National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (1)
- Behavioral Health (1)
- Blood Pressure (1)
- Cardiovascular Conditions (1)
- (-) Healthcare Costs (23)
- Healthcare Utilization (1)
- Health Insurance (9)
- Health Services Research (HSR) (1)
- Health Status (1)
- Home Healthcare (1)
- Hospitals (2)
- Kidney Disease and Health (1)
- Low-Income (1)
- Medicaid (6)
- Medical Expenditure Panel Survey (MEPS) (2)
- Medical Liability (1)
- Medicare (3)
- Medication (1)
- Nutrition (1)
- Patient Safety (1)
- Payment (4)
- (-) Policy (23)
- Prevention (1)
- Public Health (1)
- Quality of Care (1)
- Screening (1)
- Substance Abuse (1)
- Transplantation (1)
- Vulnerable Populations (1)
- Women (1)
- Young Adults (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
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 DisplayedYu H, Greenberg M, Haviland A
The impact of state medical malpractice reform on individual-level health care expenditures.
This study aims to fill the evidence gap concerning the effect of different types of malpractice reform by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. It found that only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures.
AHRQ-funded; HS023336.
Citation: Yu H, Greenberg M, Haviland A .
The impact of state medical malpractice reform on individual-level health care expenditures.
Health Serv Res 2017 Dec;52(6):2018-37. doi: 10.1111/1475-6773.12789.
.
.
Keywords: Healthcare Costs, Policy, Medical Liability, Policy
Leider JP, Tung GJ, Lindrooth RC
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, the researchers constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending.
.
.
AHRQ-funded; HS024959
Citation: Leider JP, Tung GJ, Lindrooth RC .
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
J Public Health Manag Pract 2017 Nov/Dec;23(6):e1-e9. doi: 10.1097/phh.0000000000000493.
Keywords: Healthcare Costs, Policy, Hospitals
Kazi DS, Lu CY, Lin GA
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
In this research letter the investigators analyzed the June 2016 Centers for Medicare and Medicaid Services Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files for all Part D plans (except special-needs plans that may have had specialized formularies) and out-of-pocket cost requirements for PCSK9is (alirocumab and evolocumab) averaged across all plans by counties and states. The authors asserted that their findings suggest a need to lower out-of pocket costs to ensure affordability of PCSK9is for Medicare beneficiaries covered by Part D.
AHRQ-funded; HS016772.
Citation: Kazi DS, Lu CY, Lin GA .
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
JAMA Cardiol 2017 Oct;2(10):1164-66. doi: 10.1001/jamacardio.2017.3051..
Keywords: Healthcare Costs, Medicare, Medication, Policy
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.
.
.
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Policy, Young Adults
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
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
Jacobs PD, Cohen ML, Keenan P
AHRQ Author: Jacobs PD; Keenan P
Risk adjustment, reinsurance improved financial outcomes for individual market insurers with the highest claims.
To assess the impact of a risk adjustment program and a temporary reinsurance program, the researchers compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. They found that both programs were relatively well targeted in the first two years.
AHRQ-authored.
Citation: Jacobs PD, Cohen ML, Keenan P .
Risk adjustment, reinsurance improved financial outcomes for individual market insurers with the highest claims.
Health Aff 2017 Apr;36(4):755-63. doi: 10.1377/hlthaff.2016.1456.
.
.
Keywords: Health Insurance, Healthcare Costs, Policy
Ouayogode MH, Colla CH, Lewis VA
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
This study examined Accountable Care Organization (ACO) and market factors associated with superior financial performance in Medicare ACO programs. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Colla CH, Lewis VA .
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
Healthc 2017 Mar;5(1-2):53-61. doi: 10.1016/j.hjdsi.2016.08.002.
.
.
Keywords: Healthcare Costs, Payment, Policy, Medicare
Rees MA, Dunn TB, Kuhr CS
Kidney exchange to overcome financial barriers to kidney transplantation.
Organ shortage is the major limitation to kidney transplantation in the developed world. This proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers.
AHRQ-funded; HS020610.
Citation: Rees MA, Dunn TB, Kuhr CS .
Kidney exchange to overcome financial barriers to kidney transplantation.
Am J Transplant 2017 Mar;17(3):782-90. doi: 10.1111/ajt.14106.
.
.
Keywords: Transplantation, Healthcare Costs, Policy, Kidney Disease and Health, Kidney Disease and Health
Webb M, Fahimi S, Singh GM
Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations.
This study quantified the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide. It concluded that a government "soft regulation" strategy combining targeted industry agreements and public education to reduce dietary sodium is projected to be highly cost effective worldwide, even without accounting for potential healthcare savings.
AHRQ-funded; HS000062.
Citation: Webb M, Fahimi S, Singh GM .
Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations.
BMJ 2017 Jan 10;356:i6699. doi: 10.1136/bmj.i6699.
.
.
