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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
Angier H, Gregg J, Gold R
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
The researchers explored low-income parents’ perspectives on accessing health care. Interviews with 29 Oregon parents revealed that affordability and limited availability were seen as barriers to care; while a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children.
Citation: Angier H, Gregg J, Gold R . Understanding how low-income families prioritize elements of health care access for their children via the optimal care model. BMC Health Serv Res 2014 Nov 19;14:585. doi: 10.1186/s12913-014-0585-2..
Keywords: Access to Care, Children/Adolescents, Low-Income, Social Determinants of Health, Healthcare Costs
Fiscella K, Geiger HJ
Caring for the poor in the 21st century: enabling community health centers for a new era.
This article discusses various challenges facing community health centers (CHCs) in the 21st century. These include: potential erosion of the Medicaid prospective payment system, the failure of many States to expand Medicaid, the growth of accountable care organizations, the growth of high deductible health insurance for the privately insured, and increased competition for primary care clinicians.
Citation: Fiscella K, Geiger HJ . Caring for the poor in the 21st century: enabling community health centers for a new era. J Health Care Poor Underserved. 2014 Nov;25(4):2044-52. doi: 10.1353/hpu.2014.0182..
Keywords: Low-Income, Primary Care, Medicaid, Health Insurance
Lyles CR, Schafer AL, Seligman HK
Income, food insecurity, and osteoporosis among older adults in the 2007-2008 National Health and Nutrition Examination Survey (NHANES).
The researchers investigated osteoporosis and low socioeconomic status (SES). They concluded that income and food insecurity may have significant implications not just for immediate nutritional outcomes, but also for conditions such as osteoporosis that develop over the lifespan.
Citation: Lyles CR, Schafer AL, Seligman HK . Income, food insecurity, and osteoporosis among older adults in the 2007-2008 National Health and Nutrition Examination Survey (NHANES). J Health Care Poor Underserved 2014 Nov;25(4):1530-41. doi: 10.1353/hpu.2014.0174.
Keywords: Elderly, Nutrition, Osteoporosis, Social Determinants of Health, Low-Income
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
Kaiboriboon K, Schiltz NK, Bakaki PM
Premature mortality in poor health and low income adults with epilepsy.
This research study’s objective was to examine mortality and causes of death in socioeconomically disadvantaged persons with epilepsy in the United States. While death from epilepsy-related causes was about 10%, comorbidities like cardiovascular disease, cancer, and unintentional injuries caused 18.4% of deaths. Socioeconomically deprived and Medicaid-insured patients died 17 years prematurely.
Epilepsia. 2014 Nov;55(11):1781-8. doi: 10.1111/epi.12789.
Citation: Kaiboriboon K, Schiltz NK, Bakaki PM . Premature mortality in poor health and low income adults with epilepsy. .
Keywords: Low-Income, Mortality, Neurological Disorders, Social Determinants of Health
Gupta S, Brenner AT, Ratanawongsa N
Patient trust in physician influences colorectal cancer screening in low-income patients.
The study objective was to characterize the relationship between patient trust and colorectal cancer (CRC) screening behavior among racially and ethnically diverse, low-income patients who had all received a physician recommendation for screening. After controlling for traditional factors, trust in the primary care provider remained the only significant driver of CRC screening completion.
AHRQ-funded; HS013853; HS000032; HS022561
Citation: Gupta S, Brenner AT, Ratanawongsa N . Patient trust in physician influences colorectal cancer screening in low-income patients. Am J Prev Med. 2014 Oct;47(4):417-23. doi: 10.1016/j.amepre.2014.04.020..
Keywords: Screening, Racial / Ethnic Minorities, Low-Income, Primary Care
Sharma R, Lebrun-Harris LA, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.
The authors determined the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). They found that, compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings.
Citation: Sharma R, Lebrun-Harris LA, Ngo-Metzger Q . Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents. Medicare Medicaid Res Rev 2014 Sep 8;4(3). doi: 10.5600/mmrr.004.03.a05.
Keywords: Access to Care, Community-Based Practice, Quality of Care, Low-Income, Medicare
Abdus S, Hudson J, Hill SC
AHRQ Author: Abdus S, Hudson J, Hill SC, Selden TM
Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.
Using MEPS data, the authors showed that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. They found that the increase in uninsurance is largest among children whose parents lack offers of employer coverage.
