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
51 to 75 of 77 Research Studies DisplayedBarnett ML, Clark KL, Sommers BD
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
This study examined patient satisfaction among Medicaid enrollees nationally from 2014-2015. Significant disparities were found among racial/ethnic groups. Managed care enrollees had higher satisfaction ratings than those with fee-for-service. If the patient had a personal doctor that increased satisfaction for an average 4.6 percent.
AHRQ-funded; HS021291.
Citation: Barnett ML, Clark KL, Sommers BD .
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
Health Aff 2018 Oct;37(10):1647-55. doi: 10.1377/hlthaff.2018.0505..
Keywords: Access to Care, Disparities, Medicaid, Patient Experience, Policy, Racial and Ethnic Minorities
Moniz MH, Kirch MA, Solway E
Association of access to family planning services with Medicaid expansion among female enrollees in Michigan.
The purpose of this study was to evaluate the association of Medicaid expansion coverage with access to birth control and family planning services among women of reproductive age enrolled in the Michigan expansion plan. The investigators found that one in 3 women of reproductive age reported better ability to access birth control and family planning services through Healthy Michigan Plan compared with before enrollment.
AHRQ-funded; HS025465.
Citation: Moniz MH, Kirch MA, Solway E .
Association of access to family planning services with Medicaid expansion among female enrollees in Michigan.
JAMA Network Open 2018 Aug 31;1(4). doi: 10.1001/jamanetworkopen.2018.1627..
Keywords: Medicaid, Women, Sexual Health, Access to Care, Policy
Andrews CM, Grogan CM, Smith BT
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
This study looked at the effects the Affordable Care Act (ACA) had on Medicaid benefits for addiction treatment. The ACA established a minimum standard of benefits and required state Medicaid programs to make changes to their treatment benefits. Researchers surveyed all 50 states and the District of Columbia in 2014 and 2017 when the ACA requirements came into effect. There was a substantial increase in benefits with a decrease in annual service limits of over 50 percent. There was a large reduction in preauthorization requirements for medications to treat opioid use disorder as well as other reductions in preauthorizations.
AHRQ-funded; HS000084.
Citation: Andrews CM, Grogan CM, Smith BT .
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
Health Aff 2018 Aug;37(8):1216-22. doi: 10.1377/hlthaff.2018.0272..
Keywords: Access to Care, Behavioral Health, Health Insurance, Medicaid, Policy, Substance Abuse
Myerson R, Lu T, Tonnu-Mihara I
Medicaid eligibility expansions may address gaps in access to diabetes medications.
The purpose of this study was to examine the impacts of Medicaid expansion on access to diabetes medications, researchers analyzed data on over ninety-six million prescription fills using Medicaid insurance in the period January 2008-December 2015. The researchers found that the increase in prescription fills grew significantly over time. Overall, fills for insulin and for newer medications increased by 40 percent and 39 percent, respectively.
AHRQ-funded; HS023964.
Citation: Myerson R, Lu T, Tonnu-Mihara I .
Medicaid eligibility expansions may address gaps in access to diabetes medications.
Health Aff 2018 Aug;37(8):1200-07. doi: 10.1377/hlthaff.2018.0154..
Keywords: Access to Care, Diabetes, Policy, Medicaid, Medication
Kung SA, Darney BG, Saavedra-Avendano B
Access to abortion under the health exception: a comparative analysis in three countries.
Access to abortion under the health exception varies widely. This study examines factors that result in heterogeneous application of health exception laws and consequences for access to legal abortion. The study concluded that the health exception is a valuable tool for expanding access to legal abortion. Differences in the use of the health exception as an indication for legal abortion resulted in wide access for women in Britain to nearly no access in Mexican states. The findings highlight the difference between theoretical and real access to legal abortion.
AHRQ-funded; HS022981.
Citation: Kung SA, Darney BG, Saavedra-Avendano B .
Access to abortion under the health exception: a comparative analysis in three countries.
Reprod Health 2018 Jun 13;15(1):107. doi: 10.1186/s12978-018-0548-x..
Keywords: Access to Care, Policy, Women
Mehrotra S, Kilambi V, Bui K
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Policymakers are deliberating policy reforms to reduce geographic disparity in liver allocation. This study conducted simulations comparing current allocation with the neighborhoods and sharing policies. The study concluded that the current 11 districts can be adapted systematically by adding neighboring donor service areas (DSAs) to improve geographic disparity, mortality, and airplane travel distance. Modifications to Share 35 and Share 15 policies result in further improvements.
AHRQ-funded; HS024840.
Citation: Mehrotra S, Kilambi V, Bui K .
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Transplantation 2018 Feb;102(2):255-78. doi: 10.1097/tp.0000000000001934..
