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AHRQ Research Studies Date
Topics
- Access to Care (2)
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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 23 of 23 Research Studies DisplayedHerring B, Trish E
Explaining the growth in US health care spending using state-level variation in income, insurance, and provider market dynamics.
The authors estimated a regression model for state personal health care spending for 1991-2009, then used the results to produce state-level projections of health care spending for 2010-2013 and compared those average projected state values with actual national spending for 2010-2013. They found that at least 70% of the recent slowdown in health care spending can likely be explained by long-standing patterns.
AHRQ-funded; HS000046.
Citation: Herring B, Trish E .
Explaining the growth in US health care spending using state-level variation in income, insurance, and provider market dynamics.
Inquiry 2015 Dec 9;52. doi: 10.1177/0046958015618971.
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Keywords: Healthcare Costs, Health Insurance, Provider: Health Personnel, Policy, Policy
Jacobs PD, Banthin JS, Trachtman S
AHRQ Author: Jacobs PD
Insurer competition in federally run marketplaces is associated with lower premiums.
The researchers studied insurer participation and premiums during the first two years of the Marketplaces. They found that the addition of a single insurer in a county was associated with a 1.2 percent lower premium for the average silver plan and a 3.5 percent lower premium for the benchmark plan in the federally run Marketplaces.
AHRQ-authored.
Citation: Jacobs PD, Banthin JS, Trachtman S .
Insurer competition in federally run marketplaces is associated with lower premiums.
Health Aff 2015 Dec;34(12):2027-35. doi: 10.1377/hlthaff.2015.0548..
Keywords: Healthcare Costs, Health Insurance
Neprash HT, Wallace J, Chernew ME
Measuring prices in health care markets using commercial claims data.
The objective of this study was to compare methods of price measurement in health care markets. It concluded that market-level price measures reflecting broad sets of services are likely to rank markets similarly. Price indices relying on individual sentinel services may be more appropriate for examining specialty- or service-specific drivers of prices.
AHRQ-funded; HS000055.
Citation: Neprash HT, Wallace J, Chernew ME .
Measuring prices in health care markets using commercial claims data.
Health Serv Res 2015 Dec;50(6):2037-47. doi: 10.1111/1475-6773.12304..
Keywords: Data, Healthcare Costs, Health Insurance, Health Services Research (HSR)
Vistnes J, Selden TM, Zawacki A
AHRQ Author: Vistnes J, Selden TM
Several factors responsible for the recent slowdown in premium growth in employer-sponsored insurance.
Researchers have been seeking to identify which factors behind the recent spending slowdown . This study found that the slowdown in premium growth that preceded the recession reflected declining growth rates in per policyholder premiums. For 2009-11, however, the dominant contributors to the slowdown were factors underlying declining employee enrollment: a sharp downturn in employment in 2009, followed by eroding offer and eligibility rates.
AHRQ-authored.
Citation: Vistnes J, Selden TM, Zawacki A .
Several factors responsible for the recent slowdown in premium growth in employer-sponsored insurance.
Health Aff 2015 Dec;34(12):2036-43. doi: 10.1377/hlthaff.2015.0436..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Health Insurance
Robinson JC, Brown TT, Whaley C
Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications.
The researchers ascertained the effect of reference payment on facility choice, insurer spending, consumer cost sharing, and procedural complications for colonoscopy. They concluded that Implementation of reference payment for colonoscopy was associated with reduced spending and no change in complications.
AHRQ-funded; HS022098.
Citation: Robinson JC, Brown TT, Whaley C .
Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications.
JAMA Intern Med 2015 Nov;175(11):1783-9. doi: 10.1001/jamainternmed.2015.4588..
Keywords: Colonoscopy, Healthcare Costs, Adverse Events, Health Insurance
Golberstein E, Gonzales G, Sommers BD
California's early ACA expansion increased coverage and reduced out-of-pocket spending for the state's low-income population.
The researchers used data from the National Health Interview Survey to examine the impact of California’s Low Income Health Program. Their study demonstrates that the county-by-county rollout of expanded public insurance coverage in California significantly increased coverage, by 7 percentage points, and significantly reduced the likelihood of any family out-of-pocket medical spending in the previous year, by 10 percentage points, among low-income adults.
