National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- (-) Access to Care (22)
- Behavioral Health (2)
- Cancer (3)
- Cancer: Colorectal Cancer (2)
- Colonoscopy (1)
- Community-Based Practice (1)
- Dental and Oral Health (2)
- Disparities (3)
- Elderly (6)
- Healthcare Costs (4)
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- (-) Medicare (22)
- Medication (2)
- Nursing Homes (1)
- Payment (3)
- Policy (4)
- Practice Patterns (1)
- Prevention (3)
- Primary Care (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (4)
- Rehabilitation (1)
- Rural Health (3)
- Screening (2)
- Social Determinants of Health (3)
- Telehealth (1)
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
1 to 22 of 22 Research Studies DisplayedZhu JM, Meiselbach MK, Drake C C
Psychiatrist networks In Medicare Advantage plans are substantially narrower than in Medicaid and ACA Markets.
The authors used a novel data set that linked insurance network service areas, plans, and providers across Medicare Advantage, Medicaid managed care, and Affordable Care Act plan markets to compare psychiatrist network breadth; their purpose was to assess the percentage of providers in a given area considered in network for a plan. They found that nearly two-thirds of psychiatrist networks in Medicare Advantage contained fewer than 25 percent of providers in a network's service area. They concluded that these findings suggest a certain “narrowness” in psychiatrist networks in Medicare Advantage, which may disadvantage enrollees attempted to obtain mental health services.
AHRQ-funded; HS000029.
Citation: Zhu JM, Meiselbach MK, Drake C C .
Psychiatrist networks In Medicare Advantage plans are substantially narrower than in Medicaid and ACA Markets.
Health Aff 2023 Jul; 42(7):909-18. doi: 10.1377/hlthaff.2022.01547..
Keywords: Elderly, Medicare, Behavioral Health, Access to Care
Roberts ET, Mellor JM, McInerny MP
Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries.
Medicare beneficiaries with income levels slightly exceeding the thresholds of eligibility for Medicaid have few affordable options for dental coverage. This gap results in a dental coverage “cliff” above these thresholds. The purpose of this study was to assess how a sudden drop-off in dental coverage from Medicaid impacts access to dental care in low-income Medicare beneficiaries. The researchers studied low-income community resident Medicare recipients whose incomes were within approximately 75 percentage points of state-specific Medicaid income eligibility thresholds. The study found that Medicare beneficiaries whose income was higher than Medicaid eligibility thresholds were 5.0 percentage points more likely to report challenges accessing dental care because of cost concerns or a lack of insurance than beneficiaries below the thresholds.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerny MP .
Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries.
Health Serv Res 2023 Jun; 58(3):589-98. doi: 10.1111/1475-6773.13981..
Keywords: Dental and Oral Health, Medicaid, Medicare, Health Insurance, Access to Care
Atherly A, Feldman R, van den Broek-Altenburg EM
Understanding factors associated with increases in Medicare Advantage enrollment, 2007-2018.
The purpose of this study was to explore the growth in the Medicare Advantage plan market share during a time period of dramatic increase. The authors investigated the factors behind the significant increase in market share of the Medicare Advantage (MA) program during a period where no structural changes were made. The study drew data from 2007-2018 and concluded that Medicare Advantage was becoming more preferred to more educated and nonminority beneficiaries compared to the past, with minority and lower-income beneficiaries also were more likely to choose the program.
AHRQ-funded; HS024281.
Citation: Atherly A, Feldman R, van den Broek-Altenburg EM .
Understanding factors associated with increases in Medicare Advantage enrollment, 2007-2018.
Am J Manag Care 2023 Apr; 29(4):e111-e16. doi: 10.37765/ajmc.2023.89351..
