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
1 to 25 of 138 Research Studies DisplayedBernard DM, Selden TM, Fang Z
AHRQ Author: Bernard
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
This AHRQ-authored paper examined the joint distribution of three financial problems related to healthcare: high out-of-pocket burdens, medical debt, and financial barriers to needed care. The authors applied relatively strict definitions of financial problems to data from the 2018-2019 MEPS and found that 27% of nonsenior adults lived in families with at least one of the three financial strains assessed. The percentage of participants who faced more broadly defined financial problems was 45.5%. This prevalence varied across sociodemographic characteristics, families' health care needs, insurance coverage, and financial resources.
AHRQ-authored.
Citation: Bernard DM, Selden TM, Fang Z .
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
Health Aff 2023 Nov; 42(11):1517-26. doi: 10.1377/hlthaff.2023.00604..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Access to Care, Health Insurance
Scott JW, Neiman PU, Scott KW
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
This retrospective analysis of claims data examined the association of a high-deductible health insurance plan (HDHP) with severe disease and catastrophic out-of-pocket payments for emergency surgical conditions (e.g., appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary outcome was disease severity at presentation-determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (e.g., perforation, abscess, diffuse peritonitis). The secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income. Among 43,516 patients [mean age 48.4 years; 51% female], 41% were enrolled in HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%); even after adjusting for relevant demographics. HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%).
AHRQ-funded; HS027788; HS028672.
Citation: Scott JW, Neiman PU, Scott KW .
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
Ann Surg 2023 Oct 1; 278(4):e667-e74. doi: 10.1097/sla.0000000000005819..
Keywords: Health Insurance, Healthcare Costs, Payment, Surgery
Mellor JM, McInerney M, Garrow RC
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
This study examined indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. The authors used data from the 2010-2018 Health and Retirement Study survey linked to annual Medicare beneficiary summary files. They estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. They also compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and living in the community. ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage, a 4.4 percentage point increase in having any institutional outpatient spending, and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment.
AHRQ-funded; HS025422.
Citation: Mellor JM, McInerney M, Garrow RC .
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
Health Serv Res 2023 Oct; 58(5):1024-34. doi: 10.1111/1475-6773.14155..
Keywords: Medicaid, Medicare, Low-Income, Healthcare Utilization, Healthcare Costs, Health Insurance
Jazowski SA, Vaidya AU, Donohue JM
Commercial health plan and enrollee out-of-pocket spending on accelerated approval products in 2019.
Accelerated approval products, including those of low or uncertain therapeutic value, have cost Medicare and Medicaid billions of dollars annually. The financial implications of this program for commercial payers is unknown. The purpose of this study was to estimate health plan and out-of-pocket spending on product indication pairs (products provided accelerated approval for specific indications) that did and did not confirm clinical benefit. The study found that commercial health plan spending on 93 product indication pairs totaled $1.3 billion in 2019. When this amount was extrapolated to all US ESI plans, the total equaled $9.0 billion. Health plans spent over double on product-indication pairs converted to full approval based on surrogate end points when compared to those based on clinical end points. Health plan expenditures on product-indication pairs not yet converted to full approval equaled $261.9 million ($1.9 billion for all US ESI plans). Sixty-nine percent of that amount was ascribed to those with post-marketing studies within FDA deadlines. Out-of-pocket spending totaled $17.5million, or $125.5 million for all US ESI enrollees. Fewer than one-fifth of enrollees pending was on product-indication pairs converted to full approval based on clinical end points. Of the $5.9 million spent on product-indication pairs not yet converted to full approval, 46%was ascribed to those with post-marketing studies within FDA deadlines.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Vaidya AU, Donohue JM .
Commercial health plan and enrollee out-of-pocket spending on accelerated approval products in 2019.
JAMA Intern Med 2023 Sep; 183(9):1016-18. doi: 10.1001/jamainternmed.2023.2381..
