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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 25 of 56 Research Studies DisplayedScott JW, Scott KW, Moniz M
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
This cross-sectional study linked insurance claims and consumer credit report data to evaluate the experience of financial distress in commercially insured adults after traumatic injury. Data from Blue Cross Blue Shield of Michigan’s preferred provider organization insurance claims from 2019 through 2021 were included. The authors identified working-age adults aged 21 to 64 whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury. This cohort of 3164 adults was compared demographically to 2223 patients in the comparison cohort. Relative to the comparison cohort, the post injury cohort had a 23% higher likelihood of having medical debt in collections, a 70% higher amount of medical debt in collections, and a 110% higher bankruptcy rate. For many commercially insured patients, the burden of out-of-pocket costs after hospitalization exceeded their ability to pay and could be associated with bankruptcy risk.
AHRQ-funded; HS028672; HS025465; HS028817.
Citation: Scott JW, Scott KW, Moniz M .
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
JAMA Health Forum 2022 Nov;3(11):e224105. doi: 10.1001/jamahealthforum.2022.4105..
Keywords: Trauma, Healthcare Costs, Health Insurance
Donohue JM, Cole ES, James CV
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
This article is a literature review of the Medicaid program focusing on Medicaid eligibility, enrollment, and spending and examined areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity. The authors included peer-reviewed articles and reports published between January 2003 and February 2022. Medicaid covered approximately 80.6 million people per month in 2022, representing 16.3% of US health spending. Managed care plans run by states enrolled 69.5% of Medicaid beneficiaries in 2019 and adopted 139 delivery system reforms from 2003 to 2019. Over half (56.4%) of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. The authors felt that additional Medicaid reforms are needed to reduce health disparities by race and ethnicity and to achieve equity in access, quality, and outcomes.
AHRQ-funded; HS026727.
Citation: Donohue JM, Cole ES, James CV .
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
JAMA 2022 Sep 20;328(11):1085-99. doi: 10.1001/jama.2022.14791..
Keywords: Medicaid, Healthcare Costs, Policy, Health Insurance
Jazowski SA, Wilson L, Dusetzina SB
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
The purpose of this study was to evaluate the relationship between High-deductible health plan (HDHP) enrollment with out-of-pocket spending and uptake of and adherence to lenalidomide anti-cancer therapy. The researchers found that among the highest spenders (95th percentile), HDHP enrollees paid $376 and $217 more for their first and any lenalidomide prescription fill, respectively, compared with non-HDHP enrollees in the 6 months after initiation. High-deductible health plan enrollment was also associated with an increased risk of paying more than $100 for the initial lenalidomide prescription fill. The study concluded that enrollment in HDHP was associated with higher out-of-pocket spending per lenalidomide prescription fill; however, no statistically significant differences in adherence patterns between HDHP and non-HDHP enrollees were observed.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Wilson L, Dusetzina SB .
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
JAMA Netw Open 2022 Jun;5(6):e2215720. doi: 10.1001/jamanetworkopen.2022.15720..
Keywords: Health Insurance, Healthcare Costs, Cancer
Levine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA .
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care
Meiselbach MK, Eisenberg MD, Bai G
Labor market concentration and worker contributions to health insurance premiums.
This study’s objective was to examine if labor market concentration was associated with higher worker contributions to health plan premiums. The authors combined publicly available data from the Census to calculate labor market concentration and the Medical Expenditure Panel Survey Insurance/Employer Component to determine premium contributions from 2010 to 2016 for metropolitan areas. They found that higher labor market concentration was associated with higher worker contributions to health plan premiums, lower take-home income, and no change in employer contributions to premiums consistent with their hypothesis.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Eisenberg MD, Bai G .
Labor market concentration and worker contributions to health insurance premiums.
Med Care Res Rev 2022 Apr;79(2):198-206. doi: 10.1177/10775587211012992..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs
Cliff BQ
Do high-deductible health plans affect price paid for childbirth?
