National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (10)
- Behavioral Health (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (2)
- Community-Based Practice (1)
- Community Partnerships (1)
- Disparities (3)
- Emergency Department (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Healthcare Utilization (1)
- Health Insurance (11)
- Hospitals (1)
- Low-Income (5)
- Medicaid (6)
- Medical Expenditure Panel Survey (MEPS) (3)
- Medicare (1)
- Medication (1)
- Policy (7)
- Primary Care (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- (-) Uninsured (17)
- Vulnerable Populations (3)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedChu J, Roby DH, Boudreaux MH
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
The purpose of this study was to estimate the effects of the Children's Health Insurance Reauthorization Act (CHIPRA) on insurance coverage, access, utilization, and health outcomes among immigrant children. The researchers utilized the restricted use 2000-2016 National Health Interview Survey (NHIS)with a sample which included immigrant children between the ages of 0 and 18 born outside the United States, with family income below 300% of the Federal Poverty Level (FPL). The study found that CHIPRA was related with a decrease in uninsured rates and an increase in public insurance enrollment for immigrant children. The effects of CHIPRA became small and statistically not significant 3 years after adoption. The researchers found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. The researchers concluded that the eligibility expansion of CHIPRA was related with increases in public insurance coverage for low-income children. However, no effect of CHIPRA on access to care and health was found.
AHRQ-funded; HS028532.
Citation: Chu J, Roby DH, Boudreaux MH .
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
Health Serv Res 2022 Dec;57(suppl 2):315-25. doi: 10.1111/1475-6773.14061..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Health Insurance, Access to Care, Vulnerable Populations, Uninsured
Behr CL, Hull P, Hsu J
Geographic access to federally qualified health centers before and after the Affordable Care Act.
Funding for Federally Qualified Health Centers (FQHCs) increased with the advent of the Affordable Care Act (ACA). The purpose of this study was to define FQHC service areas based on patient use and examine the characteristics of areas that gained FQHC access post-ACA. The researchers first defined FQHC service areas using total patient counts by ZIP code from the Uniform Data System (UDS) and then compared that approach with other methods. The authors then compared the characteristics of ZIP codes from Medically Underserved Areas/ Populations (MUA/Ps) that gained access to FQHCs between 2011-2015, with MUA/P ZIP codes that did not gain access to FQHCs during that same time period. The study found that FQHC service areas based on the UDS data included a larger percentage of FQHC patients and a higher use of FQHCs among low-income residents, on average, than Primary Care Service Areas or counties. The researchers also discovered that MUA/Ps that gained access to an FQHC between 2011 and 2015 included more poor, publicly insured, uninsured, and foreign born residents than underserved areas that did not gain access. The study concluded that measures of actual patient use are a useful method of assessing FQHC service areas and access.
AHRQ-funded; HS025378.
Citation: Behr CL, Hull P, Hsu J .
Geographic access to federally qualified health centers before and after the Affordable Care Act.
BMC Health Serv Res 2022 Mar 23;22(1):385. doi: 10.1186/s12913-022-07685-0..
Keywords: Access to Care, Uninsured, Vulnerable Populations
Porteny T, Ponce N, Sommers BD
Immigrants and the Affordable Care Act: changes in coverage and access to care by documentation status.
This study used data from the California Health Interview Survey (2003-2016) to compare changes in health coverage and access to care among immigrants in California before and after the Affordable Care Act (ACA). The authors found that the ACA has led to major gains in coverage for lawful permanent residents in California, but unauthorized immigrants experienced only modest increases in coverage. This result widened the disparity in uninsured rates for unauthorized immigrants relative to citizens considerably since 2014.
AHRQ-funded; HS000055.
Citation: Porteny T, Ponce N, Sommers BD .
Immigrants and the Affordable Care Act: changes in coverage and access to care by documentation status.
J Immigr Minor Health 2022 Feb;24(1):86-94. doi: 10.1007/s10903-020-01124-0..
Keywords: Access to Care, Health Insurance, Uninsured, Vulnerable Populations
Chang L, Rees CA, Michelson KA
Association of socioeconomic characteristics with where children receive emergency care.
This study’s objective was to characterize national associations of neighborhood income and insurance type for children with the characteristics of emergency departments (EDs) from which they receive care. The authors conducted a cross-sectional study of ED visits by children from 2014 to 2017 using the Nationwide Emergency Department Sample. Emergency department characteristics were characterized by pediatric volume category. There was a total of 107.6 million ED visits from 2014 to 2017. Children outside of the wealthiest neighborhood income quartile had lower proportions of visits to high-volume pediatric EDs and greater proportions of visits to low-volume pediatric EDs than children in the wealthiest quartile. Publicly insured children were modestly more likely to visit higher-volume pediatric EDs than privately insurance and uninsured children. This association appears to be principally driven by urban-rural differences in access to pediatric emergency care.
