP visits did increase but no reductions in overall costs occurred there was an offset from increased outpatient utilization.
AHRQ-funded; HS022534.
Citation: Bradley CJ, Neumark D, Walker LS .
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
J Health Econ 2018 Nov;62:121-33. doi: 10.1016/j.jhealeco.2018.07.006..
Keywords: Healthcare Utilization, Health Insurance, Low-Income, Primary Care, Uninsured, Vulnerable Populations
Keenan PS, Jacobs PD, Miller GE
AHRQ Author: Kennan PS, Jacobs PD, Miller GE
Despite coverage gains, one-third of people in small-firm low-income families were uninsured in 2014-15.
Using data from the Medical Expenditure Panel Survey, the investigators examined health insurance coverage for workers at small firms and the self-employed and found that the overall uninsurance rate for these workers and their families declined by 5 percentage points over the past decade, but one-third of those with lower incomes remained uninsured in 2014-15.
AHRQ-authored.
Citation: Keenan PS, Jacobs PD, Miller GE .
Despite coverage gains, one-third of people in small-firm low-income families were uninsured in 2014-15.
Health Aff 2018 Oct;37(10):1673-77. doi: 10.1377/hlthaff.2018.0479..
Keywords: Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS), Uninsured
Berdahl TA, Moriya AS
AHRQ Author: Berdahl TA, Moriya AS
Difference in uninsurance rates between full- and part-time workers declined in 2014.
This study examined uninsurance rates between full and part time workers using data from 2010-2015. The authors found that uninsurance declined more for part-time workers, with pathways to coverage varying by state Medicaid expansion status.
AHRQ-authored.
Citation: Berdahl TA, Moriya AS .
Difference in uninsurance rates between full- and part-time workers declined in 2014.
Health Aff 2018 Oct;37(10):1669-72. doi: 10.1377/hlthaff.2018.0345.
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Keywords: Health Insurance, Medicaid, Medical Expenditure Panel Survey (MEPS), Uninsured
Nguyen KH, Trivedi AN, Shireman TI
Lesbian, gay, and bisexual adults report continued problems affording care despite coverage gains.
This study’s investigators used data from three waves of the Behavioral Risk Factor Surveillance System to examine access to a personal doctor, affordability of care, type of health insurance coverage, and self-reported health in LGB adults in the period January 2014-February 2017 in thirty-one states that implemented the Affordable Care Act system's sexual orientation module.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN, Shireman TI .
Lesbian, gay, and bisexual adults report continued problems affording care despite coverage gains.
Health Aff 2018 Aug;37(8):1306-12. doi: 10.1377/hlthaff.2018.0281.
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Keywords: Access to Care, Healthcare Costs, Health Insurance, Uninsured, Vulnerable Populations
Decker SL, Moriya AS, Soni A
AHRQ Author: AHRQ authors - Decker and Moriya
Coverage for self-employed and others without employer offers increased after 2014.
This study examined how the Affordable Care Act might have differentially affected insurance coverage for self-employed workers, wage earners with and without offers of employer-sponsored insurance, and people not employed.
AHRQ-authored.
Citation: Decker SL, Moriya AS, Soni A .
Coverage for self-employed and others without employer offers increased after 2014.
Health Aff 2018 Aug;37(8):1238-42. doi: 10.1377/hlthaff.2017.1663..
Keywords: Health Insurance, Policy, Uninsured
Vistnes JP, Cohen JW
AHRQ Author: Vistnes JP, Cohen JW
Duration of uninsured spells for nonelderly adults declined after 2014.
Using MEPS data, the authors found that nonelderly respondents in 2014-15, following implementation of ACA coverage provisions, experienced shorter periods of being uninsured than did respondents in 2012-13 and 2013-14, especially for people with preexisting health conditions.
AHRQ-authored.
Citation: Vistnes JP, Cohen JW .
Duration of uninsured spells for nonelderly adults declined after 2014.
Health Aff 2018 Jun;37(6):951-55. doi: 10.1377/hlthaff.2017.1638.
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Keywords: Health Insurance, Policy, Medical Expenditure Panel Survey (MEPS), Uninsured
Fingar KR, Coffey RM, Mulcahy AW
AHRQ Author: Andrews RM, Stocks C
Shifts in Medicaid and uninsured payer mix at safety-net and non-safety-net hospitals during the Great Recession.
