National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Behavioral Health (2)
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- Children/Adolescents (1)
- Chronic Conditions (1)
- Dental and Oral Health (1)
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- (-) Healthcare Costs (30)
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- Young Adults (2)
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 30 Research Studies DisplayedBiener AI, Selden TM
AHRQ Author: Biener AI, Selden TM
Public and private payments for physician office visits.
Using data for 2014-15 from the Medical Expenditure Panel Survey to estimate standardized payments for nonelderly adults' physician office visits by type of insurance, researchers found that adults with public insurance, especially Medicaid, had substantially lower provider payments, out-of-pocket spending, and third-party payments than their peers with employer-sponsored or Marketplace insurance.
AHRQ-authored.
Citation: Biener AI, Selden TM .
Public and private payments for physician office visits.
Health Aff 2017 Dec;36(12):2160-64. doi: 10.1377/hlthaff.2017.0749.
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Keywords: Healthcare Costs, Payment, Health Insurance, Ambulatory Care and Surgery, Medical Expenditure Panel Survey (MEPS)
Adrion ER, Kocher KE, Nallamothu BK
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Using multipayer commercial claims for the period 2009-13, the investigators evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In their study period, the use of observation care increased relative to that of short-stay hospitalizations. In addition, total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly--and at rates much higher than spending in the inpatient setting--over the study period.
AHRQ-funded; HS000053.
Citation: Adrion ER, Kocher KE, Nallamothu BK .
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Health Aff 2017 Dec;36(12):2102-09. doi: 10.1377/hlthaff.2017.0774..
Keywords: Health Insurance, Healthcare Costs, Healthcare Delivery, Healthcare Utilization, Hospitalization, Hospitals, Medicare
Whaley CM, Guo C, Brown TT
The moral hazard effects of consumer responses to targeted cost-sharing.
This paper examines the effects of the reference pricing program implemented by the California Public Employees Retirement System (CalPERS) in 2012. The investigators found that the cost savings from the reference pricing program was about two to three times as large as the reduction from implementing a high-deductible health plan, while the accompanying consumer surplus reduction was much smaller under reference pricing.
AHRQ-funded; HS022098.
Citation: Whaley CM, Guo C, Brown TT .
The moral hazard effects of consumer responses to targeted cost-sharing.
J Health Econ 2017 Dec;56:201-21. doi: 10.1016/j.jhealeco.2017.09.012..
Keywords: Healthcare Costs, Health Insurance, Payment
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.
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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
Ndumele CD, Schpero WL, Schlesinger MJ
Association between health plan exit from Medicaid managed care and quality of care, 2006-2014.
This study aimed to determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. It found that between 2006 and 2014, health plan exit from the US Medicaid program was frequent; however the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market.
AHRQ-funded; HS017589; HS016978.
Citation: Ndumele CD, Schpero WL, Schlesinger MJ .
Association between health plan exit from Medicaid managed care and quality of care, 2006-2014.
JAMA 2017 Jun 27;317(24):2524-31. doi: 10.1001/jama.2017.7118.
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Keywords: Medicaid, Healthcare Costs, Health Insurance, Quality of Care
Miller GE, Vistnes J, Buettgens M
AHRQ Author: Miller GE, Vistnes J
The availability and marginal costs of dependent employer-sponsored health insurance.
In this study, the investigators examined differences by firm size in the availability of dependent coverage and the incremental cost of such coverage. They indicate that their results suggest that firm size may be an important factor in policy assessments, such as analyses of the financial implications for families excluded from subsidized Marketplace coverage due to affordable offers of single coverage or of potential rollbacks to public coverage for children.
AHRQ-authored.
Citation: Miller GE, Vistnes J, Buettgens M .
The availability and marginal costs of dependent employer-sponsored health insurance.
Int J Health Econ Manag 2017 Jun;17(2):251-60. doi: 10.1007/s10754-016-9210-8..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs
Woodworth L, Romano PS, Holmes JF
Does insurance status influence a patient's hospital charge?