Keywords: Healthcare Costs, Nutrition, Cardiovascular Conditions, Blood Pressure, Policy
Jacobs PD, Hill SC, Abdus S
AHRQ Author: Jacobs PD, Hill SC, Abdus S
Adults are more likely to become eligible for Medicaid during future recessions if their state expanded Medicaid.
The researchers simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states. Their simulations showed that the ACA expansion increased Medicaid's responsiveness to changes in unemployment.
AHRQ-authored.
Citation: Jacobs PD, Hill SC, Abdus S .
Adults are more likely to become eligible for Medicaid during future recessions if their state expanded Medicaid.
Health Aff 2017 Jan;36(1):32-39. doi: 10.1377/hlthaff.2016.1076.
.
.
Keywords: Medicaid, Health Insurance, Policy, Healthcare Costs
Sood N, Alpert A, Barnes K
Effects of payment reform in more versus less competitive markets.
In this paper, the authors exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, they find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets..
AHRQ-funded; HS018541.
Citation: Sood N, Alpert A, Barnes K .
Effects of payment reform in more versus less competitive markets.
J Health Econ 2017 Jan;51:66-83. doi: 10.1016/j.jhealeco.2016.12.006.
.
.
Keywords: Healthcare Costs, Payment, Home Healthcare, Policy
Kirby JB, Davidoff AJ, Basu J
AHRQ Author: Kirby JB, Basu J
The ACA's zero cost-sharing mandate and trends in out-of-pocket expenditures on well-child and screening mammography visits.
This study used a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. It concluded that the Affordable Care Act's zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits.
AHRQ-authored.
Citation: Kirby JB, Davidoff AJ, Basu J .
The ACA's zero cost-sharing mandate and trends in out-of-pocket expenditures on well-child and screening mammography visits.
Med Care 2016 Dec;54(12):1056-62. doi: 10.1097/mlr.0000000000000610.
.
.
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Screening, Women, Policy, Prevention
. .
Why did the Affordable Care Act raise coverage?
This article discusses NBER Working Paper No. 22213 on Premium Subsidies, the Mandate,and Medicaid Expansion: Coverage Effects of the Affordable Care Act by researchers Molly Frean, Jonathan Gruber, and Benjamin Sommers. The study’s key result is that the ACA’s premium subsidies led to a 0.85 percentage point increase in coverage, while the expansion of Medicaid to newly eligible individuals led to a 0.44 point increase.
AHRQ-funded; HS021291.
Citation: . . .
Why did the Affordable Care Act raise coverage?
Natl Bur Econ Res Bull Aging Health 2016(2):3.
.
.
Keywords: Medicaid, Health Insurance, Policy, Healthcare Costs
O'Shea L, Bindman AB
AHRQ Author: Bindman AB
Personal health budgets for patients with complex needs.
Some of the highest cost patients have functional impairments and social needs that necessitate long-term services and supports. One approach from England entails the creation of “personal health budgets,” a model for self-directed support that may be worth considering in the United States. The authors discuss this approach and conclude that the evidence from England suggests that patients themselves can help to design higher-value care.
AHRQ-authored.
Citation: O'Shea L, Bindman AB .
Personal health budgets for patients with complex needs.
N Engl J Med 2016 Nov 10;375(19):1815-17. doi: 10.1056/NEJMp1606040.
.
.
Keywords: Healthcare Costs, Policy, Policy
Colla CH, Lewis VA, Kao LS
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
The purpose of this cohort study was to examine the effect of Medicare accountable care organization (ACO) contracts on both spending and high-cost institutional utilization for all Medicare beneficiaries and for clinically vulnerable beneficiaries. The main outcomes and measures for this study were total spending per beneficiary-quarter, spending categories, utilization of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. The study found that total spending decreased by $34 per beneficiary-quarter after implementation of ACO contracts across the overall Medicare population and decreased $114 in clinically vulnerable patients. In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively. Hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively. Variations in total spending related with ACOs did not differ by clinical condition of beneficiaries.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Kao LS .
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
JAMA Intern Med 2016 Aug;176(8):1167-75. doi: 10.1001/jamainternmed.2016.2827.
.
.
Keywords: Medicare, Policy, Healthcare Costs, Payment, Vulnerable Populations
Jacobs PD, Duchovny N, Lipton BJ
AHRQ Author: Jacobs PD
Changes in health status and care use after ACA expansions among the insured and uninsured.
The authors investigated average health status and use of health care following the Affordable Care Act's insurance expansion provisions in 2014, finding that Medicaid enrollees and the uninsured were both healthier in 2014 than those respective groups were in 2013, but that those with individual private insurance coverage appeared less healthy as a group.
AHRQ-authored.
Citation: Jacobs PD, Duchovny N, Lipton BJ .
Changes in health status and care use after ACA expansions among the insured and uninsured.
Health Aff 2016 Jul;35(7):1184-8. doi: 10.1377/hlthaff.2015.1539.
