National Healthcare Quality and Disparities Report
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- Access to Care (2)
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- (-) Hospitals (17)
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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 17 of 17 Research Studies DisplayedSmith K, Padmanabhan P, Chen A
The impacts of the 340B Program on health care quality for low-income patients.
This study’s objective was to assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients. HCUP State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and the American Hospital Association Annual Survey were all used to extract inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data was linked on hospital 340B eligibility and participation. The authors did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality, 30-day readmission rates, or other measures. Among insured and non-Medicaid patients, they found discontinuities for acute myocardial infarction and postoperative sepsis mortality.
AHRQ-funded; HS026980.
Citation: Smith K, Padmanabhan P, Chen A .
The impacts of the 340B Program on health care quality for low-income patients.
Health Serv Res 2023 Oct; 58(5):1089-97. doi: 10.1111/1475-6773.14204..
Keywords: Low-Income, Hospitals, Vulnerable Populations, Medicaid, Uninsured, Inpatient Care, Quality of Care
Desai SM, Padmanabhan P, Chen AZ
Hospital concentration and low-income populations: evidence from New York State Medicaid.
The purpose of this study was to utilize comprehensive discharge data from New York State to assess the effects of changes in market concentration on hospital-level inpatient Medicaid volumes. The study found that for the average hospital, a one percent increase in HHI led to a 0.6% decrease in the number of Medicaid admissions. The strongest effects were on admissions for birth. These hospital-level decreases primarily reflect redistribution of Medicaid patients across hospitals, rather than overall reductions in hospitalizations for Medicaid patients. Specifically, hospital concentration leads to a redistribution of admissions from non-profit hospitals to public hospitals. The researchers found evidence that for births, physicians serving high proportions of Medicaid beneficiaries experience decreased admissions as concentration increased.
AHRQ-funded; HS026980.
Citation: Desai SM, Padmanabhan P, Chen AZ .
Hospital concentration and low-income populations: evidence from New York State Medicaid.
J Health Econ 2023 Jul; 90:102770. doi: 10.1016/j.jhealeco.2023.102770..
Keywords: Hospitals, Low-Income, Medicaid
Meille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
AHRQ-funded; HS024763.
Citation: Taylor K, Diaz A, Nuliyalu U .
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords: Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
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
Chatterjee P, Qi M, Werner RM
Association of Medicaid expansion with quality in safety-net hospitals.
The authors compared changes in quality from 2012 to 2018 between safety net hospitals (SNHs) in states that expanded Medicaid vs those in states that did not. They found that, despite reductions in uncompensated care and improvements in operating margins, there appeared to be little evidence of quality improvement among SNHs in states that expanded Medicaid compared with those in states that did not.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Werner RM .
Association of Medicaid expansion with quality in safety-net hospitals.
JAMA Intern Med 2021 May;181(5):590-97. doi: 10.1001/jamainternmed.2020.9142..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Medicaid, Quality Improvement, Quality of Care
Bucholz EM,, Schuster MA, Toomey SL
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
This study examined trends in 30-day readmission rates for Medicaid and privately insured pediatric patients from 2010 to 2017. The HCUP Nationwide Readmissions Database was used to compare hospital-level risk-adjusted readmission rates. Higher readmission rates were found for Medicaid beneficiaires compared to privately insured pediatric patients during the time period.
AHRQ-funded; HS020513; HS025299.
Citation: Bucholz EM,, Schuster MA, Toomey SL .
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
Pediatrics 2020 Aug;146(2). doi: 10.1542/peds.2020-0270..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Health Insurance, Medicaid, Hospitals
Selden TM
AHRQ Author: Selden TM
Differences between public and private hospital payment rates narrowed, 2012-16.
In 2000-12 payments for inpatient hospital stays, emergency department visits, and outpatient hospital care for privately insured patients grew much faster than payments for Medicare and Medicaid patients. This widening of private-public payment gaps slowed or even reversed itself in 2012-16. In this paper, the author discusses the differences between public and private hospital payment rates, 2012-2016.
AHRQ-authored.
Citation: Selden TM .
Differences between public and private hospital payment rates narrowed, 2012-16.
Health Aff 2020 Jan;39(1):94-99. doi: 10.1377/hlthaff.2019.00415..
Keywords: Medical Expenditure Panel Survey (MEPS), Hospitals, Payment, Healthcare Costs, Medicaid, Medicare
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Wu VY, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
The purpose of the study was to examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). The investigators concluded that postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance.
AHRQ-authored; AHRQ-funded; 290201300002.
Citation: Wu VY, Fingar KR, Jiang HJ .
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
Health Serv Res 2018 Oct;53(5):3617-39. doi: 10.1111/1475-6773.12812..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid
Casucci S, Lin L, Hewner S
Estimating the causal effects of chronic disease combinations on 30-day hospital readmissions based on observational Medicaid data.