Keywords: Health Insurance, Healthcare Costs
Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
AHRQ-funded; HS000029.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A .
High-deductible health plans and nonfatal opioid overdose.
Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Hill SC, Jacobs PD, Johnson CA
AHRQ Author: Hill SC, Jacobs PD
Availability of off-marketplace plans with lower premiums for higher-income families.
Prior to 2021, families with incomes above 400% of the federal poverty level were ineligible for marketplace premium tax credits and may again be after 2025. This income cap was temporarily removed by current laws, but some higher-income families still receive zero tax credits because credits limit out-of-pocket premiums for a reference plan as a portion of income. The purpose of this study was to quantify 2 variables: 1) premium variations between on- and off-marketplace plans and 2) the relationship between these premium variations and state decisions to finance cost-sharing reductions (CSRs) for lower-income families. The researchers developed a comprehensive database of on- and off-marketplace plans in each county and compared on- and off-marketplace plan premiums in 2020 and the rates of growth in the numbers of plans. The study found that in 2020, 89% of the United States population lived in counties with an availability of plans offered only off-marketplace. In those counties premiums for the lowest-cost off-marketplace plans averaged 11.3% less than premiums for the lowest-cost on-marketplace plans. In comparison the lowest-cost off-marketplace plans were more expensive on average. Silver plan premiums were 6.1% higher off-marketplace than on-marketplace in states that loaded CSRs on all silver plans, and 13.5% lower in states that loaded CSRs only on on-marketplace silver plans.
AHRQ-authored.
Citation: Hill SC, Jacobs PD, Johnson CA .
Availability of off-marketplace plans with lower premiums for higher-income families.
Am J Manag Care 2023 Jul; 29(7):371-76. doi: 10.37765/ajmc.2023.89397..
Keywords: Health Insurance, Healthcare Costs
Carlton EF, Becker NV, Moniz MH
Out-of-pocket spending for non-birth-related hospitalizations of privately insured US children, 2017 to 2019.
This study’s goal was to estimate out-of-pocket spending for non-birth pediatric hospitalizations of privately insured children from 2017 to 2019. This study used data from the IBM MarketScan Commercial Database. Among 183,780 hospitalizations, half were for female children, with a median age of 12 (4-16) years. Most (79.0%) hospitalizations were for children with a chronic condition and 24.1% were covered by a high-deductible health plan. Mean (SD) and median (IQR) out-of-pocket spending per hospitalization was $1313 and $656 respectively. Out-of-pocket spending exceeded $3000 for 14.0% of hospitalizations. Factors associated with higher out-of-pocket spending included hospitalization in quarter 1 compared with quarter 4 (average marginal effect [AME], $637) and lack of chronic conditions compared with having a complex chronic condition (AME, $732). Hospitalizations covered by the least generous plans (deductible of $3000 or more and coinsurance of 20% or more) found mean out-of-pocket spending was $1974, while the most generous plans (deductible less than $1000 and coinsurance of 1-19%), mean out-of-pocket spending was found to be $826.
AHRQ-funded; HS025465; HS028817.
Citation: Carlton EF, Becker NV, Moniz MH .
Out-of-pocket spending for non-birth-related hospitalizations of privately insured US children, 2017 to 2019.
JAMA Pediatr 2023 May; 177(5):516-25. doi: 10.1001/jamapediatrics.2023.0130..
Keywords: Children/Adolescents, Healthcare Costs, Hospitalization, Health Insurance
Treasure G, Anderson DM, Hatcher L
Plan selection, enrollee risk, and health spending on the Patient Protection and Affordable Care Act individual marketplaces, 2019.
This study’s goal was to describe individual Patient Protection and Affordable Care Act (ACA) marketplace enrollees’ metal tier selections by risk score and assess enrollees’ health spending by metal tier, risk score, and spending type. This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database including enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year. Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019. Enrollment and claims data were obtained for 1,317,707 enrollees (53.5% female; mean age, 46.35 years) across all census areas, age groups, and sexes. Of this cohort, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans compared with enrollees in bronze plans (17.2%). Median total spending was lower among bronze plan enrollees ($593; interquartile range (IQR), $28-$2100) vs platinum ($4111; IQR, $992-$15,821) or gold ($2675; IQR, $728-$9070).
