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 (3)
- Behavioral Health (2)
- Cancer (2)
- Cancer: Ovarian Cancer (1)
- Comparative Effectiveness (1)
- COVID-19 (2)
- Depression (1)
- Evidence-Based Practice (1)
- Genetics (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- (-) Health Insurance (10)
- Hospitalization (1)
- Labor and Delivery (1)
- Maternal Care (7)
- Medicaid (3)
- Outcomes (2)
- Patient-Centered Outcomes Research (2)
- Pregnancy (3)
- Screening (2)
- Surgery (1)
- Uninsured (1)
- (-) Women (10)
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 10 of 10 Research Studies DisplayedEliason E, Admon LK, Steenland MW
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
The purpose of this study was to explore the loss of Medicaid coverage in toward the end of the postpartum period prior to COVID-19 and describe the implications for Medicaid unwinding. The researchers utilized unique Pregnancy Risk Assessment Monitoring System follow-up data from prior to the COVID-19 pandemic. The study found that only 68% of enrollees in prenatal Medicaid maintained continuous Medicaid coverage through 9 or 10 months postpartum. Of the total prenatal Medicaid enrollees who lost their coverage in the early postpartum period, two-thirds continued to be uninsured 9 to 10 months postpartum. The researchers concluded that extensions to state postpartum Medicaid could prevent a return to postpartum coverage loss rates similar to the level in the prepandemic period.
AHRQ-funded; HS027464; HS000011.
Citation: Eliason E, Admon LK, Steenland MW .
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
Health Aff 2023 Jul; 42(7):966-72. doi: 10.1377/hlthaff.2022.01659..
Keywords: COVID-19, Maternal Care, Medicaid, Women, Access to Care, Uninsured, Health Insurance
Saldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
AHRQ-funded; 75Q80120D00001.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Health insurance coverage and postpartum outcomes in the US: a systematic review.
JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
Steenland MW, Wherry LR
Medicaid expansion led to reductions in postpartum hospitalizations.
The purpose of this study was to assess whether the Medicaid expansions of the Affordable Care Act (ACA) affected rates of postpartum hospitalization. The researchers compared states that did and did not expand Medicaid under the ACA as they related to changes in hospitalizations among birthing people with a Medicaid-financed delivery. The study found a 17% reduction in hospitalizations during the first 60 days postpartum associated with the Medicaid expansions, and evidence of a lesser decrease in hospitalizations between 61 days and 6 months postpartum. The researchers concluded that Medicaid coverage expansion under the ACA resulted in improved postpartum health for low-income birthing people.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wherry LR .
Medicaid expansion led to reductions in postpartum hospitalizations.
Health Aff 2023 Jan; 42(1):18-25. doi: 10.1377/hlthaff.2022.00819..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Hospitalization, Maternal Care, Women, Health Insurance, Access to Care
Tabb KM, Dalton VK, Tilea A
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
This study examined trends in antenatal depression and suicidal ideation among commercially insured childbearing individuals from 2008 to 2018. The study included 536,647 individuals aged 15-44 continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. Primary outcomes included depression or suicidal ideation based on relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. Rates of depression increased by 39% from 540 per 10,000 individuals in 2008 to 750 per 10,000 individuals in 2018. Suicidal ideation increased by 100% from 15 per 10,000 individuals in 2008 to 44 per 10,000 individuals in 2018. Black persons experienced the sharpest proportional increases.
AHRQ-funded; HS027640.
Citation: Tabb KM, Dalton VK, Tilea A .
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
J Affect Disord 2023 Jan 1;320:263-67. doi: 10.1016/j.jad.2022.09.120..
Keywords: Pregnancy, Maternal Care, Depression, Behavioral Health, Women, Health Insurance
Eliason Gordon, Gordon SH
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
This study assessed the association between postpartum insurance instability and access to postpartum mental health services. The authors used data from the 2018-2019 Colorado Health eMoms survey, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified at each time point as stably insured or unstable insured based on postpartum insurance status. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage. Respondents were more likely to experience unstable postpartum insurance if they were younger, had incomes of less than $50,000, and were of Hispanic ethnicity. Respondents who experienced postpartum insurance instability had lower odds of reporting that they discussed mental health at a postpartum check-up and received postpartum mental health services.
AHRQ-funded; HS000011.
Citation: Eliason Gordon, Gordon SH .
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
Womens Health Issues 2022 Nov-Dec;32(6):550-56. doi: 10.1016/j.whi.2022.06.010..
Keywords: Maternal Care, Access to Care, Women, Behavioral Health, Health Insurance
Ellison J, Wang C, Yarrington C
Insurance and geographic variations in non-invasive prenatal testing.
