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 15 of 15 Research Studies DisplayedZachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Roberts ET, Kwon Y, Hames AG
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
The purpose of this study was to examine whether exceeding the income threshold for Medicaid, which causes a sudden loss of Medicaid eligibility, is related with higher racial and ethnic disparities in access to and use of care. The researchers evaluated Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities related with the loss of Medicaid eligibility, the researchers compared discontinuities in outcomes among Black and Hispanic beneficiaries and White beneficiaries. Analyses were conducted between January 1, 2022, and October 1, 2022. The primary outcomes were patient-reported challenges accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data. The study included 8,144 participants representing 151,282, 957 weighted person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% of the federal poverty level (FPL). Study findings indicate that exceeding the Medicaid eligibility threshold was related with a 43.8 percentage point (pp) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care, lower outpatient use, and fewer medication fills, but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use and medication fills among Black and Hispanic vs White beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Kwon Y, Hames AG .
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
JAMA Intern Med 2023 Jun; 183(6):534-43. doi: 10.1001/jamainternmed.2023.0512..
Keywords: Disparities, Racial and Ethnic Minorities, Medicaid, Access to Care, Health Insurance, Low-Income, Access to Care
Moriya AS, Chakravarty S
AHRQ Author: Moriya AS
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, 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
Hammad Mrig E
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
This paper proposes that Pierre Bourdieu's theories of capital and symbolic power can be integrated with fundamental cause theory to address limitations in the latter theory, making it more useful in health disparities research. This work deepens appreciation for the durable relationship between socioeconomic status and health. Study results reveal the multiple and complex mechanisms that play a role in access to healthcare services, which has significant implications for how we think about the role of health policy in addressing health disparities.
AHRQ-funded; HS017589.
Citation: Hammad Mrig E .
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
Sociol Health Illn 2021 Jan;43(1):133-48. doi: 10.1111/1467-9566.13195..
Keywords: Social Determinants of Health, Disparities, Health Insurance, Access to Care, Genetics, Policy
Nguyen KH, Trivedi AN
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
This study compared coverage and access to care between non-Hispanic White and Asian American adults after the ACA in California. The data was disaggregated into the five most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). The outcomes measured were 1) being uninsured, 2) having a usual source of care, 3) delaying necessary medical care, and 4) delaying necessary prescription medications. The sample included 19,201 non-Hispanic White and 3077 Asian American adults aged 18 to 64 in California. Koreans were significantly less likely to report a usual source of care relative to non-Hispanic whites while Chinese and Vietnamese adults were significantly less likely to delay necessary care.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN .
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
J Gen Intern Med 2019 Nov;34(11):2660-68. doi: 10.1007/s11606-019-05328-5..
Keywords: Racial and Ethnic Minorities, Access to Care, Disparities, Health Insurance, Uninsured, Policy
Kemmick Pintor J, Call KT
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Investigators sought to measure differences in insurance by mother's documentation status among a nationally representative sample of US-born children in immigrant families and to examine the role of state-level immigrant access to prenatal coverage. They found that, in states with nonrestrictive prenatal coverage for immigrants, there were no differences in children's insurance by mother's documentation status, while large inequities were observed within states with restrictive policies.
AHRQ-funded; HS021973.
Citation: Kemmick Pintor J, Call KT .
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Glob Pediatr Health 2019 Sep 26;6:2333794x19873535. doi: 10.1177/2333794x19873535..
Keywords: Policy, Health Insurance, Children/Adolescents, Access to Care, Vulnerable Populations, Disparities
Dy CJ, Tipping AD, Nickel KB
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
This study examined rates of Medicaid-funded surgical procedures for orthopedic patients. The authors hypothesized that orthopedists and hospitals are often unwilling to perform surgery on underinsured patients. The payer mix was examined for select inpatient orthopedic surgical procedures within a single region, including elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial or fibular fracture repair) among 22 hospitals from 2011 to 2016 for patients aged 18 to 64 years. For all cases (n = 19,204) the mean percentage of Medicaid-funded surgical procedures was 7.6%. Elective surgery cases were 5.5% and trauma cases 14.7% which supports their beliefs about delivery rates of orthopedic care on the basis of socioeconomic markers.
AHRQ-funded; HS019455.
Citation: Dy CJ, Tipping AD, Nickel KB .