AHRQ-funded; HS026503.
Citation: Chang L, Rees CA, Michelson KA .
Association of socioeconomic characteristics with where children receive emergency care.
Pediatr Emerg Care 2022 Jan;38(1):e264-e67. doi: 10.1097/pec.0000000000002244..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Health Insurance, Uninsured, Low-Income
Selden TM, Lipton BJ, Decker SL
AHRQ Author: Selden TM, Lipton BJ, Decker SL
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
The researchers found that as of 2015, adults with incomes of 100-138 percent of the federal poverty level had experienced large declines in uninsurance rates in both expansion and nonexpansion states. Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost.
AHRQ-authored.
Citation: Selden TM, Lipton BJ, Decker SL .
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
Health Aff 2017 Dec;36(12):2069-77. doi: 10.1377/hlthaff.2017.0830.
.
.
Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Kirby JB, Sharma R
AHRQ Author: Kirby JB
The availability of community health center services and access to medical care.
This study examined the associations between the availability of Community Health Centers (CHCs) services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period. It found that the availability of CHC services was positively associated with both measures of access among those with no insurance coverage.
AHRQ-authored.
Citation: Kirby JB, Sharma R .
The availability of community health center services and access to medical care.
Healthc 2017 Dec;5(4):174-82. doi: 10.1016/j.hjdsi.2016.12.006.
.
.
Keywords: Access to Care, Community-Based Practice, Medicaid, Medical Expenditure Panel Survey (MEPS), Uninsured
Yabroff KR, Kirby J, Zodet M
AHRQ Author: Kirby J, Zodet M
Association of insurance gains and losses with access to prescription drugs.
The researchers used longitudinal data to assess the effects of insurance gains and losses on prescription drug access. Their findings that unmet need for prescription drugs declined among initially uninsured adults who gained coverage and doubled among initially insured adults who lost coverage provide longitudinal evidence that having and maintaining health insurance is a key protection against unmet need for prescription drugs in a nationally representative sample.
AHRQ-authored.
Citation: Yabroff KR, Kirby J, Zodet M .
Association of insurance gains and losses with access to prescription drugs.
JAMA Intern Med 2017 Oct;177(10):1531-32. doi: 10.1001/jamainternmed.2017.4011.
.
.
Keywords: Access to Care, Health Insurance, Medication, Medical Expenditure Panel Survey (MEPS), Uninsured
Huguet N, Hoopes MJ, Angier H
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Rates of uninsured visits decreased pre- to post- Affordable Care Act with greater drops in expansion (-57 percent) versus nonexpansion (-20 percent) states. Medicaid-insured visits increased 60 percent in expansion states while remaining unchanged in nonexpansion states.
AHRQ-funded; HS024270.
Citation: Huguet N, Hoopes MJ, Angier H .
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
J Prim Care Community Health 2017 Oct;8(4):206-12. doi: 10.1177/2150131917709403.
.
.
Keywords: Community Partnerships, Health Insurance, Policy, Medicaid, Uninsured
Angier H, Hoopes M, Marino M
Uninsured primary care visit disparities under the Affordable Care Act.
The researchers aimed to assess changes in insurance coverage at community health center (CHC) visits after the Patient Protection and Affordable Care Act (ACA) Medicaid expansion by race and ethnicity. After the ACA was implemented, uninsured visit rates decreased for all racial and ethnic groups. Hispanic patients experienced the greatest increases in Medicaid-insured visit rates after ACA implementation in expansion states.
AHRQ-funded; HS024270.
Citation: Angier H, Hoopes M, Marino M .
Uninsured primary care visit disparities under the Affordable Care Act.
Ann Fam Med 2017 Sep;15(5):434-42. doi: 10.1370/afm.2125.
.
.
Keywords: Uninsured, Primary Care, Disparities, Healthcare Utilization, Access to Care
Novak P, Williams-Parry KF, Chen J
AHRQ Author: Novak P
Racial and ethnic disparities among the remaining uninsured young adults with behavioral health disorders after the ACA expansion of dependent coverage.
The objective of this study is to explore the population characteristics of the remaining uninsured individuals with and without behavioral health disorders (BHDs) and to examine whether the factors that contribute to racial and ethnic disparities in the likelihood of being uninsured were different after ACA. The major factor associated with the ethnic disparity among those with BHDs was the immigrant status of Latinos, and the major factor associated with racial disparity was geographic location.
AHRQ-authored; AHRQ-funded; HS022135.
Citation: Novak P, Williams-Parry KF, Chen J .
Racial and ethnic disparities among the remaining uninsured young adults with behavioral health disorders after the ACA expansion of dependent coverage.
J Racial Ethn Health Disparities 2017 Aug;4(4):607-14. doi: 10.1007/s40615-016-0264-6.
.
.