The objective of this study was to determine whether hospitals charge patients differently based on their insurance status. It concluded that conditional on patient characteristics, length of stay, and expected intensity of resource utilization, patients with private insurance and patients with Medicare were charged more (before discounting) than their uninsured counterparts within the same hospital.
AHRQ-funded; HS022236.
Citation: Woodworth L, Romano PS, Holmes JF .
Does insurance status influence a patient's hospital charge?
Appl Health Econ Health Policy 2017 Jun;15(3):353-62. doi: 10.1007/s40258-017-0308-z.
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Keywords: Healthcare Costs, Health Insurance, Hospitals, Medicare, Uninsured
Jacobs PD, Molloy E
AHRQ Author: Jacobs PD
How do Medicare Advantage beneficiary payments vary with tenure?
This study compared how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. Beneficiaries who remained in their plans for 6 or more years were paying $786 more than they would have spent in the lowest-cost plan compared with $552 for beneficiaries in their first year of enrollment.
AHRQ-authored.
Citation: Jacobs PD, Molloy E .
How do Medicare Advantage beneficiary payments vary with tenure?
Am J Manag Care 2017 Jun;23(6):372-77.
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Keywords: Medicare, Payment, Healthcare Costs, Health Insurance
Carey K, Dor A
http://www.healthfinancejournal.com/index.php/johcf/article/view/114
Price variations and their trends in U.S. hospitals.
This study tracked trends in prices paid to hospitals by commercial insurers over the period 2008 to 2014 using private sector claims data that contain actual payments. It contrasted these with trends in the CMS published charges. Results indicated that variation in actual commercially-transacted prices is substantially lower than variation in published charges.
AHRQ-funded; HS023610.
Citation: Carey K, Dor A .
Price variations and their trends in U.S. hospitals.
J Health Care Finance 2017 Sum;44(1).
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Keywords: Healthcare Costs, Payment, Health Insurance, Hospitals
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
Zullo AR, Howe CJ, Galarraga O
Estimating the effect of health insurance on personal prescription drug importation.
Personal prescription drug importation occurs in the United States because of the high cost of U.S. medicines and lower cost of foreign equivalents. The investigators used inverse probability weighted marginal structural models and data on 87,494 individuals from the 2011-2013 National Health Interview Survey to estimate the marginal association between no health insurance and importation within U.S. subpopulations.
AHRQ-funded; HS022998.
Citation: Zullo AR, Howe CJ, Galarraga O .
Estimating the effect of health insurance on personal prescription drug importation.
Med Care Res Rev 2017 Apr;74(2):178-207. doi: 10.1177/1077558716629039..
Keywords: Health Insurance, Healthcare Costs, Medication
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.
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Keywords: Health Insurance, Healthcare Costs, Policy
Yeung K, Basu A, Marcum ZA
Impact of a value-based formulary in three chronic disease cohorts.
This study assessed the impact of a value based formulary (VBF) on medication adherence and patient and health plan expenditures on 3 chronic disease states: diabetes, hypertension, and hyperlipidemia. The investigators measured medication expenditures from member, health plan, and member-plus-health plan (overall) perspectives and medication adherence as proportion of days covered. They conducted an exploratory analysis of medication utilization classifying medications according to whether co-payments moved up or down in the year following VBF implementation.
AHRQ-funded; HS022982.
Citation: Yeung K, Basu A, Marcum ZA .
Impact of a value-based formulary in three chronic disease cohorts.
Am J Manag Care 2017 Mar; 23(3 Suppl):S46-s53..
Keywords: Chronic Conditions, Health Insurance, Patient Adherence/Compliance, Medication, Healthcare Costs
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.
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Keywords: Medicaid, Health Insurance, Policy, Healthcare Costs
Abdus S, Selden TM, Keenan P
AHRQ Author: Abdus S, Selden TM, Keenan P
The financial burdens of high-deductible plans.
The increased prevalence of high-deductible health plans raises concerns regarding high financial burdens from health care, particularly for low-income adults.
AHRQ-authored.
Citation: Abdus S, Selden TM, Keenan P .
The financial burdens of high-deductible plans.
Health Aff 2016 Dec;35(12):2297-301. doi: 10.1377/hlthaff.2016.0842.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Social Determinants of Health
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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.