Keywords: Medicare, Access to Care, Health Insurance
Friedman HR, Holmes GM
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
This study looked at trends in admission to urban hospitals by rural Medicare FFS beneficiaries from 2010 to 2018. The authors combined data from the 2010 to 2018 Hospital Service Area File (HSAF) and the 2010-2017 American Hospital Association (AHA) survey. They found that controlling for distance to the nearest hospitals, an increase of 1 year was associated with a 2.0% increase in the number of admissions to urban hospitals from each rural ZIP code. New system affiliation of the nearest rural hospital was associated with an increase of 1.7%.
AHRQ-funded; HS000032.
Citation: Friedman HR, Holmes GM .
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
Health Serv Res 2022 Oct;57(5):1029-34. doi: 10.1111/1475-6773.14017..
Keywords: Medicare, Rural Health, Hospitals, Access to Care
Roberts ET, Mellor JM
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
This study compared access to, use of, and satisfaction with care among dual eligibles enrolled in Dual Eligible Special Needs Plans (D-SNPs) versus those enrolled in Medicare Advantage (MA) plans and traditional Medicare. Findings showed that, compared with those in traditional Medicare, dual eligibles generally reported greater access to care, preventive service use, and satisfaction with care in D-SNPs. There were, however, fewer differences in these outcomes among dual eligibles in D-SNPs versus other MA plans. Overall, these findings suggested that D-SNPs altogether have not provided consistently superior or more equitable care, and they highlight areas where federal and state policy could strengthen incentives for D-SNPs to improve care.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM .
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
Health Aff 2022 Sep;41(9):1238-47. doi: 10.1377/hlthaff.2022.00463..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care
Jacobs PD, Abdus S
AHRQ Author: Jacobs PD, Abdus S
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Researchers examined whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using MEPS data and examining six preventive services, they found that, for non-Hispanic Black adults, preventive service use increased after age 65. Further, for all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable between these groups after reaching the Medicare eligibility age. They concluded that Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
AHRQ-authored.
Citation: Jacobs PD, Abdus S .
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Prev Med 2022 Apr;157:106996. doi: 10.1016/j.ypmed.2022.106996..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities, Medicare, Prevention, Access to Care, Disparities, Health Insurance
Roberts ET, Desai SM
Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries?
The objective of this paper was to assess changes in physicians' provision of care to duals (low-income individuals with Medicare and Medicaid) in response to a policy that required Medicaid to fully pay Medicare's cost sharing for office visits with these patients. This policy-a provision of the Affordable Care Act-effectively increased payments for office visits with duals by 0%-20%, depending on the state, in 2013 and 2014.
AHRQ-funded; HS026727; HS026980.
Citation: Roberts ET, Desai SM .
Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries?
Health Serv Res 2021 Jun;56(3):528-39. doi: 10.1111/1475-6773.13650..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care, Healthcare Costs, Low-Income
Fung V, McCarthy S, Price M
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
This study examined whether the Affordable Care Act (ACA) primary care fee bump for dual-eligible Medicare-Medicaid beneficiaries impacted primary care physicians (PCP) acceptance of duals. The authors assessed differences in the likelihood that PCPs had dual caseloads of ≥10% or 20% in states with lower versus full dual reimbursement using linear probability models adjusted for physician and area-level traits. The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017. The fee bump was not consistently associated with increases in dual caseloads.
AHRQ-funded; HS024725.
Citation: Fung V, McCarthy S, Price M .
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
Med Care 2021 Jun;59(6):487-94. doi: 10.1097/mlr.0000000000001525..
Keywords: Primary Care, Medicaid, Medicare, Health Insurance, Payment, Access to Care
Reistetter TA, Eschbach K K, Prochaska J
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
This study’s goal was to demonstrate a method for developing rehabilitation service areas for post-acute care. A secondary analysis of 2013-2014 Medicare records for older patients in Texas (n = 469,172) was conducted. The analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The authors used Ward’s algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. They set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions. Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas were the methods used to evaluate rehabilitation service areas. The service areas had a higher ICC and variance in beds than the hospital referral regions.
AHRQ-funded; HS024711.
Citation: Reistetter TA, Eschbach K K, Prochaska J .