The purpose of this study was to demonstrate how observational causal inference methods can generate insights into the impact of chronic disease combinations on patients' 30-day hospital readmissions. The investigators concluded that multi-hypothesis causal analysis, a new methodological tool, generates meaningful insights from health care claims data, guiding the design of care and intervention programs.
AHRQ-funded; HS022575.
Citation: Casucci S, Lin L, Hewner S .
Estimating the causal effects of chronic disease combinations on 30-day hospital readmissions based on observational Medicaid data.
J Am Med Inform Assoc 2018 Jun;25(6):670-78. doi: 10.1093/jamia/ocx141.
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Keywords: Chronic Conditions, Hospital Readmissions, Medicaid, Hospitals
Fingar KR, Coffey RM, Mulcahy AW
AHRQ Author: Andrews RM, Stocks C
Shifts in Medicaid and uninsured payer mix at safety-net and non-safety-net hospitals during the Great Recession.
The authors examined payer mix at safety-net hospitals (SNHs) and non-SNHs during a period covering the Great Recession using data from 38 states. The number of privately insured stays decreased at both SNHs and non-SNHs. Non-SNHs increasingly served Medicaid-enrolled and uninsured patients; in SNHs, the number of Medicaid stays decreased and uninsured stays remained stable.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Fingar KR, Coffey RM, Mulcahy AW .
Shifts in Medicaid and uninsured payer mix at safety-net and non-safety-net hospitals during the Great Recession.
J Healthc Manag 2018 May-Jun;63(3):156-72. doi: 10.1097/jhm-d-16-00024.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid, Uninsured
Lindrooth RC, Perraillon MC, Hardy RY
Understanding the relationship between Medicaid expansions and hospital closures.
The investigators hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. They tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance and discuss their findings in this paper.
AHRQ-funded; HS024959; HS025208.
Citation: Lindrooth RC, Perraillon MC, Hardy RY .
Understanding the relationship between Medicaid expansions and hospital closures.
Health Aff 2018 Jan;37(1):111-20. doi: 10.1377/hlthaff.2017.0976..
Keywords: Healthcare Costs, Policy, Hospitals, Medicaid, Rural Health
Simon TD, Cawthon ML, Popalisky J
Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
The Pediatric Medical Complexity Algorithm (PMCA) was developed to stratify children by level of medical complexity. The researchers sought to refine PMCA and evaluate its performance based on the duration of eligibility and completeness of Medicaid data. They concluded that PMCA version 2.0 identifies children with C-CD with good sensitivity and very good specificity when applied to Medicaid data.
AHRQ-funded; HS020506.
Citation: Simon TD, Cawthon ML, Popalisky J .
Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
Hosp Pediatr 2017 Jul;7(7):373-77. doi: 10.1542/hpeds.2016-0173.
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Keywords: Chronic Conditions, Hospitals, Medicaid, Ambulatory Care and Surgery, Children/Adolescents
Horwitz LI, Bernheim SM, Ross JS
Hospital characteristics associated with risk-standardized readmission rates.
This national study using Medicare data examined the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR). Overall, larger, urban, academic facilities had modestly higher RSRRs than smaller, suburban, community hospitals, although there was a wide range of performance. The strong regional effect suggests that local practice patterns are an important influence.
AHRQ-funded; HS022882.
Citation: Horwitz LI, Bernheim SM, Ross JS .
Hospital characteristics associated with risk-standardized readmission rates.
Med Care 2017 May;55(5):528-34. doi: 10.1097/mlr.0000000000000713.
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Keywords: Hospitals, Hospital Readmissions, Medicaid, Risk, Quality of Care
Woodworth L
A leak in the lifeboat: the effect of Medicaid managed care on the vitality of safety-net hospitals.
Woodworth estimated the impact of Medicaid managed care on safety-net hospitals by exploiting a Florida pilot program that required Medicaid recipients in five counties to enroll in managed care. The results suggested that this mandate led to a small reduction in safety-net hospitals' average ratio of payment-to-cost and that the effect on safety-net hospitals was disproportionate.
AHRQ-funded; HS022236.
Citation: Woodworth L .
A leak in the lifeboat: the effect of Medicaid managed care on the vitality of safety-net hospitals.
J Regul Econ 2016 Dec;50(3):251-70. doi: 10.1007/s11149-016-9312-8.
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Keywords: Hospitals, Medicaid, Health Insurance
Sommers BD, Stone J, Kane N
Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act.
The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. It found that university governance was the strongest positive predictor of operating margin. Safety net hospital financial performance varied considerably. Academic hospitals had higher operating margins, while more generous Medicaid eligibility and reimbursement policies improved hospitals' ability to recoup costs.
AHRQ-funded; HS021291.
Citation: Sommers BD, Stone J, Kane N .
Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act.
Int J Health Serv 2016;46(1):166-84. doi: 10.1177/0020731415586408.
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Keywords: Hospitals, Policy, Medicaid, Payment