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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 16 of 16 Research Studies Displayed
Furtado KS, Kaphingst KA, Perkins H
Health insurance information-seeking behaviors among the uninsured.
In order to better understand how to reach the uninsured and support their health insurance decision making, this study examined where the uninsured collect information about health insurance and the extent to which they trust those sources and media. Its findings suggest that strategies that pair health care professionals, lay health advisors, or community liaisons with the ubiquity of the Internet may be a strong approach for delivering quality health insurance information to the uninsured.
Citation: Furtado KS, Kaphingst KA, Perkins H . Health insurance information-seeking behaviors among the uninsured. J Health Commun 2016;21(2):148-58. doi: 10.1080/10810730.2015.1039678.
Keywords: Uninsured, Health Insurance, Education: Patient and Caregiver, Web-Based
Harrison KL, Taylor HA
Healthcare resource allocation decisions affecting uninsured services.
The authors described resource allocation and policy decisions related to providing health services for the uninsured. They recommend that how healthcare decisions are actually made can be matched with literature that describes how healthcare resource decisions ought to be made, in order to provide a normative grounding for future decisions.
Citation: Harrison KL, Taylor HA . Healthcare resource allocation decisions affecting uninsured services. J Health Organ Manag 2016 Nov 21;30(8):1162-82. doi: 10.1108/jhom-01-2016-0003.
Keywords: Decision Making, Health Services Research (HSR), Policy, Uninsured
Politi MC, Kaphingst KA, Liu JE
A randomized trial examining three strategies for supporting health insurance decisions among the uninsured.
This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. Participants were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. It found that participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features.
Citation: Politi MC, Kaphingst KA, Liu JE . A randomized trial examining three strategies for supporting health insurance decisions among the uninsured. Med Decis Making. 2016 Oct;36(7):911-22. doi: 10.1177/0272989X15578635.
Keywords: Health Insurance, Uninsured, Value
Vistnes JP, Cohen JW
AHRQ Author: Vistnes JP, Cohen JW
Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions.
The researchers used data from the Medical Expenditure Panel Survey-Household Component to examine coverage transitions for nonelderly US adults. They found that 71.5 percent of Marketplace enrollees in 2014 had some period of uninsurance before enrollment. In Medicaid expansion states, 17.4 percent of adults who were uninsured throughout 2013 gained Medicaid coverage in 2014, compared with only 5.6 percent in those states between 2012 and 2013.
Citation: Vistnes JP, Cohen JW . Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions. Health Aff 2016 Oct 1;35(10):1825-29. doi: 10.1377/hlthaff.2016.0500.
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicaid, Uninsured, Policy
Sommers BD, Gourevitch R, Maylone B
Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.
The researchers explored the frequency and implications of changes in insurance coverage over time (i.e., "churning,")through surveying low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. They found that churning was associated with disruptions in physician care and medication adherence, and increased emergency department use.
Citation: Sommers BD, Gourevitch R, Maylone B . Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many. Health Aff 2016 Oct;35(10):1816-24. doi: 10.1377/hlthaff.2016.0455.
Keywords: Medicaid, Uninsured, Policy, Health Insurance
Sommers BD, Chua KP, Kenney GM
California's early coverage expansion under the Affordable Care Act: a county-level analysis.
The researchers assessed the coverage effects of California's 2011 Low-Income Health Program (LIHP), enacted as an "early expansion" under the Affordable Care Act (ACA), and to demonstrate the feasibility of using Census data to measure county-level coverage changes. They concluded that California's 2011 expansion produced significant increases in public coverage for low-income individuals, particularly Latinos.
Citation: Sommers BD, Chua KP, Kenney GM . California's early coverage expansion under the Affordable Care Act: a county-level analysis. Health Serv Res 2016 Jun;51(3):825-45. doi: 10.1111/1475-6773.12397.
Keywords: Medicaid, Uninsured, Policy, Health Insurance, Racial / Ethnic Minorities
Raghavan R, Allaire BT, Brown DS
Medicaid disenrollment patterns among children coming into contact with child welfare agencies.
The authors examined retention of Medicaid coverage over time for children in the child welfare system. Using Medicaid claims files from 36 states, they found that half retained Medicaid coverage across 4 years of follow up, with most disenrollments happening in year 4. They recommend finding ways to promote entry of child welfare-involved children into health insurance coverage in order to assure services.
Citation: Raghavan R, Allaire BT, Brown DS . Medicaid disenrollment patterns among children coming into contact with child welfare agencies. Matern Child Health J 2016 Jun;20(6):1280-7. doi: 10.1007/s10995-016-1929-9.
Keywords: Children/Adolescents, Family Health and History, Medicaid, Uninsured, Vulnerable Populations
DeVoe JE, Tillotson CJ, Marino M
Trends in type of health insurance coverage for US children and their parents, 1998-2011.
The objective of this paper is to examine trends in health insurance type among US children and their parents. Using Medical Expenditure Panel Survey data (1998-2011), the authors found that low- and middle-income US families experienced a decrease in the percentage of child-parent pairs with private health insurance and pairs without insurance. At the same time, they found a rise in discordant coverage patterns - mainly publicly insured children with uninsured parents.
Citation: DeVoe JE, Tillotson CJ, Marino M . Trends in type of health insurance coverage for US children and their parents, 1998-2011. Acad Pediatr 2016 Mar;16(2):192-9. doi: 10.1016/j.acap.2015.06.009.