AHRQ-funded; HS021291.
Citation: Golberstein E, Gonzales G, Sommers BD .
California's early ACA expansion increased coverage and reduced out-of-pocket spending for the state's low-income population.
Health Aff 2015 Oct;34(10):1688-94. doi: 10.1377/hlthaff.2015.0290..
Keywords: Low-Income, Healthcare Costs, Health Insurance, Uninsured
Gray SH, Trudell EK, Emans SJ
Total direct medical expenses and characteristics of privately insured adolescents who incur high costs.
This study assessed health care expenditures for high-cost adolescents and described the patient characteristics associated with high medical costs. It concluded that total direct medical expenses for privately insured high-cost adolescents are associated with medical complexity, mental health conditions, and obesity. Cost reduction strategies in similar populations should be tailored to these cost drivers.
AHRQ-funded; HS023092.
Citation: Gray SH, Trudell EK, Emans SJ .
Total direct medical expenses and characteristics of privately insured adolescents who incur high costs.
JAMA Pediatr 2015 Oct;169(10):e152682. doi: 10.1001/jamapediatrics.2015.2682..
Keywords: Access to Care, Children/Adolescents, Healthcare Costs, Health Insurance
Jacobs PD, Buntin MB
AHRQ Author: Jacobs PD
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
This study evaluated the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. It found that Medicare Advantage enrollees are relatively insensitive to premiums, but more responsive to reductions in medical cost sharing in their benefit packages.
AHRQ-authored.
Citation: Jacobs PD, Buntin MB .
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
Am J Manag Care 2015 Jul;21(7):498-504..
Keywords: Medicare, Health Insurance, Healthcare Costs
Trish EE, Herring BJ
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
The authors examined the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. They found that premiums are higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration.
AHRQ-funded; HS000046.
Citation: Trish EE, Herring BJ .
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
J Health Econ 2015 Jul;42:104-14. doi: 10.1016/j.jhealeco.2015.03.009.
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Keywords: Health Insurance, Healthcare Costs, Payment, Health Insurance, Hospitals
Herring B, Trish E
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
The authors discuss a provision of the ACA that will introduce a 40 percent excise tax on health benefits exceeding a $10,200 threshold for single coverage and a $27,500 threshold for family coverage, annually. They argue that the low-income workers receive a relatively smaller subsidy to offset a portion of the Cadillac tax while the high-income workers receive a relatively larger subsidy to offset a portion of the Cadillac tax. All this adds up to a regressive effect.
AHRQ-funded; HS000046.
Citation: Herring B, Trish E .
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
AMA J Ethics 2015 Jul;17(7):672-9. doi: 10.1001/journalofethics.2015.17.7.sect1-1507..
Keywords: Healthcare Costs, Health Insurance, Policy
Shih YC, Smieliauskas F, Geynisman DM
Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011.
This study sought to define and identify drivers of trends in cost and use of targeted therapeutics among privately insured nonelderly patients with cancer receiving chemotherapy between 2001 and 2011. It found a large increase in the use of targeted intravenous anticancer medications and a gradual increase in targeted oral anticancer medications; targeted therapies accounted for 63 percent of all chemotherapy expenditures in 2011.
AHRQ-funded; HS018535; HS020263.
Citation: Shih YC, Smieliauskas F, Geynisman DM .
Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011.
J Clin Oncol 2015 Jul 1;33(19):2190-6. doi: 10.1200/jco.2014.58.2320..
Keywords: Healthcare Costs, Cancer, Health Insurance, Medication
Akosa Antwi Y, Moriya AS, Simon K
AHRQ Author: Moriya AS
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
This study examined the effects of the Affordable Care Act’s expansion of family insurance coverage to include dependents up to the age of 26 on the use of the emergency department by 19 to 25 year young adults. It found a modest but statistically significant decrease in ED use related to weekday visits, nonurgent conditions and conditions treatable in other settings.
AHRQ Author
Citation: Akosa Antwi Y, Moriya AS, Simon K .
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
Ann Emerg Med. 2015 Jun;65(6):664-672.e2. doi: 10.1016/j.annemergmed.2015.01.010..