Citation: Abdus S, Hudson J, Hill SC . Children's health insurance program premiums adversely affect enrollment, especially among lower-income children. Health Aff 2014 Aug;33(8):1353-60. doi: 10.1377/hlthaff.2014.0182.
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Low-Income
Allgood KL, Rauscher GH, Whitman S
Validating self-reported mammography use in vulnerable communities: findings and recommendations.
The researchers examined the potential extent of overreporting of mammography use in low-income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. They found that although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all ethnic groups studied.
Citation: Allgood KL, Rauscher GH, Whitman S . Validating self-reported mammography use in vulnerable communities: findings and recommendations. Cancer Epidemiol Biomarkers Prev 2014 Aug;23(8):1649-58. doi: 10.1158/1055-9965.epi-13-1253.
Keywords: Healthcare Utilization, Mammogram, Racial / Ethnic Minorities, Vulnerable Populations, Low-Income, Urban Health, Women
Fung V, Graetz I, Galbraith A
Financial barriers to care among low-income children with asthma: health care reform implications.
This study examined the associations between cost-sharing, income, and care seeking and financial stress among children with asthma. It found that cost-related barriers to care among children with asthma were concentrated among low-income families with higher cost-sharing levels.
Citation: Fung V, Graetz I, Galbraith A . Financial barriers to care among low-income children with asthma: health care reform implications. JAMA Pediatr. 2014 Jul;168(7):649-56. doi: 10.1001/jamapediatrics.2014.79..
Keywords: Children/Adolescents, Asthma, Low-Income, Access to Care, Healthcare Costs
Zhang Y, Zhou C, Baik SH
A simple change to the Medicare Part D low-income subsidy program could save $5 billion.
The authors used an intelligent reassignment algorithm and 2008-09 Medicare Part D drug use and spending data to match enrollees to available Part D plans according to their medication needs. They found that such a reassignment approach, compared to the current approach, could have saved the federal government over $5 billion in 2009.
Citation: Zhang Y, Zhou C, Baik SH . A simple change to the Medicare Part D low-income subsidy program could save $5 billion. Health Aff 2014 Jun;33(6):940-5. doi: 10.1377/hlthaff.2013.1083.
Keywords: Healthcare Costs, Low-Income, Medicare, Medication, Value
McGarry BE, Strawderman RL, Li Y
Lower Hispanic participation in Medicare Part D may reflect program barriers.
This study found that Hispanics were 35 percent less likely than non-Hispanic whites to have Medicare Part D coverage. This difference may be driven by ethnic disparities among those eligible for the low-income Part D subsidy but not automatically enrolled in it.
Citation: McGarry BE, Strawderman RL, Li Y . Lower Hispanic participation in Medicare Part D may reflect program barriers. Health Aff. 2014 May;33(5):856-62. doi: 10.1377/hlthaff.2013.0671..
Keywords: Medicare, Disparities, Racial / Ethnic Minorities, Low-Income, Healthcare Costs
Hill SC, Abdus S, Hudson JL
AHRQ Author: Hill SC, Hudson JL, Selden TM
Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees.
The investigators used MEPS data to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA's Medicaid expansion and thus newly eligible for coverage. They found that both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees. They concluded that by expanding Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care.
Citation: Hill SC, Abdus S, Hudson JL . Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees. Health Aff 2014 Apr;33(4):691-9. doi: 10.1377/hlthaff.2013.0743.
Keywords: Health Insurance, Policy, Health Status, Low-Income, Medicaid, Medical Expenditure Panel Survey (MEPS)
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
Schwartz AL, Sommers BD
Moving for Medicaid? Recent eligibility expansions did not induce migration from other states.
This study used 26 measures of low value services to examine service use and associated spending detected by these measures in Medicaid. In the six categories of care measured, services detected by a limited number of measures of low-value care constituted modest proportions of overall spending (2.7 percent) but affected 42 percent of beneficiaries.
AHRQ-funded; HS00055; HS021291
Citation: Schwartz AL, Sommers BD . Moving for Medicaid? Recent eligibility expansions did not induce migration from other states. Health Aff. 2014 Jan;33(1):88-94. doi: 10.1377/hlthaff.2013.0910..
Keywords: Medicaid, Value, Healthcare Costs, Low-Income, Healthcare Utilization
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