National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (8)
- Ambulatory Care and Surgery (1)
- Behavioral Health (3)
- Cancer (2)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (3)
- Chronic Conditions (1)
- Communication (1)
- Community Partnerships (1)
- Comparative Effectiveness (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Diabetes (1)
- Disparities (3)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Costs (15)
- Healthcare Delivery (1)
- Healthcare Utilization (3)
- (-) Health Insurance (40)
- Health Services Research (HSR) (3)
- Hospitalization (4)
- Hospitals (4)
- Inpatient Care (1)
- Low-Income (5)
- Medicaid (9)
- Medical Expenditure Panel Survey (MEPS) (6)
- Medicare (5)
- Medication (3)
- Mortality (2)
- Outcomes (2)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Patient Experience (1)
- Payment (4)
- Policy (16)
- Quality Measures (1)
- Quality of Care (4)
- Racial and Ethnic Minorities (3)
- Skin Conditions (1)
- Substance Abuse (1)
- Surgery (1)
- Tobacco Use (1)
- Uninsured (8)
- Vulnerable Populations (1)
- Women (1)
- Young Adults (2)
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 25 of 40 Research Studies DisplayedSelden 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.
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Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Biener AI, Selden TM
AHRQ Author: Biener AI, Selden TM
Public and private payments for physician office visits.
Using data for 2014-15 from the Medical Expenditure Panel Survey to estimate standardized payments for nonelderly adults' physician office visits by type of insurance, researchers found that adults with public insurance, especially Medicaid, had substantially lower provider payments, out-of-pocket spending, and third-party payments than their peers with employer-sponsored or Marketplace insurance.
AHRQ-authored.
Citation: Biener AI, Selden TM .
Public and private payments for physician office visits.
Health Aff 2017 Dec;36(12):2160-64. doi: 10.1377/hlthaff.2017.0749.
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Keywords: Healthcare Costs, Payment, Health Insurance, Ambulatory Care and Surgery, Medical Expenditure Panel Survey (MEPS)
Adrion ER, Kocher KE, Nallamothu BK
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Using multipayer commercial claims for the period 2009-13, the investigators evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In their study period, the use of observation care increased relative to that of short-stay hospitalizations. In addition, total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly--and at rates much higher than spending in the inpatient setting--over the study period.
AHRQ-funded; HS000053.
Citation: Adrion ER, Kocher KE, Nallamothu BK .
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Health Aff 2017 Dec;36(12):2102-09. doi: 10.1377/hlthaff.2017.0774..
Keywords: Health Insurance, Healthcare Costs, Healthcare Delivery, Healthcare Utilization, Hospitalization, Hospitals, Medicare
Whaley CM, Guo C, Brown TT
The moral hazard effects of consumer responses to targeted cost-sharing.
This paper examines the effects of the reference pricing program implemented by the California Public Employees Retirement System (CalPERS) in 2012. The investigators found that the cost savings from the reference pricing program was about two to three times as large as the reduction from implementing a high-deductible health plan, while the accompanying consumer surplus reduction was much smaller under reference pricing.
AHRQ-funded; HS022098.
Citation: Whaley CM, Guo C, Brown TT .
The moral hazard effects of consumer responses to targeted cost-sharing.
J Health Econ 2017 Dec;56:201-21. doi: 10.1016/j.jhealeco.2017.09.012..
Keywords: Healthcare Costs, Health Insurance, Payment
Borah BJ, Yao X, Laughlin-Tommaso SK
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
The objective of this retrospective analysis of administrative claims from a large U.S. commercial insurance database, was to compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery.
AHRQ-funded; HS023418.
Citation: Borah BJ, Yao X, Laughlin-Tommaso SK .
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
Obstet Gynecol 2017 Nov;130(5):1047-56. doi: 10.1097/AOG.0000000000002331..
Keywords: Cancer, Comparative Effectiveness, Health Insurance, Outcomes, Patient-Centered Outcomes Research, Surgery, Women
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.
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Keywords: Access to Care, Health Insurance, Medication, Medical Expenditure Panel Survey (MEPS), Uninsured
Ndumele CD, Cohen MS, Cleary PD
Association of state access standards with accessibility to specialists for Medicaid managed care enrollees.
The researchers compared ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. Overall, there was no significant improvement in timely access to specialty services for Medicaid managed care enrollees in the period following implementation of standard(s) nor was there any impact of access standards on insurance-based disparities in access.
AHRQ-funded; HS016978; HS017589.
Citation: Ndumele CD, Cohen MS, Cleary PD .
Association of state access standards with accessibility to specialists for Medicaid managed care enrollees.
JAMA Intern Med 2017 Oct;177(10):1445-51. doi: 10.1001/jamainternmed.2017.3766.
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Keywords: Access to Care, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Health Insurance, Patient Experience
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.