.
.
Keywords: Healthcare Costs, Health Insurance, Policy, Health Status, Medicaid
Friedman AS, Schpero WL, Busch SH
Evidence suggests that the ACA's tobacco surcharges reduced insurance take-up and did not increase smoking cessation.
The authors examined the effect of tobacco surcharges on insurance status and smoking cessation in the first year of the health insurance exchanges' implementation, among adults most likely to purchase insurance from them. Their findings suggest that tobacco surcharges conflicted with a major goal of the Affordable Care Act - increased financial protection - without increasing smoking cessation.
AHRQ-funded; HS017589.
Citation: Friedman AS, Schpero WL, Busch SH .
Evidence suggests that the ACA's tobacco surcharges reduced insurance take-up and did not increase smoking cessation.
Health Aff 2016 Jul;35(7):1176-83. doi: 10.1377/hlthaff.2015.1540.
.
.
Keywords: Healthcare Costs, Health Insurance, Policy
Bartsch SM, Lopman BA, Ozawa S
Global economic burden of norovirus gastroenteritis.
The researchers developed a computational simulation model to estimate the economic burden of norovirus in every country/area stratified by WHO region and globally, from the health ystem and societal perspectives. They found that globally, orovirus resulted in a total of $4.2 billion in direct health system costs and $60.3 billion in societal costs per year.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Lopman BA, Ozawa S .
Global economic burden of norovirus gastroenteritis.
PLoS One 2016 Apr 26;11(4):e0151219. doi: 10.1371/journal.pone.0151219.
.
.
Keywords: Healthcare Costs, Public Health, Policy
Sommers BD, Blendon RJ, Orav EJ
Both the 'private option' and traditional Medicaid expansions improved access to care for low-income adults.
This study found that other than coverage type and trouble paying medical bills (which decreased more in Kentucky than in Arkansas), there were no significant differences between Kentucky's traditional Medicaid expansion and Arkansas's private option, which suggests that both approaches improved access among low-income adults.
AHRQ-funded; HS021291.
Citation: Sommers BD, Blendon RJ, Orav EJ .
Both the 'private option' and traditional Medicaid expansions improved access to care for low-income adults.
Health Aff 2016 Jan;35(1):96-105. doi: 10.1377/hlthaff.2015.0917.
.
.
Keywords: Medicaid, Low-Income, Healthcare Costs, Access to Care, Policy
Gooptu A, Moriya AS, Simon KI
AHRQ Author: Moriya AS
Medicaid expansion did not result in significant employment changes or job reductions in 2014.
To view the impact of the Affordable Care Act (ACA) on current labor market participation, the researchers analyzed labor-market participation among adults with incomes below 138 percent of the federal poverty level, comparing Medicaid expansion and nonexpansion states and Medicaid-eligible and -ineligible groups, for the pre-ACA period (2005-13) and the first fifteen months of the expansion (January 2014-March 2015). Medicaid expansion did not result in significant changes in employment, job switching, or full- versus part-time status.
AHRQ-authored; AHRQ-funded; HS021291.
Citation: Gooptu A, Moriya AS, Simon KI .
Medicaid expansion did not result in significant employment changes or job reductions in 2014.
Health Aff 2016 Jan;35(1):111-8. doi: 10.1377/hlthaff.2015.0747.
.
.
Keywords: Medicaid, Health Insurance, Healthcare Costs, Policy, Policy
Ryan AM, Mushlin AI
The Affordable Care Act's payment reforms and the future of hospitals.
The author places likely hospital responses to the Affordable Care Act’s payment reforms in the historical context of their previous responses to such reforms as price controls, certificate-of-need laws, and prospective payment systems. He then discusses possible hospital responses to counter readmission penalties, revenue reductions, bundled payment strategies, and accountable care organizations.
AHRQ-funded; HS018546
Citation: Ryan AM, Mushlin AI .
The Affordable Care Act's payment reforms and the future of hospitals.
Ann Intern Med. 2014 May 20;160(10):729-30. doi: 10.7326/M13-2033..
Keywords: Healthcare Costs, Payment, Hospitals, Policy
Kronick R, McKinney M
AHRQ Author: Kronick R
Ready to provide evidence for ‘making adjustments’ in Obamacare.
In this interview with Modern Healthcare, Richard Kronick, director of the Agency for Healthcare Research and Quality (AHRQ), states that his main objective for AHRQ is to produce evidence to improve the quality, safety, accessibility, and affordability of health care. He discusses several AHRQ programs and places them in the context of changes in the healthcare system triggered by Affordable Care Act.
AHRQ-authored
Citation: Kronick R, McKinney M .
Ready to provide evidence for ‘making adjustments’ in Obamacare.
Mod Healthc. 2014 Jan 6;44(1):28-9..
Keywords: Healthcare Costs, Quality of Care, Policy, Patient Safety