Keywords: Children/Adolescents, Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS), Uninsured
Hoopes MJ, Angier H, Gold R
Utilization of community health centers in Medicaid expansion and nonexpansion states, 2013-2014.
Using electronic health record data, the researchers examined longitudinal changes in community health center (CHC) visit rates from 2013 through 2014 in Medicaid expansion versus nonexpansion states. Rates increased in expansion state CHCs for new patient, preventive, and limited-service visits (14 percent, 41percent, and 23 percent, respectively), whereas these rates remained unchanged in nonexpansion states.
Citation: Hoopes MJ, Angier H, Gold R . Utilization of community health centers in Medicaid expansion and nonexpansion states, 2013-2014. J Ambul Care Manage 2016 Jan 13;39(4):290-8. doi: 10.1097/jac.0000000000000123.
Keywords: Electronic Health Records (EHRs), Community-Based Practice, Healthcare Utilization, Medicaid, Uninsured
Vargas Bustamante A, Chen J
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
This study of the association between the timing of the Great Recession (GR) and health spending among uninsured U.S. immigrants found that the probability of any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported 27 percent higher spending during the GR.
Citation: Vargas Bustamante A, Chen J . The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation. Health Serv Res. 2014 Dec;49(6):1900-24. doi: 10.1111/1475-6773.12193..
Keywords: Healthcare Costs, Uninsured, Disparities
Epstein AM, Sommers BD, Kuznetsov Y
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
The authors explored what low-income Americans think about Medicaid. They found that nearly 80 percent of their telephone survey sample favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability.
Citation: Epstein AM, Sommers BD, Kuznetsov Y . Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion. Health Aff 2014 Nov;33(11):2041-7. doi: 10.1377/hlthaff.2014.0747.
Keywords: Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Heintzman J, Marino M, Hoopes M
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
This study used EHR data to compare the preventive service utilization of uninsured patients receiving care at Oregon community health centers (CHCs) in 2008 through 2011 with that of continuously insured patients at the same CHCs in the same period. The results showed that CHCs provided many preventive services to uninsured patients, but that uninsured patients were less likely than continuously insured patients to receive 5 of 11 preventive services. The authors concluded that lack of insurance is a barrier to preventive service utilization, even in patients who can access care at a CHC.
Citation: Heintzman J, Marino M, Hoopes M . Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients. Prev Med 2014 Oct;67:306-10. doi: 10.1016/j.ypmed.2014.08.006.
Keywords: Community-Based Practice, Electronic Health Records (EHRs), Healthcare Utilization, Prevention, Uninsured
Yehia BR, Fleishman JA, Agwu AL
AHRQ Author: Fleishman JA
Health insurance coverage for persons in HIV care, 2006-2012.
The authors examined trends in health insurance coverage at 11 US HIV clinics between 2006 and 2012. They found that Medicaid coverage was more prevalent among women than men; blacks and Hispanics than whites; and individuals with injection drug use risk compared with other transmission risk factors, with Hispanics and younger age groups more likely to be uninsured than other racial/ethnic and older age groups, respectively.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, Fleishman JA, Agwu AL . Health insurance coverage for persons in HIV care, 2006-2012. J Acquir Immune Defic Syndr 2014 Sep 1;67(1):102-6. doi: 10.1097/qai.0000000000000251.
Keywords: Health Insurance, Human Immunodeficiency Virus (HIV), Medicare, Racial / Ethnic Minorities, Uninsured
Crisp GD, Roberts AW, Esserman DA
The University of North Carolina's Health Care Pharmacy Assistance Program.
This study examined a program providing financial assistance to uninsured residents of North Carolina who need prescription medications. It found that from 2009 to 2011, the program served 7,180 patients in 81 counties. These patients received a mean of 23 prescriptions at an average cost of $754 per recipient per year.
Citation: Crisp GD, Roberts AW, Esserman DA . The University of North Carolina's Health Care Pharmacy Assistance Program. N C Med J. 2014 Sep-Oct;75(5):303-9..
Keywords: Healthcare Costs, Uninsured, Medication, Healthcare Utilization
Politi MC, Kaphingst KA, Kreuter M
Knowledge of health insurance terminology and details among the uninsured.
This study examined currently uninsured individuals’ understanding of terminology and details in health care plans in a series of interviews of a small mostly low-income and African American population. It found that the cost of the premium and having fixed costs through co-payments rather than coinsurance were very important so that individuals could budget as best as possible.
Citation: Politi MC, Kaphingst KA, Kreuter M . Knowledge of health insurance terminology and details among the uninsured. Med Care Res Rev 2014 Feb;71(1):85-98. doi: 10.1177/1077558713505327..
Keywords: Uninsured, Low-Income, Health Insurance
Sommers BD, Kenney GM, Epstein AM
New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions.
Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the Affordable Care Act’s option to expand coverage earlier to a portion of low-income childless adults. The researchers present new data on these expansions focusing on several questions including the extent to which childless adults’ new enrollment in Medicaid result from extending coverage to uninsured people as opposed to replacing private coverage.
Citation: Sommers BD, Kenney GM, Epstein AM . New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions. Health Aff 2014 Jan;33(1):78-87. doi: 10.1377/hlthaff.2013.1087..
Keywords: Low-Income, Uninsured, Medicaid, Health Insurance