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Keywords: Community Partnerships, Health Insurance, Policy, Medicaid, Uninsured
Chen J, Vargas-Bustamante A, Novak P
Reducing young adults' health care spending through the ACA expansion of dependent coverage.
The researchers estimated health care expenditure trends among young adults ages 19-25 before and after the 2010 implementation of the Affordable Care Act (ACA) provision that extended eligibility for dependent private health insurance coverage. They found that increased health insurance enrollment as a consequence of the ACA provision for dependent coverage has successfully reduced spending and catastrophic expenditures, providing financial protections for young adults.
AHRQ-funded; HS022135.
Citation: Chen J, Vargas-Bustamante A, Novak P .
Reducing young adults' health care spending through the ACA expansion of dependent coverage.
Health Serv Res 2017 Oct;52(5):1835-57. doi: 10.1111/1475-6773.12555.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Policy, Young Adults
Schoenbaum M, Sutherland JM, Chappel A
AHRQ Author: Sutherland JM
Twelve-month health care use and mortality in commercially insured young people with incident psychosis in the United States.
This study assessed 12-month mortality and patterns of outpatient and inpatient treatment among young people experiencing an incident episode of psychosis in the United States. The hugely elevated mortality observed, when compared to the general population, underscores that young people experiencing psychosis warrant intensive clinical attention-yet the researchers found low rates of pharmacotherapy and limited use of psychosocial treatment.
AHRQ-authored.
Citation: Schoenbaum M, Sutherland JM, Chappel A .
Twelve-month health care use and mortality in commercially insured young people with incident psychosis in the United States.
Schizophr Bull 2017 Oct;43(6):1262-72. doi: 10.1093/schbul/sbx009.
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Keywords: Healthcare Utilization, Health Insurance, Health Services Research (HSR), Behavioral Health, Young Adults
Hudson JL, Moriya AS
AHRQ Author: Hudson JL, Moriya AS
Medicaid expansion for adults had measurable 'welcome mat' effects on their children.
This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post Affordable Care Act (ACA). It estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
Medicaid expansion for adults had measurable 'welcome mat' effects on their children.
Health Aff 2017 Sep;36(9):1643-51. doi: 10.1377/hlthaff.2017.0347.
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Keywords: Children/Adolescents, Health Insurance, Policy, Low-Income
Kwa MC, Ardalan K, Laumann AE
Predictors of hospitalization, length of stay and costs of care among adults with dermatomyositis in the United States.
The researchers sought to determine the prevalence and risk factors for hospitalization with dermatomyositis and to assess inpatient burden of dermatomyositis. They concluded that there is a significant and increasing inpatient burden for dermatomyositis in the US. Also, there appear to be racial differences as non-whites have higher prevalence of admission, increased length of stay and cost of care.
AHRQ-funded; HS023011.
Citation: Kwa MC, Ardalan K, Laumann AE .
Predictors of hospitalization, length of stay and costs of care among adults with dermatomyositis in the United States.
Arthritis Care Res 2017 Sep;69(9):1391-99. doi: 10.1002/acr.23190.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Health Insurance, Skin Conditions
Vistnes JP, Rohde F, Miller GE
AHRQ Author: Vistnes JP, Rohde F, Miller GE, Cooper PF
Substantial churn in health insurance offerings by small employers, 2014-15.
New data for 2014-15 from the Medical Expenditure Panel Survey-Insurance Component longitudinal survey show substantial churn in insurance offers by small employers (those with fifty or fewer workers), with 14.6 percent of employers that offered insurance in 2014 having dropped it in 2015 and 5.5 percent of those that did not offer it adding coverage.
AHRQ-authored.
Citation: Vistnes JP, Rohde F, Miller GE .
Substantial churn in health insurance offerings by small employers, 2014-15.
Health Aff 2017 Sep;36(9):1632-36. doi: 10.1377/hlthaff.2017.0431.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Health Insurance
Friedman S, Xu H, Harwood JM
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
The purpose of this study was to determine whether Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with increased behavioral health expenditures and utilization among a population with substance use disorder (SUD) diagnoses. The investigators found that MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Harwood JM .
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
J Subst Abuse Treat 2017 Sep;80:67-78. doi: 10.1016/j.jsat.2017.06.006..
Keywords: Behavioral Health, Healthcare Costs, Healthcare Utilization, Health Insurance, Policy, Health Services Research (HSR), Substance Abuse
Ndumele CD, Schpero WL, Schlesinger MJ
Association between health plan exit from Medicaid managed care and quality of care, 2006-2014.
This study aimed to determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. It found that between 2006 and 2014, health plan exit from the US Medicaid program was frequent; however the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market.
AHRQ-funded; HS017589; HS016978.
Citation: Ndumele CD, Schpero WL, Schlesinger MJ .
Association between health plan exit from Medicaid managed care and quality of care, 2006-2014.