AHRQ-funded; HS026395.
Citation: Treasure G, Anderson DM, Hatcher L .
Plan selection, enrollee risk, and health spending on the Patient Protection and Affordable Care Act individual marketplaces, 2019.
JAMA Netw Open 2023 Mar; 6(3):e234529. doi: 10.1001/jamanetworkopen.2023.4529..
Keywords: Health Insurance, Healthcare Costs, Policy
Scott JW, Scott KW, Moniz M
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
This cross-sectional study linked insurance claims and consumer credit report data to evaluate the experience of financial distress in commercially insured adults after traumatic injury. Data from Blue Cross Blue Shield of Michigan’s preferred provider organization insurance claims from 2019 through 2021 were included. The authors identified working-age adults aged 21 to 64 whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury. This cohort of 3164 adults was compared demographically to 2223 patients in the comparison cohort. Relative to the comparison cohort, the post injury cohort had a 23% higher likelihood of having medical debt in collections, a 70% higher amount of medical debt in collections, and a 110% higher bankruptcy rate. For many commercially insured patients, the burden of out-of-pocket costs after hospitalization exceeded their ability to pay and could be associated with bankruptcy risk.
AHRQ-funded; HS028672; HS025465; HS028817.
Citation: Scott JW, Scott KW, Moniz M .
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
JAMA Health Forum 2022 Nov;3(11):e224105. doi: 10.1001/jamahealthforum.2022.4105..
Keywords: Trauma, Healthcare Costs, Health Insurance
Donohue JM, Cole ES, James CV
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
This article is a literature review of the Medicaid program focusing on Medicaid eligibility, enrollment, and spending and examined areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity. The authors included peer-reviewed articles and reports published between January 2003 and February 2022. Medicaid covered approximately 80.6 million people per month in 2022, representing 16.3% of US health spending. Managed care plans run by states enrolled 69.5% of Medicaid beneficiaries in 2019 and adopted 139 delivery system reforms from 2003 to 2019. Over half (56.4%) of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. The authors felt that additional Medicaid reforms are needed to reduce health disparities by race and ethnicity and to achieve equity in access, quality, and outcomes.
AHRQ-funded; HS026727.
Citation: Donohue JM, Cole ES, James CV .
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
JAMA 2022 Sep 20;328(11):1085-99. doi: 10.1001/jama.2022.14791..
Keywords: Medicaid, Healthcare Costs, Policy, Health Insurance
Jazowski SA, Wilson L, Dusetzina SB
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
The purpose of this study was to evaluate the relationship between High-deductible health plan (HDHP) enrollment with out-of-pocket spending and uptake of and adherence to lenalidomide anti-cancer therapy. The researchers found that among the highest spenders (95th percentile), HDHP enrollees paid $376 and $217 more for their first and any lenalidomide prescription fill, respectively, compared with non-HDHP enrollees in the 6 months after initiation. High-deductible health plan enrollment was also associated with an increased risk of paying more than $100 for the initial lenalidomide prescription fill. The study concluded that enrollment in HDHP was associated with higher out-of-pocket spending per lenalidomide prescription fill; however, no statistically significant differences in adherence patterns between HDHP and non-HDHP enrollees were observed.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Wilson L, Dusetzina SB .
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
JAMA Netw Open 2022 Jun;5(6):e2215720. doi: 10.1001/jamanetworkopen.2022.15720..
Keywords: Health Insurance, Healthcare Costs, Cancer
Levine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA .
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care
Meiselbach MK, Eisenberg MD, Bai G
Labor market concentration and worker contributions to health insurance premiums.