The purpose of this study was to test whether out-of-pocket costs and negotiated hospital prices for childbirth change after enrollment in high-deductible health plans (HDHPs) and whether price effects differ in markets with more hospitals. Administrative medical claims data from three large commercial insurers with plans in all U.S. states was provided by the Health Care Cost Institute. Findings showed that prices for childbirth in markets with more hospitals decreased after HDHP switch due to lower hospital prices for HDHPs relative to prices at those same hospitals for non-HDHPs.
AHRQ-funded; HS025614.
Citation: Cliff BQ .
Do high-deductible health plans affect price paid for childbirth?
Health Serv Res 2022 Feb;57(1):27-36. doi: 10.1111/1475-6773.13702..
Keywords: Labor and Delivery, Health Insurance, Healthcare Costs, Women
Friedman S, Xu H, Azocar F
Carve-out plan financial requirements associated with national behavioral health parity.
The authors examined changes in carve-out financial requirements following the Mental Health Parity and Addiction Equity Act (MHPAEA). They found that the MHPAEA was associated with increased generosity in most observed financial requirements, but increased use of deductibles may have reduced generosity for some patients.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Azocar F .
Carve-out plan financial requirements associated with national behavioral health parity.
Health Serv Res 2020 Dec;55(6):924-31. doi: 10.1111/1475-6773.13542..
Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Access to Care, Policy
Henke RM, Karaca Z, Gibson TB
Medicaid Accountable Care Organizations and childbirth outcomes.
This study examined the impact of Accountable Care Organizations (ACOs) to childbirth outcomes. States that use Medicaid ACOs were compared with states that had not adopted ACO. Using HCUP data, the relationship between Medicaid ACO adoption and neonatal and maternal outcomes, and cost per birth was examined. Medicaid ACO implementation was associated with a moderate reduction in hospital costs per birth and decreased cesarean section rates with results varying by state. There was no association with other birth outcomes, including infant inpatient mortality, low birthweight, neonatal intensive care unit utilization and severe maternal morbidity.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicaid Accountable Care Organizations and childbirth outcomes.
Med Care Res Rev 2020 Dec;77(6):559-73. doi: 10.1177/1077558718823132..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Health Insurance, Healthcare Costs, Labor and Delivery, Pregnancy, Women, Outcomes
Zhou RA, Beaulieu ND, Cutler D
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
The purpose of this study was to characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population. Investigators concluded that a growing share of physicians were part of a health system from 2012 to 2016.
AHRQ-funded; HS024072.
Citation: Zhou RA, Beaulieu ND, Cutler D .
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
Health Serv Res 2020 Dec;55(Suppl 3):1098-106. doi: 10.1111/1475-6773.13590.
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Keywords: Primary Care, Quality of Care, Health Insurance, Healthcare Costs
Dalton VK, Moniz MH, Bailey MJ
Trends in birth rates after elimination of cost sharing for contraception by the Patient Protection and Affordable Care Act.
Researchers evaluated changes in birth rates by income level among commercially insured women before (2008-2013) and after (2014-2018) the elimination of cost sharing for contraception under the Patient Protection and Affordable Care Act (ACA). The analytic sample included over 4.5 million women enrolled in 47,721 health plans. In this cross-sectional study, the researchers found that the elimination of cost sharing for contraception under the ACA was associated with improvements in contraceptive method prescription fills and a decrease in births among commercially insured women. Women with low income had more precipitous decreases than women with higher income, suggesting that enhanced access to contraception may address well-documented income-related disparities in unintended birth rates.
AHRQ-funded; HS025465; HS023784.
Citation: Dalton VK, Moniz MH, Bailey MJ .
Trends in birth rates after elimination of cost sharing for contraception by the Patient Protection and Affordable Care Act.
JAMA Netw Open 2020 Nov 2;3(11):e2024398. doi: 10.1001/jamanetworkopen.2020.24398..
Keywords: Policy, Health Insurance, Women, Healthcare Costs, Pregnancy, Sexual Health
Wisk LE, Peltz A, Galbraith AA
Changes in health care-related financial burden for US families with children associated with the Affordable Care Act.
The Affordable Care Act (ACA) sought to improve access and affordability of health insurance. Although most ACA policies targeted childless adults, the extent to which these policies also impacted families with children remains unclear. The purpose of this study was to examine changes in health care-related financial burden for US families with children before and after the ACA was implemented based on income eligibility for ACA policies.