JAMA 2017 Jun 27;317(24):2524-31. doi: 10.1001/jama.2017.7118.
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Keywords: Medicaid, Healthcare Costs, Health Insurance, Quality of Care
Miller GE, Vistnes J, Buettgens M
AHRQ Author: Miller GE, Vistnes J
The availability and marginal costs of dependent employer-sponsored health insurance.
In this study, the investigators examined differences by firm size in the availability of dependent coverage and the incremental cost of such coverage. They indicate that their results suggest that firm size may be an important factor in policy assessments, such as analyses of the financial implications for families excluded from subsidized Marketplace coverage due to affordable offers of single coverage or of potential rollbacks to public coverage for children.
AHRQ-authored.
Citation: Miller GE, Vistnes J, Buettgens M .
The availability and marginal costs of dependent employer-sponsored health insurance.
Int J Health Econ Manag 2017 Jun;17(2):251-60. doi: 10.1007/s10754-016-9210-8..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs
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.
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Keywords: Healthcare Costs, Health Insurance, Hospitals, Medicare, Uninsured
Jacobs PD, Molloy E
AHRQ Author: Jacobs PD
How do Medicare Advantage beneficiary payments vary with tenure?
This study compared how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. Beneficiaries who remained in their plans for 6 or more years were paying $786 more than they would have spent in the lowest-cost plan compared with $552 for beneficiaries in their first year of enrollment.
AHRQ-authored.
Citation: Jacobs PD, Molloy E .
How do Medicare Advantage beneficiary payments vary with tenure?
Am J Manag Care 2017 Jun;23(6):372-77.
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Keywords: Medicare, Payment, Healthcare Costs, Health Insurance
Heintzman J, Bailey SR, DeVoe J
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
This study compared the insurance status of low-income patients served in 23 community health centers (CHCs) in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion in 2014. It found that among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos.
AHRQ-funded; HS021522; HS024270.
Citation: Heintzman J, Bailey SR, DeVoe J .
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
J Racial Ethn Health Disparities 2017 Jun;4(3):329-36. doi: 10.1007/s40615-016-0232-1.
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Keywords: Disparities, Health Insurance, Policy, Low-Income, Racial and Ethnic Minorities
Carey K, Dor A
http://www.healthfinancejournal.com/index.php/johcf/article/view/114
Price variations and their trends in U.S. hospitals.
This study tracked trends in prices paid to hospitals by commercial insurers over the period 2008 to 2014 using private sector claims data that contain actual payments. It contrasted these with trends in the CMS published charges. Results indicated that variation in actual commercially-transacted prices is substantially lower than variation in published charges.
AHRQ-funded; HS023610.
Citation: Carey K, Dor A .
Price variations and their trends in U.S. hospitals.
J Health Care Finance 2017 Sum;44(1).
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Keywords: Healthcare Costs, Payment, Health Insurance, Hospitals
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.
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Keywords: Policy, Low-Income, Access to Care, Health Insurance, Uninsured
Pesko MF, Maclean JC, Kaplan CM
AHRQ Author: Hill SC
Trends over time in enrollment in non-group health insurance plans by tobacco use in the United States.
The researchers tabulated enrollment information for 35 states offering insurance plans through Healthcare.gov in both 2014 and 2016. They found that non-tobacco user enrollment rose faster than reported tobacco user enrollment in 30 out of 35 states. Reported tobacco users are enrolling in marketplace plans at a lower rate and are more likely to enroll in less generous plans.
AHRQ-authored.
Citation: Pesko MF, Maclean JC, Kaplan CM .
Trends over time in enrollment in non-group health insurance plans by tobacco use in the United States.
Prev Med Rep 2017 May 17;7:46-49. doi: 10.1016/j.pmedr.2017.05.010.
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Keywords: Health Insurance, Tobacco Use
Abdus S, Hill SC
AHRQ Author: Abdus S, Hill SC
Growing insurance coverage did not reduce access to care for the continuously insured.
The researchers examined data for the period 2008-14 from the Medical Expenditure Panel Survey and found no consistent evidence that increases in the proportions of adults with insurance at the local-area level affected access to care for adults residing in the same areas who already had, and continued to have, insurance.
AHRQ-authored.
Citation: Abdus S, Hill SC .
Growing insurance coverage did not reduce access to care for the continuously insured.
Health Aff 2017 May;36(5):791-98. doi: 10.1377/hlthaff.2016.1671.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Access to Care, Policy
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.
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Keywords: Medicaid, Low-Income, Health Insurance, Uninsured, Policy
Frean M, Gruber J, Sommers BD
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. Win this study, the investigators provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time.
AHRQ-funded; HS021291.
Citation: Frean M, Gruber J, Sommers BD .
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
J Health Econ 2017 May;53:72-86. doi: 10.1016/j.jhealeco.2017.02.004..
Keywords: Healthcare Costs, Health Insurance, Policy, Medicaid