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
Am J Phys Med Rehabil 2021 May;100(5):465-72. doi: 10.1097/phm.0000000000001577..
Keywords: Elderly, Rehabilitation, Medicare, Nursing Homes, Long-Term Care, Home Healthcare, Access to Care
Sanchez JI, Shankaran V, Unger JM
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underused, especially among racial/ethnic minorities. This study assessed the association between patient and neighborhood factors and receipt of surveillance colonoscopy. The investigators concluded that receipt of initial surveillance colonoscopy remained low, and that there were acute disparities between Black and NHW patients.
AHRQ-funded; HS013853.
Citation: Sanchez JI, Shankaran V, Unger JM .
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
Cancer 2021 Feb;127(3):412-21. doi: 10.1002/cncr.33262..
Keywords: Colonoscopy, Cancer: Colorectal Cancer, Cancer, Access to Care, Screening, Prevention, Disparities, Medicare
Fung V, Price M, Hull P
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
The purpose of this study was to examine the association between the Affordable Care Act (ACA) fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Medicare claims data from 2012 to 2016 was used. Findings showed that the ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Additionally, visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.
AHRQ-funded; HS024725; HS025378.
Citation: Fung V, Price M, Hull P .
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
JAMA Netw Open 2021 Jan;4(1):e2033424. doi: 10.1001/jamanetworkopen.2020.33424..
Keywords: Access to Care, Medicaid, Medicare, Health Insurance, Healthcare Costs, Policy
Roberts ET, Mehrotra A
Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine.
In this study, the investigators examined disparities in digital access (ie, access at home to technology that enables video telemedicine visits) among Medicare beneficiaries by socioeconomic and demographic characteristics. The investigators concluded that the proportion of beneficiaries who lacked digital access was higher among those with low socioeconomic status, those 85 years or older, and in communities of color.
AHRQ-funded; HS026727.
Citation: Roberts ET, Mehrotra A .
Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine.
JAMA Intern Med 2020 Oct;180(10):1386-89. doi: 10.1001/jamainternmed.2020.2666..
Keywords: Elderly, Medicare, Telehealth, Health Information Technology (HIT), Disparities, Access to Care, Social Determinants of Health, Low-Income, Racial and Ethnic Minorities
Mroz TM, Patterson DG, Frogner BK
The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties.
This analysis looked at the impact of Medicare’s rural add-on payments on supply of home health agencies serving rural counties. The authors used data from Home Health Compare. The results suggest that while supply changes are similar in rural counties adjacent to urban areas and urban counties regardless of add-on payments, only higher add-payments of 5 to 10 percent to rural counties keep them on pace with those in urban counties.
AHRQ-funded; HS024777.
Citation: Mroz TM, Patterson DG, Frogner BK .
The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties.
Health Aff 2020 Jun;39(6):949-57. doi: 10.1377/hlthaff.2019.00952..
Keywords: Elderly, Medicare, Home Healthcare, Rural Health, Payment, Access to Care
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
AHRQ-authored.
Citation: Cook BL, Flores M, Zuvekas SH .
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Meyerhoefer CD, Zuvekas SH, Farkhad BF
AHRQ Author: Zuvekas SH
The demand for preventive and restorative dental services among older adults.
This study examined the use of preventive and restorative dental services among older adults. Traditional Medicare does not have dental benefits, and older adults must either be employed, have post-retirement dental benefits or spousal coverage, or enroll in a Medicare Advantage program that includes dental coverage. The authors used 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices to estimate the demand for dental care. Dental service was not sensitive to out-of-pocket prices. Older adults with private dental insurance increased preventive service by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%. Women used dental insurance more than men.
AHRQ-authored.
Citation: Meyerhoefer CD, Zuvekas SH, Farkhad BF .
The demand for preventive and restorative dental services among older adults.
Health Econ 2019 Sep;28(9):1151-58. doi: 10.1002/hec.3921..