AHRQ-funded; HS024700.
Citation: Wisk LE, Peltz A, Galbraith AA .
Changes in health care-related financial burden for US families with children associated with the Affordable Care Act.
JAMA Pediatr 2020 Nov;174(11):1032-40. doi: 10.1001/jamapediatrics.2020.3973..
Keywords: Children/Adolescents, Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Health Insurance, Policy, Access to Care
Roberts ET, McGarry BE, Glynn A
Cognition and take-up of the Medicare Savings Programs.
In this study, the investigators examined the association between cognition and Medicare Savings Program (MSP) enrollment among elderly Medicare beneficiaries who qualified for these programs. They also examined enrollment in the Low-Income Subsidy (LIS), a separate program that provides premium and cost-sharing assistance in Medicare Part D that Medicare beneficiaries automatically received if they are enrolled in an MSP.
AHRQ-funded; HS026727.
Citation: Roberts ET, McGarry BE, Glynn A .
Cognition and take-up of the Medicare Savings Programs.
JAMA Intern Med 2020 Nov;180(11):1529-31. doi: 10.1001/jamainternmed.2020.2783..
Keywords: Elderly, Medicare, Health Insurance, Healthcare Costs, Low-Income, Dementia, Neurological Disorders
Hill SC, Miller GE, Ding Y
AHRQ Author: Hill SC, Miller GE, Ding Y
Net spending on retail specialty drugs grew rapidly, especially for private insurance and Medicare Part D.
This study examined net spending trends on retail specialty drugs from 2010 to 2017. Spending has been difficult to measure due to proprietary rebate payments by manufacturers by insurers, pharmacy benefit managers and state Medicaid agencies. The authors incorporated those rebates into their research. They found that specialty drugs accounted for 37.7% of retail and mail-order prescription spending net of rebates in 2016-17. The spending net of rebates tripled for Medicare Part D beneficiaries and more than doubled for people with private insurance from 2010 to 2017. Medicaid net spending of rebates had a slower increase.
AHRQ-authored.
Citation: Hill SC, Miller GE, Ding Y .
Net spending on retail specialty drugs grew rapidly, especially for private insurance and Medicare Part D.
Health Aff 2020 Nov;39(11):1970-76. doi: 10.1377/hlthaff.2019.01830..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Medication, Medicare, Health Insurance
Fung V, Price M, Nierenberg AA
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
This study looked at outcomes from reducing behavioral health care Medicare coinsurance from 50% to 20% from 2009 to 2013. The sample of patients looked at included some diagnosed with SMI (serious mental illness) including schizophrenia, bipolar, or major depressive disorder). Data analysis was performed on 793,275 beneficiaries with SMI in 2008 and compared them with costs in 2013. The mean adjusted out-of-pocket costs for outpatient behavioral care decreased from $132 annually to $64, but the number of visits only increased slightly. No association was found between cost-sharing reductions and changes in behavioral health care visits.
AHRQ-funded; HS024725.
Citation: Fung V, Price M, Nierenberg AA .
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
JAMA Netw Open 2020 Oct;3(10):e2019854. doi: 10.1001/jamanetworkopen.2020.19854..
Keywords: Medicare, Health Insurance, Depression, Behavioral Health, Low-Income, Healthcare Costs, Healthcare Utilization
Nicholas LH, Wu S
Do Medicare Advantage rebates reduce enrollees' out-of-pocket spending?
Researchers used survey data on Medicare Advantage (MA) beneficiaries' actual out-of-pocket spending linked to MA payment information to test whether higher plan payments and rebates lowered enrollee out-of-pocket spending. They found that beneficiaries recovered only $0.65 of every $1.00 in payments exceeding fee-for-service spending through lower out-of-pocket spending but more than fully recovered the value of the rebates supporting supplemental benefits.
AHRQ-funded; HS000029.
Citation: Nicholas LH, Wu S .
Do Medicare Advantage rebates reduce enrollees' out-of-pocket spending?
Med Care Res Rev 2020 Oct;77(5):474-82. doi: 10.1177/1077558718807847..