Keywords: Access to Care, Disparities, Policy, Transplantation
Tran Smith B, Seaton K, Andrews C
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
This study assessed the extent to which state insurance departments regulate the types of substance use disorder (SUD) treatment that services and medications plans must provide, and also their use of utilization controls. Data were obtained from state insurance departments via an internet-based survey, as part of the National Drug Abuse Treatment System Survey. The results indicate that states vary widely in regulations on qualified health plans’ (QHPs) administration of SUD treatment benefits; some required plans to cover all the SUD treatment services and medications assessed in this study, while others did not require plans to cover any at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance on their usage. The authors conclude that by not requiring coverage for the entire SUD continuum of care, some states hinder client access to the appropriate types of care needed for recovery.
AHRQ-funded; HS000084.
Citation: Tran Smith B, Seaton K, Andrews C .
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
Am J Drug Alcohol Abuse 2018;44(4):426-30. doi: 10.1080/00952990.2017.111934..
Keywords: Access to Care, Health Insurance, Medication, Policy, Substance Abuse
Selden TM, Lipton BJ, Decker SL
AHRQ Author: Selden TM, Lipton BJ, Decker SL
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
The researchers found that as of 2015, adults with incomes of 100-138 percent of the federal poverty level had experienced large declines in uninsurance rates in both expansion and nonexpansion states. Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost.
AHRQ-authored.
Citation: Selden TM, Lipton BJ, Decker SL .
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
Health Aff 2017 Dec;36(12):2069-77. doi: 10.1377/hlthaff.2017.0830.
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Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Allen CD, McNeely CA
Do restrictive omnibus immigration laws reduce enrollment in public health insurance by Latino citizen children? A comparative interrupted time series study.
This study uses nationally-representative data from the National Health Interview Survey (2005-2014) and comparative interrupted time series methods to assess whether passage of state omnibus immigration laws reduced access to Medicaid/CHIP for US citizen Latino children. The authors found that law passage did not reduce enrollment for children with noncitizen parents and actually resulted in temporary increases in coverage among Latino children with at least one citizen parent.
AHRQ-funded; HS024248.
Citation: Allen CD, McNeely CA .
Do restrictive omnibus immigration laws reduce enrollment in public health insurance by Latino citizen children? A comparative interrupted time series study.
Soc Sci Med 2017 Oct;191:19-29. doi: 10.1016/j.socscimed.2017.08.039..
Keywords: Access to Care, Children/Adolescents, Children's Health Insurance Program (CHIP), Policy, Racial and Ethnic Minorities
Gonzales G, Golberstein E, Hill SC
AHRQ Author: Hill, SC; Zuvekas, SH
Psychological distress and enrollment in Medicaid.
Adults with poor mental health may want and need insurance to obtain care, but symptoms may impede enrollment into public health insurance. The enrollment response to Medicaid expansions prior to the Affordable Care Act was stronger for adults symptomatic of psychological distress compared with adults without distress and compared to adults with chronic physical health problems.
AHRQ-authored.
Citation: Gonzales G, Golberstein E, Hill SC .
Psychological distress and enrollment in Medicaid.
J Behav Health Serv Res 2017 Oct;44(4):523-35. doi: 10.1007/s11414-016-9532-9.
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Keywords: Access to Care, Policy, Medicaid, Medical Expenditure Panel Survey (MEPS), Behavioral Health
Hatch B, Marino M, Killerby M
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
This study assessed changes in biomarkers of chronic disease among community health center (CHC) patients who gained Medicaid coverage with the Oregon Medicaid expansion (2008-2011). It found that patients with uncontrolled chronic conditions experienced objective health improvements over time. In two of three chronic disease cohorts, those who gained Medicaid coverage were more likely to achieve a controlled measurement than those who remained uninsured.
AHRQ-funded; HS024270.
Citation: Hatch B, Marino M, Killerby M .
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
J Gen Intern Med 2017 Aug;32(8):940-47. doi: 10.1007/s11606-017-4051-9.
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Keywords: Medicaid, Chronic Conditions, Access to Care, Policy
Sommers BD, Maylone B, Blendon RJ
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage, researchers found that by the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state.
AHRQ-funded; HS021291.
Citation: Sommers BD, Maylone B, Blendon RJ .
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Health Aff 2017 Jun;36(6):1119-28. doi: 10.1377/hlthaff.2017.0293.
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Keywords: Policy, Low-Income, Access to Care, Health Insurance, Uninsured
Abdus S, Hill SC
AHRQ Author: Abdus S, Hill SC
Growing insurance coverage did not reduce access to care for the continuously insured.