This study’s objective was to examine if labor market concentration was associated with higher worker contributions to health plan premiums. The authors combined publicly available data from the Census to calculate labor market concentration and the Medical Expenditure Panel Survey Insurance/Employer Component to determine premium contributions from 2010 to 2016 for metropolitan areas. They found that higher labor market concentration was associated with higher worker contributions to health plan premiums, lower take-home income, and no change in employer contributions to premiums consistent with their hypothesis.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Eisenberg MD, Bai G .
Labor market concentration and worker contributions to health insurance premiums.
Med Care Res Rev 2022 Apr;79(2):198-206. doi: 10.1177/10775587211012992..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs
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
Jacobs PD, Hill SC
AHRQ Author: Jacobs PD, Hill SC
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
This study calculated Marketplace premiums as a percentage of family income among middle-class families with incomes of 401-600% of poverty. The ACA premiums have been increasing since inception, with half of this population paying at least 7.7% of their income for the lowest-cost bronze plan, increasing to 11.3% in 2019. By 2019 half of the near elderly ages 55-64 would have paid at least 18.9% of their income for the lowest-cost bronze plan in their area. Results suggest that after the American Rescue Plan Act which temporarily expanded tax credit eligibility for 2021 and 2022 runs out, families will again face substantial financial burdens.
AHRQ-authored.
Citation: Jacobs PD, Hill SC .
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
Health Aff 2021 Nov;40(11):1713-21. doi: 10.1377/hlthaff.2021.00945..
Keywords: Health Insurance, Healthcare Costs
Aouad M, Brown TT, Whaley CM
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Investigators examined the heterogeneous effects of reference pricing, a health insurance reform introduced by the California Public Employees' Retirement System (CalPERS), on the distribution of spending by patients and insurers. Using the changes-in-changes approach to estimate the quantile treatment effects (QTE) of the program across different medical procedures, they found that the QTE vary across the patient spending distributions, with a range of positive and negative estimates of the QTE, depending on the medical procedure considered.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Health Econ 2021 Nov;30(11):2780-93. doi: 10.1002/hec.4410..
Keywords: Health Insurance, Healthcare Costs
Abdus S
AHRQ Author: Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
AHRQ-authored.
Citation: Abdus S .
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Hero JO, Sinaiko AD, Peltz A
In New England, partisan differences In ACA marketplace participation and potential financial harm.
This study examined how political orientation was associated with decisions to use the Affordable Care Act Marketplaces to enroll in nongroup health insurance plans and whether it was also associated with adverse financial consequences. Using data from a large insurer in New England, findings showed that Republican enrollees were less likely than Democratic enrollees of comparable subsidy eligibility to enroll through the Marketplaces and receive subsidies. Among income-eligible enrollees, Republican subscribers received $66 per month less in premium subsidies than Democratic subscribers. However, results suggested that party effects on decision making may inversely relate to the magnitude of the financial consequence.
AHRQ-funded; HS024700.
Citation: Hero JO, Sinaiko AD, Peltz A .
In New England, partisan differences In ACA marketplace participation and potential financial harm.
Health Aff 2021 Sep;40(9):1420-29. doi: 10.1377/hlthaff.2021.00624..
Keywords: Health Insurance, Healthcare Costs
Moloci NM, Si Y, Norton EC
Predicting losses from Medicare Shared Savings Program departures.
Researchers conducted an observational study to understand how accountable care organization (ACO) exit could affect Shared Savings Program (SSP) financial performance. They found that nearly 80% of ACOs were still active at the end of 2016. Among the subset that faced contract renewal in 2019, 40% were known to have exited the SSP. By 2022, ACOs that exited in 2019 could cost the SSP $186.9 million in lost savings. If the exit rate observed in 2019 continues, the SSP could suffer $396.8 million in lost savings by 2022.
AHRQ-funded; HS024525; HS024728.
Citation: Moloci NM, Si Y, Norton EC .
Predicting losses from Medicare Shared Savings Program departures.
J Gen Intern Med 2021 Aug;36(8):2490-91. doi: 10.1007/s11606-020-06424-7..