Keywords: Medical Expenditure Panel Survey (MEPS), Elderly, Dental and Oral Health, Medicare, Health Insurance, Access to Care
Zhou M, Oakes AH, Bridges JFP
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
The goal of this study was to explore health care system factors associated with regional variation in overuse of resources, as measured by the Johns Hopkins Overuse Index (JHOI). Medicare fee-for-service claims data from beneficiaries age 65 was used to calculate the JHOI for 306 hospital referral regions in the U.S. Regions with a higher density of primary care physicians had a lower JHOI, which indicates less systemic overuse. Regional characteristics associated with higher JHOI included the number of acute care hospital beds per 1000 residents and number of hospital-based anesthesiologists, pathologists, and radiologists. The authors conclude that regional variations in health care resources are associated with the level of systemic overuse of health care, and that the role of primary care doctors in reducing overuse deserves further attention.
AHRQ-funded; T32 HS000029.
Citation: Zhou M, Oakes AH, Bridges JFP .
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
J Gen Intern Med 2018 Dec;33(12):2127-31. doi: 10.1007/s11606-018-4638-9..
Keywords: Access to Care, Elderly, Healthcare Delivery, Healthcare Utilization, Medicare, Practice Patterns
Gowrisankaran G, Lucarelli C, Schmidt-Dengler P
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
This paper sought to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on hospital choice and consumer welfare for rural residents. The Flex Program created a new class of hospital, the Critical Access Hospital (CAH), which received more generous Medicare reimbursements in return for limits on capacity and length of stay. The investigators found that conversion to CAH status resulted in a 4.7 percent drop in inpatient admissions to participating hospitals, almost all of which was driven by factors other than capacity constraints.
AHRQ-funded; HS018424.
Citation: Gowrisankaran G, Lucarelli C, Schmidt-Dengler P .
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
J Health Econ 2018 Mar;58:110-22. doi: 10.1016/j.jhealeco.2018.01.004..
Keywords: Rural Health, Access to Care, Hospitals, Medicare, Payment
Adams AS, Madden JM, Zhang F
Effects of transitioning to Medicare Part D on access to drugs for medical conditions among dual enrollees with cancer.
This study evaluated the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. Its findings suggest that the removal of drug caps under Part D had a modest impact on the treatment of hypercholesterolemia overall and may have reduced white-black gaps in the use of lipid-lowering and antidepressant therapies.
AHRQ-funded; HS018577.
Citation: Adams AS, Madden JM, Zhang F .
Effects of transitioning to Medicare Part D on access to drugs for medical conditions among dual enrollees with cancer.
Value Health 2017 Dec;20(10):1345-54. doi: 10.1016/j.jval.2017.05.023.
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Keywords: Access to Care, Cancer, Medicare, Medication, Racial and Ethnic Minorities
Taira DA, Shen C, King M
Access to medications for Medicare enrollees related to race/ethnicity: results from the 2013 Medicare Current Beneficiary Survey.
Prescription medications are taken by millions of Americans to manage chronic conditions and treat acute conditions. These medications, however, are not equally accessible to all. The purpose of this study was to examine medication access by race/ethnicity among Medicare beneficiaries. The authors found that possible interventions for non-Hispanic blacks might include assisting them in finding the best drug plan to meeting their needs, connecting them to medication assistance programs, and discussing convenience of pharmacy with patients.
AHRQ-funded; HS023185.
Citation: Taira DA, Shen C, King M .
Access to medications for Medicare enrollees related to race/ethnicity: results from the 2013 Medicare Current Beneficiary Survey.
Res Social Adm Pharm 2017 Nov;13(6):1208-13. doi: 10.1016/j.sapharm.2016.10.021..
Keywords: Access to Care, Medicare, Medication, Racial and Ethnic Minorities, Social Determinants of 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
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.
AHRQ-authored.
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.
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Keywords: Access to Care, Community-Based Practice, Quality of Care, Low-Income, Medicare