The authors examined payer mix at safety-net hospitals (SNHs) and non-SNHs during a period covering the Great Recession using data from 38 states. The number of privately insured stays decreased at both SNHs and non-SNHs. Non-SNHs increasingly served Medicaid-enrolled and uninsured patients; in SNHs, the number of Medicaid stays decreased and uninsured stays remained stable.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Fingar KR, Coffey RM, Mulcahy AW .
Shifts in Medicaid and uninsured payer mix at safety-net and non-safety-net hospitals during the Great Recession.
J Healthc Manag 2018 May-Jun;63(3):156-72. doi: 10.1097/jhm-d-16-00024.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid, Uninsured
Abdus S, Decker SL
AHRQ Author: Abdus S, Decker SL
The long-term uninsured were less likely than the short-term uninsured to gain insurance in 2014.
This study assessed the probability of having insurance in at least 1 month of 2014 for a sample of US citizens aged 19–63 who were uninsured in December 2013. It found that among those uninsured at the end of 2013, 2014 insurance take-up was lower the longer a person had been uninsured.
AHRQ-authored.
Citation: Abdus S, Decker SL .
The long-term uninsured were less likely than the short-term uninsured to gain insurance in 2014.
J Gen Intern Med 2018 May;33(5):593-95. doi: 10.1007/s11606-018-4365-2.
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Keywords: Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Uninsured
Kirby JB, Cohen JW
AHRQ Author: Kirby JB, Cohen JW
Do people with health insurance coverage who live in areas with high uninsurance rates pay more for emergency department visits?
This study investigated the relationship between the percent uninsured in a county and expenditures associated with the typical emergency department visit. Among those with private insurance, it found that an increase of 1 percentage point in the county uninsurance rate is associated with a $20 increase in the mean emergency department payment. No such association was observed among visits covered by other insurance types.
AHRQ-authored.
Citation: Kirby JB, Cohen JW .
Do people with health insurance coverage who live in areas with high uninsurance rates pay more for emergency department visits?
Health Serv Res 2018 Apr;53(2):768-86. doi: 10.1111/1475-6773.12659.
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Keywords: Emergency Department, Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Uninsured
Likosky DS, Sukul D, Seth M
Association between Medicaid expansion and cardiovascular interventions in Michigan.
This study evaluated Michigan’s Medicaid expansion as it relates to access and outcomes for 7,558 coronary artery bypass grafting operations at 33 hospitals and 45,183 percutaneous coronary interventions at 47 hospitals. Most of the change in access to revascularization occurred within the first quarter following expansion. Michigan’s Medicaid expansion was associated with changes in the demographic of those using specialty cardiovascular services (i.e., reduction in uninsured patients undergoing coronary rrevascularization).
AHRQ-funded; HS022535.
Citation: Likosky DS, Sukul D, Seth M .
Association between Medicaid expansion and cardiovascular interventions in Michigan.
J Am Coll Cardiol 2018 Mar 6;71(9):1050-51. doi: 10.1016/j.jacc.2017.12.044.
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Keywords: Access to Care, Cardiovascular Conditions, Heart Disease and Health, Surgery, Uninsured
Soni A, Sabik LM, Simon K
Changes in insurance coverage among cancer patients under the Affordable Care Act.
Uninsurance among patients with newly diagnosed cancer fell by one-third in the ACA’s first year. Coverage gains were significant across numerous common cancers, multiple demographic groups, and early-stage and late-stage disease. Large gains among Hispanic individuals were consistent with findings of other ACA studies and may indicate narrowing disparities.
AHRQ-funded; HS021291.
Citation: Soni A, Sabik LM, Simon K .
Changes in insurance coverage among cancer patients under the Affordable Care Act.
JAMA Oncol 2018 Jan;4(1):122-24. doi: 10.1001/jamaoncol.2017.3176.
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Keywords: Cancer, Health Insurance, Policy, Uninsured
Hsuan C, Horwitz JR, Ponce NA
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
EMTALA, which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. Respondents identified 5 main causes of noncompliance as well as suggesting methods to improve compliance.
AHRQ-funded; HS024247.
Citation: Hsuan C, Horwitz JR, Ponce NA .
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
J Healthc Risk Manag 2018 Jan;37(3):31-41. doi: 10.1002/jhrm.21288.
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Keywords: Emergency Medical Services (EMS), Payment, Hospitals, Medicare, Uninsured