The researchers examined data for the period 2008-14 from the Medical Expenditure Panel Survey and found no consistent evidence that increases in the proportions of adults with insurance at the local-area level affected access to care for adults residing in the same areas who already had, and continued to have, insurance.
AHRQ-authored.
Citation: Abdus S, Hill SC .
Growing insurance coverage did not reduce access to care for the continuously insured.
Health Aff 2017 May;36(5):791-98. doi: 10.1377/hlthaff.2016.1671.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Access to Care, Policy
Thalmayer AG, Friedman SA, Azocar F
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: impact on quantitative treatment limits.
This study assessed Mental Health Parity and Addiction Equity Act’s (MHPAEA) effect on the prevalence of behavioral health quantitative treatment limits (QTLs). It concluded that, before MHPAEA, QTLs were common. Postimplementation, virtually all plans dropped such limits, suggesting that MHPAEA was effective at eliminating QTLs.
AHRQ-funded; HS024866.
Citation: Thalmayer AG, Friedman SA, Azocar F .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: impact on quantitative treatment limits.
Psychiatr Serv 2017 May;68(5):435-42. doi: 10.1176/appi.ps.201600110.
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Keywords: Access to Care, Health Insurance, Policy, Behavioral Health
Huguet N, Angier H, Marino M
Protocol for the analysis of a natural experiment on the impact of the Affordable Care Act on diabetes care in community health centers.
It is hypothesized that Affordable Care Act (ACA) Medicaid expansions could substantially improve access to health insurance and healthcare services for patients at risk for diabetes mellitus (DM), with pre-DM, or already diagnosed with DM. Data collection will include information on changes in health insurance, service receipt, and health outcomes, spanning 9 years (pre- and post-expansion), comparing states that expanded Medicaid, and those that did not.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Marino M .
Protocol for the analysis of a natural experiment on the impact of the Affordable Care Act on diabetes care in community health centers.
Implement Sci 2017 Feb 10;12(1):14. doi: 10.1186/s13012-017-0543-6.
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Keywords: Diabetes, Policy, Access to Care, Health Insurance
Cole MB, Galarraga O, Wilson IB
At federally funded health centers, Medicaid expansion was associated with improved quality of care.
In 2014 many uninsured, low-income nonelderly adults gained access to health insurance in states that expanded Medicaid eligibility under the Affordable Care Act. The researchers used a difference-in-differences approach to compare changes among 1,057 such centers in expansion versus nonexpansion States. Medicaid expansion was associated with improved quality for asthma treatment, Pap testing, body mass index assessment, and hypertension control.
AHRQ-funded; HS024652.
Citation: Cole MB, Galarraga O, Wilson IB .
At federally funded health centers, Medicaid expansion was associated with improved quality of care.
Health Aff 2017 Jan;36(1):40-48. doi: 10.1377/hlthaff.2016.0804.
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Keywords: Quality of Care, Policy, Uninsured, Low-Income, Access to Care
Sampson UK, Kaplan RM, Cooper RS
AHRQ Author: Kaplan RM
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities think tank meeting.
The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. Details of the panel's remarks and recommendations are provided in this report.
AHRQ-authored.
Citation: Sampson UK, Kaplan RM, Cooper RS .
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities think tank meeting.
J Am Coll Cardiol 2016 Aug 2;68(5):517-24. doi: 10.1016/j.jacc.2016.04.059.
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Keywords: Access to Care, Disparities, Guidelines, Policy
Creedon TB, Cook BL
Access to mental health care increased but not for substance use, while disparities remain.
The researchers assessed whether early implementation of Affordable Care Act (ACA) Medicaid expansion and state health insurance exchanges increased access to mental health and substance use treatment among those in need and whether these changes differed by racial/ethnic group. They found that mental health treatment rates increased significantly but found no evidence of a reduction in the wide racial/ethnic disparities in mental health treatment that preceded ACA expansion from 2005 to 2013.
AHRQ-funded; HS021486.
Citation: Creedon TB, Cook BL .
Access to mental health care increased but not for substance use, while disparities remain.
Health Aff 2016 Jun;35(6):1017-21. doi: 10.1377/hlthaff.2016.0098.
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Keywords: Access to Care, Disparities, Health Insurance, Policy, Medicaid, Behavioral Health, Substance Abuse
Kennedy-Hendricks A, Huskamp HA, Rutkow L
Improving access to care and reducing involvement in the criminal justice system for people with mental illness.
The authors summarized current knowledge about the involvement of people with mental illness in the criminal justice system and considered the recent opportunities presented by national and local policies that aim to lower the proportion of such people who are incarcerated.
AHRQ-funded; HS000029.
Citation: Kennedy-Hendricks A, Huskamp HA, Rutkow L .