Keywords: Healthcare Costs, Emergency Department, Health Insurance
Hirth RA, Gibson TB, Levy HG
New evidence on the persistence of health spending.
Using the MarketScan claims database, the researchers characterized the persistence of health care spending in the privately insured, under-65 population. They found that over a 6-year period,69.8 percent of enrollees never had annual spending in the top 10 percent of the distribution and the bottom 50 percent of spenders accounted for less than 10 percent of spending.
AHRQ-funded; HS017706.
Citation: Hirth RA, Gibson TB, Levy HG .
New evidence on the persistence of health spending.
Med Care Res Rev 2015 Jun;72(3):277-97. doi: 10.1177/1077558715572387..
Keywords: Healthcare Costs, Health Insurance, Data
Geynisman DM, Hu JC, Liu L
Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States.
The researchers used a large claims database to examine the evolution of treatment patterns and associated costs for 1527 metastatic renal cell carcinoma (mRCC) patients in the United States. They found that the treatment of mRCC has transitioned from cytokines and cytotoxic chemotherapy to almost exclusively targeted therapy. Cost of care for mRCC is rising each year, and out-of-pocket costs for patients are significant.
AHRQ-funded; HS018535; HS020263.
Citation: Geynisman DM, Hu JC, Liu L .
Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States.
Clin Genitourin Cancer 2015 Apr;13(2):e93-100. doi: 10.1016/j.clgc.2014.08.013..
Keywords: Cancer, Kidney Disease and Health, Health Insurance, Healthcare Costs
Robinson JC, Brown T, Whaley C
Reference-based benefit design changes consumers' choices and employers' payments for ambulatory surgery.
The researchers analyzed the impact of reference-based benefit (RBB) designs on cataract surgery patients choice of less-expensive ambulatory surgery centers over more expensive hospital outpatient departments. Examining two groups of patients, one in plans incorporating RBB and the other in non-RBB plans, they found that the shift to RBB led to an 8.6 percent increase in ambulatory surgery centers as well as a 19.7 percent decrease in payments per procedure.
AHRQ-funded; HS022098
Citation: Robinson JC, Brown T, Whaley C .
Reference-based benefit design changes consumers' choices and employers' payments for ambulatory surgery.
Health Aff. 2015 Mar;34(3):415-22. doi: 10.1377/hlthaff.2014.1198..
Keywords: Ambulatory Care and Surgery, Eye Disease and Health, Health Insurance, Healthcare Costs, Health Insurance
Manski RJ, Moeller JF, Chen H
AHRQ Author: Manski RJ
Dental use and expenditures for older uninsured Americans: the simulated impact of expanded coverage.
The purpose of this paper is to empirically determine if insurance alone would close the current gaps in dental use and expenditures between insured and uninsured older Americans. Comparing simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured, the authors found that it would close previous gaps in use and expense.
AHRQ-authored.
Citation: Manski RJ, Moeller JF, Chen H .
Dental use and expenditures for older uninsured Americans: the simulated impact of expanded coverage.
Health Serv Res. 2015 Feb;50(1):117-35. doi: 10.1111/1475-6773.12205..
Keywords: Medical Expenditure Panel Survey (MEPS), Dental and Oral Health, Health Insurance, Elderly, Healthcare Costs
Hill SC
AHRQ Author: Hill SC
Medicaid expansion in opt-out states would produce consumer savings and less financial burden than exchange coverage.
This study simulated potential differences in out-of-pocket spending for uninsured adults gaining eligibility for Marketplace coverage (silver plan) because their states have not used the provisions of the Affordable Care Act to expand Medicaid. Compared with having a Marketplace silver plan, being able to take advantage to expanded Medicaid would reduce average out-of-pocket spending by more than 50 percent for these adults and their families.
AHRQ-authored.
Citation: Hill SC .
Medicaid expansion in opt-out states would produce consumer savings and less financial burden than exchange coverage.
Health Aff. 2015 Feb;34(2):340-9. doi: 10.1377/hlthaff.2014.1058..
Keywords: Healthcare Costs, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Scott JW, Sommers BD, Tsai TC
Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients.
