National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (6)
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Community-Based Practice (2)
- Digestive Disease and Health (1)
- Disparities (2)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (4)
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- Health Insurance (12)
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- Human Immunodeficiency Virus (HIV) (1)
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- Medication (1)
- Mortality (1)
- Outcomes (1)
- Patient Safety (1)
- Policy (8)
- Prevention (2)
- Racial and Ethnic Minorities (2)
- Risk (1)
- Surgery (1)
- (-) Uninsured (16)
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 16 of 16 Research Studies DisplayedNguyen KH, Trivedi AN
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
This study compared coverage and access to care between non-Hispanic White and Asian American adults after the ACA in California. The data was disaggregated into the five most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). The outcomes measured were 1) being uninsured, 2) having a usual source of care, 3) delaying necessary medical care, and 4) delaying necessary prescription medications. The sample included 19,201 non-Hispanic White and 3077 Asian American adults aged 18 to 64 in California. Koreans were significantly less likely to report a usual source of care relative to non-Hispanic whites while Chinese and Vietnamese adults were significantly less likely to delay necessary care.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN .
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
J Gen Intern Med 2019 Nov;34(11):2660-68. doi: 10.1007/s11606-019-05328-5..
Keywords: Racial and Ethnic Minorities, Access to Care, Disparities, Health Insurance, Uninsured, Policy
Rasmussen PW, Kominski GF
Sources of success in California's individual marketplace under the Affordable Care Act.
When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. Although, the ACA has not been uniformly embraced, California has been a leader. In this paper, the authors discuss sources of success in California's individual marketplace under the Affordable Care Act.
AHRQ-funded; HS000046.
Citation: Rasmussen PW, Kominski GF .
Sources of success in California's individual marketplace under the Affordable Care Act.
J Health Polit Policy Law 2019 Aug 1;44(4):679-706. doi: 10.1215/03616878-7530849..
Keywords: Policy, Health Insurance, Uninsured, Medicaid, Medicare
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Agarwal SD, Goldman AL, Sommers BD
Blue-collar workers had greatest insurance gains after ACA implementation.
The authors analyzed national survey data and found that workers in traditionally blue-collar industries experienced the largest gains in health insurance after implementation of the Affordable Care Act (ACA) in 2014. They found that, compared to other occupations, this group had lower employer-based coverage rates before the ACA. Most of the post-ACA coverage gains came from Medicaid and directly-purchased non-group insurance.
AHRQ-funded.
Citation: Agarwal SD, Goldman AL, Sommers BD .
Blue-collar workers had greatest insurance gains after ACA implementation.
Health Aff 2019 Jul;38(7):1140-44. doi: 10.1377/hlthaff.2018.05454..
Keywords: Health Insurance, Policy, Access to Care, Uninsured
Huguet N, Valenzuela S, Marino M
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
The authors assessed ambulatory care use and diagnosed health conditions among a cohort of community health center (CHC) patients uninsured before enactment of the Affordable Care Act (ACA) and followed them after enactment. They found that, post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The authors concluded that a significant percentage of CHC patients remained uninsured; that many who remained uninsured had diagnosed health conditions; and that one-half continued to have three or more visits to CHCs, which continue to be essential providers for uninsured patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Valenzuela S, Marino M .
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
Ann Fam Med 2019 Jul;17(4):336-44. doi: 10.1370/afm.2385..
Keywords: Access to Care, Ambulatory Care and Surgery, Community-Based Practice, Health Insurance, Healthcare Delivery, Medicaid, Policy, Uninsured
Seo V, Baggett TP, Thorndike AN
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
This study assessed differences in access to care for patients at Community Health Centers (CHCs) between those with continuous Medicaid coverage and those with gaps in insurance coverage, in order to examine the role of Medicaid coverage on care patterns for those with available safety net care. Data on adult patients with continuous Medicaid coverage and those with a period without insurance coverage in the last 12 months was gathered from the 2014 Health Center Patient Survey. Reported need for various types of care, prescription drugs, or referrals to care outside of the CHC, and reports of being delayed or unable to get needed care by insurance status were examined. Patients with insurance gaps were significantly more likely to report having difficulty obtaining medical care, prescription drugs, dental care, and completing outside referrals. The authors conclude that continuous Medicaid coverage appears to mitigate barriers to care for CHC patients when compared to those who have intermittent or no insurance coverage. Policies that increase disruptions in coverage could adversely impact access to care, even among those with available safety net care.
AHRQ-funding; HS025378.
Citation: Seo V, Baggett TP, Thorndike AN .
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
BMC Health Serv Res 2019 May 8;19(1):291. doi: 10.1186/s12913-019-4124-z..
Keywords: Access to Care, Health Insurance, Medicaid, Policy, Uninsured
Rivera-Hernandez M, Rahman M, Galarraga O
Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012.
This study examined the effect of the Seguro Popular (SP) program in Mexico on preventive care utilization among low-income and uninsured elder beneficiaries. Results of three rounds of the Mexican National Health and Nutrition Survey from 2000, 2006, and 2012 was used. The findings show there was no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer for adults aged 50 to 75 years.
AHRQ-funded; HS000011.
Citation: Rivera-Hernandez M, Rahman M, Galarraga O .
Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012.
Salud Publica Mex 2019 Jan-Feb;61(1):46-53. doi: 10.21149/9185..
Keywords: Elderly, Low-Income, Prevention, Healthcare Utilization, Access to Care, Uninsured
Daniel VT, Ayturk D, Ward DV
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. In this study, the investigators evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Ward DV .