Improving access to care and reducing involvement in the criminal justice system for people with mental illness.
Health Aff 2016 Jun;35(6):1076-83. doi: 10.1377/hlthaff.2016.0006.
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Keywords: Access to Care, Policy, Behavioral Health
Keohane LM, Rahman M, Mor V
Reforming access: trends in Medicaid enrollment for new Medicare beneficiaries, 2008-2011.
This study evaluated whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. It found that the percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability.
AHRQ-funded; HS000011.
Citation: Keohane LM, Rahman M, Mor V .
Reforming access: trends in Medicaid enrollment for new Medicare beneficiaries, 2008-2011.
Health Serv Res 2016 Apr;51(2):550-69. doi: 10.1111/1475-6773.12349.
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Keywords: Medicare, Medicaid, Policy, Access to Care, Social Determinants of Health
Sommers BD, Blendon RJ, Orav EJ
Both the 'private option' and traditional Medicaid expansions improved access to care for low-income adults.
This study found that other than coverage type and trouble paying medical bills (which decreased more in Kentucky than in Arkansas), there were no significant differences between Kentucky's traditional Medicaid expansion and Arkansas's private option, which suggests that both approaches improved access among low-income adults.
AHRQ-funded; HS021291.
Citation: Sommers BD, Blendon RJ, Orav EJ .
Both the 'private option' and traditional Medicaid expansions improved access to care for low-income adults.
Health Aff 2016 Jan;35(1):96-105. doi: 10.1377/hlthaff.2015.0917.
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Keywords: Medicaid, Low-Income, Healthcare Costs, Access to Care, Policy
Sommers BD, Kronick R
AHRQ Author: Kronick R
Measuring Medicaid physician participation rates and implications for policy.
The authors’ objective was to describe several alternative measures of provider participation in Medicaid using recently publicly available data, to compare state rankings across these different metrics, and to discuss potential advantages and disadvantages of each measure for research and policy purposes. Overall, they found that Medicaid participation as measured by raw percentages of physicians taking new Medicaid patients is only weakly correlated with population-based measures that account for both participation rates and the numbers of physicians per capita or physicians per Medicaid beneficiary.
AHRQ-authored.
Citation: Sommers BD, Kronick R .
Measuring Medicaid physician participation rates and implications for policy.
J Health Polit Policy Law 2016 Jan 5;41(2):211-24. doi: 10.1215/03616878-3476117.
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Keywords: Medicaid, Policy, Access to Care, Practice Patterns, Policy
Portela M, Sommers BD
On the outskirts of national health reform: a comparative assessment of health insurance and access to care in Puerto Rico and the United States.
This article presents an overview of Puerto Rico’s health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States. It found that uninsured rates were significantly lower in Puerto Rico;. Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year.
AHRQ-funded; HS021291.
Citation: Portela M, Sommers BD .
On the outskirts of national health reform: a comparative assessment of health insurance and access to care in Puerto Rico and the United States.
Milbank Q 2015 Sep;93(3):584-608. doi: 10.1111/1468-0009.12138..
Keywords: Health Insurance, Access to Care, Policy, Medicaid, Uninsured
Toro-Diaz H, Mayorga ME, Barritt AS
Predicting liver transplant capacity using discrete event simulation.
The researchers constructed a discrete event simulation model informed by current donor characteristics to predict future liver transplant trends through the year 2030. They found that by altering assumptions about the future donor pool, their model can be used to develop policy interventions to prevent a further decline in this lifesaving therapy.
AHRQ-funded; HS019468.
Citation: Toro-Diaz H, Mayorga ME, Barritt AS .
Predicting liver transplant capacity using discrete event simulation.
Med Decis Making 2015 Aug;35(6):784-96. doi: 10.1177/0272989x14559055.
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Keywords: Access to Care, Health Services Research (HSR), Policy, Transplantation
Gold R, Bailey SR, O'Malley JP
Estimating demand for care after a Medicaid expansion: lessons from Oregon.
In order to estimate how the Affordable Care Act's Medicaid expansions will affect demand for services, the authors measured ambulatory care utilization among adult patients who gained insurance during Oregon's 2008 Medicaid expansion. They found that, in comparisons of the pre- and postcoverage periods, the mean annual encounters among persons who gained insurance increased 22% to 35%, but declined in the comparison groups.
AHRQ-funded; HS021522.
Citation: Gold R, Bailey SR, O'Malley JP .
Estimating demand for care after a Medicaid expansion: lessons from Oregon.
J Ambul Care Manage 2014 Oct-Dec;37(4):282-92. doi: 10.1097/jac.0000000000000023.
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Keywords: Access to Care, Healthcare Utilization, Policy, Health Services Research (HSR), Medicaid