Keywords: Healthcare Costs, Medicare, Health Insurance
Roberts ET, Nimgaonkar A, Aarons J
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
The authors developed the first longitudinal database of state Medicaid policies for paying the cost sharing in Medicare Part B for services provided to dual Medicare-Medicaid enrollees (duals), and an index summarizing the impact of these policies on payments for physician office services. Information from 2004-2018 was consolidated from online Medicaid policy documents, state laws, and policy data reported to them by state Medicaid programs. The database showed that in 2018 42 states had policies to limit Medicaid payments of Medicare cost sharing when Medicaid’s fee schedule was lower than Medicare’s. This was an increase from 36 such states in 2004. In most states, combined Medicare and Medicare payments for evaluation and management services provided to duals averaged 78% of the Medicare allowed amount for these services.
AHRQ-funded; HS026727.
Citation: Roberts ET, Nimgaonkar A, Aarons J .
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
Health Serv Res 2020 Oct;55(5):701-09. doi: 10.1111/1475-6773.13545..
Keywords: Medicaid, Medicare, Payment, Policy, Healthcare Costs, Health Insurance
Encinosa WE
AHRQ Author: Encinosa WE
Is it time for ACOs to start tackling the high costs of surgery?
This article discusses an article appearing in the same issue revisiting the impact of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) on surgery expenditures. The author suggests that, in order to engage even more surgeons, it is likely that MSSP ACOs will have to work with surgeons in the various Medicare bundled payment programs for surgery. He concludes that the next stage is to examine how these different programs can work together to produce even more savings in surgical care.
AHRQ-authored.
Citation: Encinosa WE .
Is it time for ACOs to start tackling the high costs of surgery?
Am J Accountable Care 2020 Sep 15;8(3):26-27..
Keywords: Surgery, Healthcare Costs, Medicaid, Health Insurance, Payment
Modi PK, Moloci N, Herrel LA
Medicare accountable care organizations reduce spending on surgery.
This study examined the impact that Medicare accountable care organization (ACO) alignment has on spending for inpatient and outpatient surgical care. Researchers identified adults 65 years of age and older enrolled in fee-for-service Medicare from among a 20% random sample of beneficiaries and distinguished between those aligned and unaligned with a Medicare ACO, then measured payments for surgical services made on the enrollees’ behalf. Findings showed that ACO alignment was associated with savings on surgical care. These savings resulted from increased outpatient surgery and reduced use of inpatient surgery as well as reduced spending per inpatient surgical episode. Greater focus on surgical care to improve the ability of ACOs to control healthcare spending was recommended.
AHRQ-funded; HS024728; HS024525; HS026908.
Citation: Modi PK, Moloci N, Herrel LA .
Medicare accountable care organizations reduce spending on surgery.
Am J Accountable Care 2020 Sep;8(3):12-19..
Keywords: Medicare, Surgery, Healthcare Costs, Health Insurance, Elderly
Brown TT, Guo C, Whaley C
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
This study examined how reference-based benefits (RBB) affect out-of-pocket payments across outpatient procedures. The California Public Employees’ Retirement System (CalPERS) applied RBB only to outpatient procedures performed in a hospital outpatient department (HOPD) and not to outpatient procedures performed in a lower cost ambulatory surgery center. Claims from 2009-2013 on arthroscopy and colonoscopy services were analyzed. CalPERS patients paid an average of 63.9% more for HOPDs than ambulatory surgery centers in 2012, but for arthroscopy there was no statistically different cost sharing. This led to high-priced HOPDs being less likely to be chosen by CalPERS patients for both procedures.
AHRQ-funded; HS022098.
Citation: Brown TT, Guo C, Whaley C .
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
Med Care Res Rev 2020 Jun;77(3):261-73. doi: 10.1177/1077558718793325..