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
Am J Surg 2019 Jan;217(1):121-25. doi: 10.1016/j.amjsurg.2018.06.025..
Keywords: Adverse Events, Digestive Disease and Health, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Patient Safety, Surgery, Uninsured
Gordon SH, Sommers BD, Wilson IB
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
This study looked at risk factors for early disenrollment from Colorado’s Affordable Care Act marketplace. Researchers used all-payer claims data from individual market enrollees from 2014-2016. They discovered that nearly 25% Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollement was 30% lower in individuals with cost-sharing plans and 21% lower for those enrolled in gold plans compared to those enrolled in silver plans without cost-sharing subsidies. There was greater disenrollment in beneficiaries with greater hospital and emergency utilization before disenrollment. Also, young adults were 70% more likely to disenroll than older adults.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
Med Care 2019 Jan;57(1):49-53. doi: 10.1097/mlr.0000000000001020..
Keywords: Healthcare Costs, Health Insurance, Policy, Risk, Uninsured
Vargas Bustamante A, Chen J
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
This study of the association between the timing of the Great Recession (GR) and health spending among uninsured U.S. immigrants found that the probability of any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported 27 percent higher spending during the GR.
AHRQ-funded; HS022634
Citation: Vargas Bustamante A, Chen J .
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
Health Serv Res. 2014 Dec;49(6):1900-24. doi: 10.1111/1475-6773.12193..
Keywords: Healthcare Costs, Uninsured, Disparities
Epstein AM, Sommers BD, Kuznetsov Y
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
The authors explored what low-income Americans think about Medicaid. They found that nearly 80 percent of their telephone survey sample favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability.
AHRQ-funded; HS021291.
Citation: Epstein AM, Sommers BD, Kuznetsov Y .
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
Health Aff 2014 Nov;33(11):2041-7. doi: 10.1377/hlthaff.2014.0747.
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Keywords: Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Heintzman J, Marino M, Hoopes M
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
This study used EHR data to compare the preventive service utilization of uninsured patients receiving care at Oregon community health centers (CHCs) in 2008 through 2011 with that of continuously insured patients at the same CHCs in the same period. The results showed that CHCs provided many preventive services to uninsured patients, but that uninsured patients were less likely than continuously insured patients to receive 5 of 11 preventive services. The authors concluded that lack of insurance is a barrier to preventive service utilization, even in patients who can access care at a CHC.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Hoopes M .
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
Prev Med 2014 Oct;67:306-10. doi: 10.1016/j.ypmed.2014.08.006.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Healthcare Utilization, Prevention, Uninsured
Yehia BR, Fleishman JA, Agwu AL
AHRQ Author: Fleishman JA
Health insurance coverage for persons in HIV care, 2006-2012.
The authors examined trends in health insurance coverage at 11 US HIV clinics between 2006 and 2012. They found that Medicaid coverage was more prevalent among women than men; blacks and Hispanics than whites; and individuals with injection drug use risk compared with other transmission risk factors, with Hispanics and younger age groups more likely to be uninsured than other racial/ethnic and older age groups, respectively.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, Fleishman JA, Agwu AL .
Health insurance coverage for persons in HIV care, 2006-2012.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):102-6. doi: 10.1097/qai.0000000000000251.
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Keywords: Health Insurance, Human Immunodeficiency Virus (HIV), Medicare, Racial and Ethnic Minorities, Uninsured
Crisp GD, Roberts AW, Esserman DA
The University of North Carolina's Health Care Pharmacy Assistance Program.
This study examined a program providing financial assistance to uninsured residents of North Carolina who need prescription medications. It found that from 2009 to 2011, the program served 7,180 patients in 81 counties. These patients received a mean of 23 prescriptions at an average cost of $754 per recipient per year.
AHRQ-funded; HS000032
Citation: Crisp GD, Roberts AW, Esserman DA .
The University of North Carolina's Health Care Pharmacy Assistance Program.
N C Med J. 2014 Sep-Oct;75(5):303-9..
Keywords: Healthcare Costs, Uninsured, Medication, Healthcare Utilization
Politi MC, Kaphingst KA, Kreuter M
Knowledge of health insurance terminology and details among the uninsured.
This study examined currently uninsured individuals’ understanding of terminology and details in health care plans in a series of interviews of a small mostly low-income and African American population. It found that the cost of the premium and having fixed costs through co-payments rather than coinsurance were very important so that individuals could budget as best as possible.
AHRQ-funded; HS020309.
Citation: Politi MC, Kaphingst KA, Kreuter M .
Knowledge of health insurance terminology and details among the uninsured.
Med Care Res Rev 2014 Feb;71(1):85-98. doi: 10.1177/1077558713505327..
Keywords: Uninsured, Low-Income, Health Insurance
Sommers BD, Kenney GM, Epstein AM
New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions.
Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the Affordable Care Act’s option to expand coverage earlier to a portion of low-income childless adults. The researchers present new data on these expansions focusing on several questions including the extent to which childless adults’ new enrollment in Medicaid result from extending coverage to uninsured people as opposed to replacing private coverage.
AHRQ-funded; HS021291.
Citation: Sommers BD, Kenney GM, Epstein AM .
New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions.
Health Aff 2014 Jan;33(1):78-87. doi: 10.1377/hlthaff.2013.1087..
Keywords: Low-Income, Uninsured, Medicaid, Health Insurance