National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
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- Access to Care (5)
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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 8 of 8 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
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