Keywords: Behavioral Health, Disparities, Policy, Medical Expenditure Panel Survey (MEPS), Uninsured
Woodworth L, Romano PS, Holmes JF
Does insurance status influence a patient's hospital charge?
The objective of this study was to determine whether hospitals charge patients differently based on their insurance status. It concluded that conditional on patient characteristics, length of stay, and expected intensity of resource utilization, patients with private insurance and patients with Medicare were charged more (before discounting) than their uninsured counterparts within the same hospital.
AHRQ-funded; HS022236.
Citation: Woodworth L, Romano PS, Holmes JF .
Does insurance status influence a patient's hospital charge?
Appl Health Econ Health Policy 2017 Jun;15(3):353-62. doi: 10.1007/s40258-017-0308-z.
.
.
Keywords: Healthcare Costs, Health Insurance, Hospitals, Medicare, Uninsured
Barnett ML, Linder JA, Clark CR
Low-value medical services in the safety-net population.
The objective of this study was to measure rates of low-value care and high-value care received by patients without insurance or with Medicaid, compared with privately insured patients, and provided by safety-net physicians vs non-safety-net physicians. The study concluded that rates of low-value and high-value care were similar among physicians serving vulnerable patients and other physicians. Overuse of low-value care is a potentially important focus for state Medicaid programs and safety-net institutions to pursue cost savings and improved quality of health care delivery.
AHRQ-funded; HS021291.
Citation: Barnett ML, Linder JA, Clark CR .
Low-value medical services in the safety-net population.
JAMA Intern Med 2017 Jun;177(6):829-37. doi: 10.1001/jamainternmed.2017.0401..
Keywords: Access to Care, Uninsured, Medicaid, Quality of Care
Sommers BD, Maylone B, Blendon RJ
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage, researchers found that by the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state.
AHRQ-funded; HS021291.
Citation: Sommers BD, Maylone B, Blendon RJ .
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Health Aff 2017 Jun;36(6):1119-28. doi: 10.1377/hlthaff.2017.0293.
.
.
Keywords: Policy, Low-Income, Access to Care, Health Insurance, Uninsured
Decker SL, Lipton BJ, Sommers BD
AHRQ Author: Decker SL, Lipton BJ
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
The researchers used detailed federal survey data through 2015 to analyze recent changes in coverage for low-income adults after the expansion associated with the Affordable Care Act's (ACA's) Medicaid expansion in 2014. They found that the uninsurance rate fell in both expansion and nonexpansion states but that it fell significantly more in expansion states.
AHRQ-authored; AHRQ-funded; HS021291.
Citation: Decker SL, Lipton BJ, Sommers BD .
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
Health Aff 2017 May;36(5):819-25. doi: 10.1377/hlthaff.2016.1462.
.
.
Keywords: Medicaid, Low-Income, Health Insurance, Uninsured, Policy
Sohn H
Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course.
This article describes age- and group-specific dynamics of insurance gain and loss that contribute to inequalities found in traditional cross-sectional studies. The authors assert that a formal decomposition on increment-decrement life-tables of insurance gain and loss shows that coverage disparities are predominately driven by minority groups' greater propensity to lose the insurance that they already have. They note that uninsured African Americans were faster to gain insurance than non-Hispanic whites but their high rates of insurance loss more than negated this advantage.
AHRQ-funded; HS000046.
Citation: Sohn H .
Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course.
Popul Res Policy Rev 2017 Apr;36(2):181-201. doi: 10.1007/s11113-016-9416-y.
.
.
Keywords: Disparities, Health Insurance, Racial and Ethnic Minorities, Uninsured
Cole MB, Galarraga O, Wilson IB
At federally funded health centers, Medicaid expansion was associated with improved quality of care.
In 2014 many uninsured, low-income nonelderly adults gained access to health insurance in states that expanded Medicaid eligibility under the Affordable Care Act. The researchers used a difference-in-differences approach to compare changes among 1,057 such centers in expansion versus nonexpansion States. Medicaid expansion was associated with improved quality for asthma treatment, Pap testing, body mass index assessment, and hypertension control.
AHRQ-funded; HS024652.
Citation: Cole MB, Galarraga O, Wilson IB .
At federally funded health centers, Medicaid expansion was associated with improved quality of care.
Health Aff 2017 Jan;36(1):40-48. doi: 10.1377/hlthaff.2016.0804.
.
.
Keywords: Quality of Care, Policy, Uninsured, Low-Income, Access to Care
Decker SL, Lipton BJ
AHRQ Author: Decker SL, Lipton BJ
Most newly insured people in 2014 were long-term uninsured.
This study found that in 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.
AHRQ-authored.
Citation: Decker SL, Lipton BJ .
Most newly insured people in 2014 were long-term uninsured.
Health Aff 2017 Jan;36(1):16-20. doi: 10.1377/hlthaff.2016.0984.
.
.
Keywords: Health Insurance, Uninsured, Medicaid, Policy