The purpose of this study was to estimate the population-level rate of non-invasive prenatal testing (NIPT) uptake in Massachusetts and identify disparities based on patient zip-code and insurance type. The researchers identified pregnant patients aged 35 years or older at their delivery between 7/1/2015 to 12/31/2015 who were eligible for NIPT use, to assess the role of area‐level sociodemographic characteristics and NIPT uptake. The study reported that considerable geographic variation was discovered. Patients living in zip‐codes within and surrounding the Boston metropolitan area were more likely to receive NIPT, as were those living in Eastern MA. The observed NIPT rate (per 1000 pregnant individuals aged 35 and over) was 48.7 for Medicaid enrollees and 272.1 for commercial enrollees; 123.0 and 223.2 for patients living in a zip‐code with a high versus low proportion of Black/Hispanic residents; and 107.7 and 218.4 for those in a zip‐code with a high versus low proportion of low‐income residents. The researchers reported that birthing people covered by Medicaid were over five times less likely to receive NIPT than their counterparts with commercial coverage. Lower NIPT rates in zip‐codes with a high proportion of low‐income or Black/Hispanic residents also suggests that geographic variations in uptake may reflect racial/ethnic and income disparities independent of insurance coverage. The researchers concluded that the study findings emphasize the presence of substantial disparities in NIPT uptake based on insurance and zip-code of residence, and that further research is needed to identify barriers and facilitators to uptake and to evaluate interventions to address inequities in NIPT use.
AHRQ-funded; HS000011.
Citation: Ellison J, Wang C, Yarrington C .
Insurance and geographic variations in non-invasive prenatal testing.
Prenat Diagn 2022 Jul;42(8):1004-07. doi: 10.1002/pd.6155..
Keywords: Pregnancy, Maternal Care, Women, Health Insurance, Screening
Eliason EL, Daw JR, Steenland MW
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
The purpose of this study was to examine changes in postpartum insurance loss or changes (churn) in Medicaid-insured pregnant people during the COVID-19 pandemic. The researchers utilized the 2019 to 2021 Current Population Survey, Annual Social and Economic Supplement
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
AHRQ-funded; HS000011; HS027464.
Citation: Eliason EL, Daw JR, Steenland MW .
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
JAMA Health Forum 2022 Apr;3(4):e220688. doi: 10.1001/jamahealthforum.2022.0688..
Keywords: COVID-19, Health Insurance, Maternal Care, Women, Pregnancy
Cliff BQ
Do high-deductible health plans affect price paid for childbirth?
The purpose of this study was to test whether out-of-pocket costs and negotiated hospital prices for childbirth change after enrollment in high-deductible health plans (HDHPs) and whether price effects differ in markets with more hospitals. Administrative medical claims data from three large commercial insurers with plans in all U.S. states was provided by the Health Care Cost Institute. Findings showed that prices for childbirth in markets with more hospitals decreased after HDHP switch due to lower hospital prices for HDHPs relative to prices at those same hospitals for non-HDHPs.
AHRQ-funded; HS025614.
Citation: Cliff BQ .
Do high-deductible health plans affect price paid for childbirth?
Health Serv Res 2022 Feb;57(1):27-36. doi: 10.1111/1475-6773.13702..
Keywords: Labor and Delivery, Health Insurance, Healthcare Costs, Women
Cham S, Landrum MB, Keating NL
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
The authors examined commercially insured populations to identify patient-, physician-, and practice-level characteristics associated with ovarian cancer testing rates. They found that only 33.9% of patients with commercial insurance were tested during the time period studied. Medical and gynecologic oncologists had similar rates of testing, while other physicians tested less often. Although independent practices often lack access to genetic counselors, women in this study had insurance coverage for in-person and telephonic counseling.
AHRQ-funded; HS024072.
Citation: Cham S, Landrum MB, Keating NL .
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
JAMA Netw Open 2022 Jan 4;5(1):e2142703. doi: 10.1001/jamanetworkopen.2021.42703..
Keywords: Cancer: Ovarian Cancer, Cancer, Screening, Genetics, Health Insurance, Women
Borah BJ, Yao X, Laughlin-Tommaso SK
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
The objective of this retrospective analysis of administrative claims from a large U.S. commercial insurance database, was to compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery.
AHRQ-funded; HS023418.
Citation: Borah BJ, Yao X, Laughlin-Tommaso SK .
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
Obstet Gynecol 2017 Nov;130(5):1047-56. doi: 10.1097/AOG.0000000000002331..
Keywords: Cancer, Comparative Effectiveness, Health Insurance, Outcomes, Patient-Centered Outcomes Research, Surgery, Women