The Affordable Care Act (ACA) allows young adults to remain covered under their parents’ plans until age 26. This study conducted a difference-in-differences analysis of coverage rates among trauma patients ages 19-25 (compared to patients ages 26 to 34) and examined trauma-relevant outcomes. It found a 3.4 percent decrease in uninsurance status among younger trauma patients following the ACA policy change.
AHRQ-funded; HS000055
Citation: Scott JW, Sommers BD, Tsai TC .
Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients.
Health Aff. 2015 Jan;34(1):125-33. doi: 10.1377/hlthaff.2014.0880..
Keywords: Access to Care, Healthcare Costs, Health Insurance, Outcomes
Chung S, Lesser LI, Lauderdale DS
Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.
The researchers find that, following the implementation of the Affordable Care Act which expanded Medicare coverage to fully cover annual preventive care visits, the annual use of preventive visits among Medicare fee-for-service patients rose from 1.7 percent to 27.5 percent. However, the increased rates are still 10-20 percentage points lower than those with private or Medicare HMO coverage.
AHRQ-funded; HS019815
Citation: Chung S, Lesser LI, Lauderdale DS .
Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.
Health Aff. 2015 Jan;34(1):11-20. doi: 10.1377/hlthaff.2014.0483..
Keywords: Medicare, Healthcare Costs, Prevention, Health Insurance
Trish E, Joyce G, Goldman DP
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
The authors analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007-11 pharmacy claims data. They found that annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, but specialty drugs accounted for less than ten percent of total drug spending per beneficiary. Additionally, in 2011, cost-sharing reductions under the Affordable Care Act significantly reduced specialty drug users' out-of-pocket burden, which decreased 26 percent from 2010.
AHRQ-funded; HS000046.
Citation: Trish E, Joyce G, Goldman DP .
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
Health Aff 2014 Nov;33(11):2018-24. doi: 10.1377/hlthaff.2014.0538.
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Keywords: Healthcare Costs, Health Insurance, Medicare, Medication
Starner CI, Alexander GC, Bowen K
Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.
The investigators examined insurers' role in maintaining the affordability and accessibility of specialty drugs while maximizing their value. They found that drug coupons accounted for $21.2 million of patients' $35.3 million annual out-of-pocket costs. In the vast majority of cases, coupons reduced monthly cost sharing to less than $250, a point at which patients were far less likely to abandon therapy with biologic anti-inflammatory drugs or with drugs for multiple sclerosis. They highlighted that, by reducing cost sharing, coupons may also circumvent efforts to encourage patients to use the most cost-effective drugs.
AHRQ-funded; HS018960.
Citation: Starner CI, Alexander GC, Bowen K .
Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.
Health Aff 2014 Oct;33(10):1761-9. doi: 10.1377/hlthaff.2014.0497.
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Keywords: Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Martin BI, Franklin GM, Deyo RA
How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.
In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among injured workers, this study compared the use of complex fusion techniques, adverse outcomes within 3 months, and costs for California and Washington State with workers’ compensation policies that differed in their coverage restrictions. The researchers found that California’s broader coverage policy was associated with more aggressive practice, higher rates of reoperation, readmission and other complications.
AHRQ-funded; HS018405
Citation: Martin BI, Franklin GM, Deyo RA .
How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.
Spine J. 2014 Jul;14(7):1237-46. doi: 10.1016/j.spinee.2013.08..
Keywords: Health Insurance, Surgery, Healthcare Costs, Healthcare Utilization
Bernard DM, Johansson P, Fang Z
AHRQ Author: Bernard DM
Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension.
The investigators examined the prevalence of high out-of-pocket burdens and self-perceived financial barriers to care among patients receiving hypertension treatment. They found that the prevalence of high total burdens was significantly greater for persons receiving treatment for hypertension compared with other chronically ill and well patients. Among hypertension patients with high total burdens, 15.7% said they were unable to get care and 13.6% said they delayed care due to financial reasons.
AHRQ-authored.
Citation: Bernard DM, Johansson P, Fang Z .
Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension.
Am J Manag Care 2014 May;20(5):406-13.
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Keywords: Medical Expenditure Panel Survey (MEPS), Blood Pressure, Healthcare Costs, Health Insurance