Keywords: Payment, Healthcare Costs, Health Insurance, Ambulatory Care and Surgery
Dekhne MS, Nuliyalu U, Schoenfeld AJ
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
This study examined “surprise” out-of-network billing in orthopedic surgery. Data was analyzed from the Clinformatics DataMart on commercial insured patients undergoing 4 different elective orthopedic procedures from 2012 to 2017: arthroscopic meniscal repair, lumbar discectomy, total knee replacement and total hip replacement. They defined surprise bills as out-of-network bills for procedures done at in-network hospitals. The rate of potential surprise bills was 24.8% for total knee replacement, 24.5% lumbar discectomy, 23.5% for total hip replacement, and 12.5% for meniscal repair. The largest number of surprise bills came from anesthesiologists (39% of all episodes), and durable medical equipment (15%). Per episode, the largest bills came from nonphysician surgical assistants, neurologists, and physician assistants.
AHRQ-funded; HS000053; HS023597.
Citation: Dekhne MS, Nuliyalu U, Schoenfeld AJ .
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
Ann Surg 2020 May;271(5):e116-e18. doi: 10.1097/sla.0000000000003825..
Keywords: Orthopedics, Surgery, Payment, Healthcare Costs, Health Insurance
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
AHRQ-authored.
Citation: Cook BL, Flores M, Zuvekas SH .
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
Tseng CW, Masuda C, Chen R
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
In this study, the investigators examined how patients’ out-of-pocket costs for insulin would have dropped from 2014 to 2019 due to Part D policy changes and whether higher insulin prices offset these potential savings. The authors concluded that efforts to reduce patients’
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
AHRQ-funded; HS024227.
Citation: Tseng CW, Masuda C, Chen R .
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
Diabetes Care 2020 Apr;43(4):e50-e51. doi: 10.2337/dc19-1294..
Keywords: Medication, Healthcare Costs, Medicare, Health Insurance, Policy
Grafova IB, Monheit AC, Kumar R
How do changes in income, employment and health insurance affect family mental health spending?
This study used eight two-year panels from the MEPS data for 2004 to 2012 to examine the effect of economic shocks on mental health spending by families with children. Researchers wanted to determine whether the greatest impact on mental health spending comes from income, employment, or health insurance shocks. They used two-part expenditure models to estimate that employment losses are positively related to an increase in total family mental health expenditures. But no link was found between economic shocks and mental health spending on fathers.
AHRQ-funded; HS024053.
Citation: Grafova IB, Monheit AC, Kumar R .
How do changes in income, employment and health insurance affect family mental health spending?
Rev Econ Househ 2020 Mar;18(1:239-63. doi: 10.1007/s11150-018-9436-y.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Behavioral Health, Social Determinants of Health, Health Insurance
Chhabra KR, Sheetz KH, Nuliyalu U
Out-of-network bills for privately insured patients undergoing elective surgery with in-network primary surgeons and facilities.
This study evaluated the prevalence of out-of-network billing for in-network elective surgery for 7 common procedures. The study used retrospective claims data from a large US commercial insurer of 347,356 patients who had undergone 1 of 7 common elective operations. The procedures performed were: arthroscopic meniscal repair [116,749]; laparoscopic cholecystectomy [82,372]; hysterectomy [67,452]; total knee replacement [42,313]; breast lumpectomy [18,018]; colectomy [14,074]; and coronary artery bypass graft surgery [6378]. These were performed by an in-network primary surgeon at an in-network facility between January 1, 2012, and September 30, 2017. A total of 20.5% of episodes had an out-of-network bill. The most common bills were associated with surgical assistants (37%) and anesthesiologists (37%). Surgical complications were associated with a higher risk of out-of-network bills as well.
AHRQ-funded; HS000053; HS023597.
Citation: Chhabra KR, Sheetz KH, Nuliyalu U .
Out-of-network bills for privately insured patients undergoing elective surgery with in-network primary surgeons and facilities.
JAMA 2020 Feb 11;323(6):538-47. doi: 10.1001/jama.2019.21463..
Keywords: Healthcare Costs, Health Insurance, Surgery
Lin SC, Yan PL, Moloci NM
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, the investigators evaluated the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15.
AHRQ-funded; HS024728; HS024525; HS025165; HS025875.
Citation: Lin SC, Yan PL, Moloci NM .
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Health Aff 2020 Feb;39(2):310-18. doi: 10.1377/hlthaff.2019.00181..
Keywords: Healthcare Costs, Primary Care, Medicare, Health Insurance