Keywords: Medicare, Health Insurance, Healthcare Costs
Eisenberg MD, Meiselbach MK, Bai G
Large self-insured employers lack power to effectively negotiate hospital prices.
This study examined the ability of self-insured employers to negotiate hospital prices and investigated the relationship between hospital prices and employer market power in the United States. Findings showed that employer market power was low in most metropolitan statistical areas. Recommendations included encouraging self-insured employers to consider building purchase alliances with state and local government employee groups in order to enhance their market power and to lower negotiated prices for hospital services.
AHRQ-funded; HS000029.
Citation: Eisenberg MD, Meiselbach MK, Bai G .
Large self-insured employers lack power to effectively negotiate hospital prices.
Am J Manag Care 2021 Jul;27(7):290-96. doi: 10.37765/ajmc.2021.88702..
Keywords: Health Insurance, Medicare, Medicaid, Healthcare Costs, Hospitals
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
Lyu PF, Chernew ME, McWilliams JM
Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions.
Using commercial claims and data on health system membership and Medicare accountable care organizations (ACOs) participation, investigators found some abrupt, large price increases for independent primary care practices that joined health system-led ACOs but were not acquired by systems. These price jumps were rare, however, increasing prices by just 4 percent, on average, among all independent practices in system-led ACOs. The price jumps were more consistent with an extension of existing pricing power from systems to some independent practices than with a major expansion of system market power.
AHRQ-funded; HS024072; HS027531.
Citation: Lyu PF, Chernew ME, McWilliams JM .
Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions.
Health Aff 2021 Jun;40(6):979-88. doi: 10.1377/hlthaff.2020.02449..
Keywords: Medicare, Health Insurance, Healthcare Costs
Chhabra KR, Fan Z, Chao GF
The role of commercial health insurance characteristics in bariatric surgery utilization.
The goal of this study was to understand relationships among insurance plan type, out-of-pocket cost sharing, and the utilization of bariatric surgery among commercially insured patients. Over 73,000 commercially insured members of the IBM MarketScan commercial claims database who underwent bariatric surgery from 2014-17 were retroactively reviewed. Findings showed that insurance plan types with higher cost sharing have lower utilization of bariatric surgery.
AHRQ-funded; HS025778; HS000053.
Citation: Chhabra KR, Fan Z, Chao GF .
The role of commercial health insurance characteristics in bariatric surgery utilization.
Ann Surg 2021 Jun;273(6):1150-56. doi: 10.1097/sla.0000000000003569..
Keywords: Health Insurance, Obesity, Obesity: Weight Management, Surgery, Healthcare Costs, Healthcare Utilization
Powell D, Goldman D
Disentangling moral hazard and adverse selection in private health insurance.
This study used claims data from a large firm which changed health insurance plan options to isolate moral hazard from plan selection to estimate a discrete choice model to predict household plan preferences and attrition. The authors found the estimates imply that 53% of the additional medical spending observed in the most generous plan in their data relative to the least generous is due to adverse selection. They found that quantifying adverse selection by using prior medical expenditures overstates the true magnitude of selection due to mean reversion.
AHRQ-funded; HS023628.
Citation: Powell D, Goldman D .
Disentangling moral hazard and adverse selection in private health insurance.
J Econom 2021 May;222(1):141-60. doi: 10.1016/j.jeconom.2020.07.030..
Keywords: Health Insurance, Healthcare Costs
Roberts ET, Glynn A, Cornelio N
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance, resulting in a supplemental coverage cliff. The authors estimated that Medicaid beneficiaries affected by this cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55 percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. They recommended expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies to lessen cost-related barriers to health care among near-poor Medicare beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Glynn A, Cornelio N .
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Health Aff 2021 Apr;40(4):552-61. doi: 10.1377/hlthaff.2020.02272..
Keywords: Medicaid, Medicare, Healthcare Costs, Low-Income, Health Insurance