National Healthcare Quality and Disparities Report
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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
26 to 38 of 38 Research Studies DisplayedRegenbogen SE, Cain-Nielsen AH, Syrjamaki JD
Spending on postacute care after hospitalization in commercial insurance and Medicare around age sixty-five.
Postacute care costs are the primary determinant of episode spending around hospitalization. Yet there is little evidence that greater spending on postacute care improves readmission rates or functional recovery. In a population-based, statewide collaborative of Michigan hospitals, the investigators used regression discontinuity design among propensity-weighted, age-adjusted cohorts to compare postacute care spending between patients with commercial insurance and those with Medicare around age sixty-five. This paper describes the study.
AHRQ-funded; HS024698.
Citation: Regenbogen SE, Cain-Nielsen AH, Syrjamaki JD .
Spending on postacute care after hospitalization in commercial insurance and Medicare around age sixty-five.
Health Aff 2019 Sep;38(9):1505-13. doi: 10.1377/hlthaff.2018.05445..
Keywords: Healthcare Costs, Health Insurance, Medicare, Hospitalization
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Hill SC, Solomon KT, Maclean JC
AHRQ Author: Hill SC
Effects of improvements in the CPS on the estimated prevalence of medical financial burdens.
The authors sought to measure the effects of questionnaire and imputation improvements in the Current Population Survey (CPS) on the estimated prevalence of high medical financial burden. They found that the estimated prevalence increased among nonelderly adults with private insurance, decreased among nonelderly adults with public coverage, and decreased among elderly adults with Medicare and no private coverage. The authors concluded that improvements in the CPS changed the estimated prevalence of high medical financial burden among key subgroups, and they recommended that researchers use caution when tracking burden across the time-period in which these improvements were implemented.
AHRQ-authored.
Citation: Hill SC, Solomon KT, Maclean JC .
Effects of improvements in the CPS on the estimated prevalence of medical financial burdens.
Health Serv Res 2019 Aug;54(4):920-29. doi: 10.1111/1475-6773.13158..
Keywords: Health Insurance, Healthcare Costs, Research Methodologies
Khandelwal N, White L, Curtis JR
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
The objective of this study was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and to examine how these costs vary by insurance coverage. Results showed that, across all categories of insurance coverage, out-of-pocket spending in the last 12 months of life was high and represented a significant portion of assets for many patients requiring intensive care and their families. Medicare fee-for-service alone did not insulate individuals from the financial burden of high-intensity care. Medicaid was found to provide the most complete hospital coverage of all the insurance groups, as well as significantly financing long-term care.
AHRQ-funded; HS022982.
Citation: Khandelwal N, White L, Curtis JR .
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
Crit Care Med 2019 Jun;47(6):749-56. doi: 10.1097/ccm.0000000000003723..
Keywords: Critical Care, Elderly, Health Insurance, Healthcare Costs, Intensive Care Unit (ICU), Medicaid, Medicare
Callaghan BC, Reynolds E, Banerjee M
Out-of-pocket costs are on the rise for commonly prescribed neurologic medications.
The purpose of this study was to determine out-of-pocket costs for neurologic medications in 5 common neurologic diseases. The investigators concluded that out-of-pocket costs for neurologic medications have increased considerably over the last 12 years, particularly for those in high-deductible health plans. Out-of-pocket costs vary widely both across and within conditions. They assert that to minimize patient financial burden, neurologists require access to precise cost information when making treatment decisions.
AHRQ-funded; HS022258.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Out-of-pocket costs are on the rise for commonly prescribed neurologic medications.
Neurology 2019 May 28;92(22):e2604-e13. doi: 10.1212/wnl.0000000000007564.
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Keywords: Health Insurance, Healthcare Costs, Medication, Neurological Disorders
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Post B, Ryan AM, Moloci NM
Physician participation in Medicare Accountable Care Organizations and spillovers in commercial spending.
The purpose of this retrospective, longitudinal study was to determine if physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercially insured patients in Michigan. Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015 was used to compare patients who experienced a significant clinical episode and were seen by physicians who participated in a Medicare ACO with those whose physicians were not part of an ACO. The researchers conclude that physicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients.
AHRQ-funded; HS024525; HS024728.
Citation: Post B, Ryan AM, Moloci NM .
Physician participation in Medicare Accountable Care Organizations and spillovers in commercial spending.
Med Care 2019 Apr;57(4):305-11. doi: 10.1097/mlr.0000000000001081..
Keywords: Health Insurance, Healthcare Costs, Medicare
Mehra R, Cunningham SD, Lewis JB
Recommendations for the pilot expansion of Medicaid coverage for doulas in New York state.
AHRQ-funded; HS017589.
Citation: Mehra R, Cunningham SD, Lewis JB .
Recommendations for the pilot expansion of Medicaid coverage for doulas in New York state.
Am J Public Health 2019 Feb;109(2):217-19. doi: 10.2105/ajph.2018.304797..
Keywords: Medicaid, Pregnancy, Maternal Care, Health Insurance, Healthcare Costs, Prevention, Women, Disparities
Gordon SH, Sommers BD, Wilson IB
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
This study looked at risk factors for early disenrollment from Colorado’s Affordable Care Act marketplace. Researchers used all-payer claims data from individual market enrollees from 2014-2016. They discovered that nearly 25% Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollement was 30% lower in individuals with cost-sharing plans and 21% lower for those enrolled in gold plans compared to those enrolled in silver plans without cost-sharing subsidies. There was greater disenrollment in beneficiaries with greater hospital and emergency utilization before disenrollment. Also, young adults were 70% more likely to disenroll than older adults.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
Med Care 2019 Jan;57(1):49-53. doi: 10.1097/mlr.0000000000001020..
Keywords: Healthcare Costs, Health Insurance, Policy, Risk, Uninsured
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