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
J Bone Joint Surg Am 2019 Aug 21;101(16):1451-59. doi: 10.2106/jbjs.18.01198.
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Keywords: Orthopedics, Healthcare Delivery, Medicaid, Surgery, Access to Care, Disparities, Health Insurance
Peterson E, Busch S
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
This article reviews the history and measures benefits from the 2008 passing of the Mental Health Parity and Addiction Equity Act (MHPAEA). It led to significant improvements in mental health care coverage. Directions for future research are also discussed.
AHRQ-funded; HS017589.
Citation: Peterson E, Busch S .
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
Annu Rev Public Health 2018 Apr 1;39:421-35. doi: 10.1146/annurev-publhealth-040617-013603..
Keywords: Access to Care, Behavioral Health, Disparities, Health Insurance, Policy, Substance Abuse
Angier H, Ezekiel-Herera D, Marino M
Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after Medicaid Expansion.
Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after Medicaid Expansion.
AHRQ-funded; HS024270.
Citation: Angier H, Ezekiel-Herera D, Marino M .
Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after Medicaid Expansion.
J Health Care Poor Underserved 2019;30(1):116-30. doi: 10.1353/hpu.2019.0011.
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Keywords: Access to Care, Diabetes, Disparities, Health Insurance, Medicaid, Racial and Ethnic Minorities
Biener AI, Zuvekas SH
AHRQ Author: Zuvekas SH
Do racial and ethnic disparities in health care use vary with health?
Researchers used Medical Expenditure Panel Survey (MEPS) data from 2010-2014 to evaluate health care use between black-white and Hispanic-white adults. They found that there was the widest disparity in health care use in adults in excellent health between Hispanics and whites but the opposite was true for blacks and whites. Differences are attributed to health insurance coverage and access to health care overall.
AHRQ-authored.
Citation: Biener AI, Zuvekas SH .
Do racial and ethnic disparities in health care use vary with health?
Health Serv Res 2019 Feb;54(1):64-74. doi: 10.1111/1475-6773.13087..
Keywords: Access to Care, Disparities, Healthcare Utilization, Health Insurance, Health Status, Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities
Lipton BJ, Decker SL, Sommers BD
AHRQ Author: Lipton BJ, Decker SL
The Affordable Care Act appears to have narrowed racial and ethnic disparities in insurance coverage and access to care among young adults.
This study analyzed insurance coverage gains of young adults aged 19 to 25 due to the Affordable Care Act’s 2010 coverage provision and also 2014 Medicaid and Marketplace expansions. There were gains in coverage of 11% for Hispanics, 10.1% for Blacks and 4.6% for Whites.
AHRQ-authored; AHRQ-funded; HS021291.
Citation: Lipton BJ, Decker SL, Sommers BD .
The Affordable Care Act appears to have narrowed racial and ethnic disparities in insurance coverage and access to care among young adults.
Med Care Res Rev 2019 Feb;76(1):1077558717706575. Epub ahead of print. doi: 10.1177/1077558717706575..
Keywords: Access to Care, Disparities, Health Insurance, Racial and Ethnic Minorities, Young Adults
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
Chen J, Vargas-Bustamante A, Mortensen K
Racial and ethnic disparities in health care access and utilization under the Affordable Care Act.
The objective of this study was to examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014. Its results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health insurance.
AHRQ-funded; HS022135.
Citation: Chen J, Vargas-Bustamante A, Mortensen K .
Racial and ethnic disparities in health care access and utilization under the Affordable Care Act.
Med Care 2016 Feb;54(2):140-6. doi: 10.1097/mlr.0000000000000467.
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Keywords: Access to Care, Disparities, Healthcare Utilization, Health Insurance
Abdus S, Mistry KB, Selden TM
AHRQ Author: Mistry KB, Selden TM
Racial and ethnic disparities in services and the Patient Protection and Affordable Care Act.
The researchers examined pre-reform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). They found that minorities were disproportionately represented among those targeted by the coverage provisions of the ACA.
AHRQ-authored.
Citation: Abdus S, Mistry KB, Selden TM .
Racial and ethnic disparities in services and the Patient Protection and Affordable Care Act.
Am J Public Health 2015 Nov;105(Suppl 5):S668-75. doi: 10.2105/ajph.2015.302892..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Disparities, Racial and Ethnic Minorities, Access to Care