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Keywords: Medicaid, Health Insurance, Policy, Healthcare Costs
Adrion ER, Ryan AM, Seltzer AC
Out-of-pocket spending for hospitalizations among nonelderly adults.
The researchers evaluated out-of-pocket spending associated with hospitalizations in order to assess how this spending varied over time and by patient characteristics, region, and type of insurance. They found that from 2009 to 2013, total cost sharing per inpatient hospitalization increased by 37 percent, from $738 in 2009 to $1013 in 2013 after adjusting for inflation and case-mix differences.
AHRQ-funded; HS000053.
Citation: Adrion ER, Ryan AM, Seltzer AC .
Out-of-pocket spending for hospitalizations among nonelderly adults.
JAMA Intern Med 2016 Sep;176(9):1325-32. doi: 10.1001/jamainternmed.2016.3663.
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Keywords: Hospitalization, Healthcare Costs, Health Insurance
Ali MM, Chen J, Mutter R
AHRQ Author: Novak P
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
The authors analyzed out-of-pocket spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. They found that the extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.
AHRQ-authored.
Citation: Ali MM, Chen J, Mutter R .
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
Psychiatr Serv 2016 Sep;67(9):977-82. doi: 10.1176/appi.ps.201500346.
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Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Young Adults
McGarry BE, Temkin-Greener H, Chapman BP
The impact of consumer numeracy on the purchase of long-term care insurance.
The researchers sought to determine the effect of consumers' numeric abilities on the likelihood of owning private long-term care insurance (LTCI). Using the 2010 wave of the Health and Retirement Study, they found that each additional correct answer on a numeracy scale was associated with a 13% increase in the likelihood of holding LTCI. They recommended that policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults' ability to prepare for future long-term care expenses.
AHRQ-funded; HS023714.
Citation: McGarry BE, Temkin-Greener H, Chapman BP .
The impact of consumer numeracy on the purchase of long-term care insurance.
Health Serv Res 2016 Aug;51(4):1612-31. doi: 10.1111/1475-6773.12439.
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Keywords: Education: Patient and Caregiver, Healthcare Costs, Health Insurance, Long-Term Care
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.
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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.
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Keywords: Healthcare Costs, Health Insurance, Policy
Brown TT, Robinson JC
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
The authors extended reference pricing (RP) models to a hospital context focusing on insurer and consumer payments. They found that, for 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. When the reference price was not reset to account for changes in market prices, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP.
AHRQ-funded; HS022098.
Citation: Brown TT, Robinson JC .
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
Health Econ 2016 Jun;25(6):740-9. doi: 10.1002/hec.3181.
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Keywords: Payment, Healthcare Costs, Health Insurance, Hospitals
Berdahl T, Hudson J, Simpson L
AHRQ Author: Berdahl T, Hudson J
Annual report on children's health care: dental and orthodontic utilization and expenditures for children, 2010-2012.
The researchers examined general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. Overall, 41.9 percent of US children reported an annual dental office-based visit for general (nonorthodontic) dental care.
AHRQ-authored.
Citation: Berdahl T, Hudson J, Simpson L .
Annual report on children's health care: dental and orthodontic utilization and expenditures for children, 2010-2012.
Acad Pediatr 2016 May-Jun;16(4):314-26. doi: 10.1016/j.acap.2016.02.013.
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Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Dental and Oral Health, Healthcare Costs, Health Insurance
Padula WV, Heru S, Campbell JD
Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: a cost-effectiveness analysis.
The researchers analyzed the cost-effectiveness of insurance coverage for medically necessary transgender-related services. They found that health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. The additional expenses incurred hold good value for reducing the risk of negative endpoints - HIV, depression, suicidality, and drug abuse.
AHRQ-funded; HS023710.
Citation: Padula WV, Heru S, Campbell JD .
Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: a cost-effectiveness analysis.
J Gen Intern Med 2016 Apr;31(4):394-401. doi: 10.1007/s11606-015-3529-6.
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Keywords: Healthcare Costs, Health Insurance, Healthcare Costs