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
76 to 100 of 134 Research Studies DisplayedZuckerman RB, Wu S, Chen LM
The five-star skilled nursing facility rating system and care of disadvantaged populations.
AHRQ-funded; HS000029.
Citation: Zuckerman RB, Wu S, Chen LM .
The five-star skilled nursing facility rating system and care of disadvantaged populations.
J Am Geriatr Soc 2019 Jan;67(1):108-14. doi: 10.1111/jgs.15629..
Keywords: Nursing Homes, Vulnerable Populations, Medicare, Elderly, Provider Performance, Quality of Care, Hospital Discharge, Disparities
Werner RM, Kanter GP, Polsky D
Association of physician group participation in Accountable Care Organizations with patient social and clinical characteristics.
The goal of this retrospective cohort study was to estimate the association between the patient characteristics of a physician group and the group's participation in a newly formed accountable care organization (ACOs). A random sample of Medicare fee-for-service beneficiaries attributed to physician groups were identified by Medicare claims made before ACO participation. Physician groups that participated and did not participate in the Medicare Shared Savings Program (MSSP) were then identified. ACO-participating physician groups were compared with non-participating groups for reference, and estimates were made at both the physician and patient level. The study found that physician groups that participated in the MSSP ACO program cared for more vulnerable patients than non-participating groups did; ACO-participating physician groups cared for an equally large number of vulnerable patients compared with non-participating groups. The authors conclude that ACOs may be an effective approach to target care among high-risk patients.
AHRQ-funded; HS025184.
Citation: Werner RM, Kanter GP, Polsky D .
Association of physician group participation in Accountable Care Organizations with patient social and clinical characteristics.
JAMA Netw Open 2019 Jan 4;2(1):e187220. doi: 10.1001/jamanetworkopen.2018.7220..
Keywords: Health Services Research (HSR), Medicare, Vulnerable Populations
Olsen MA, Stwalley D, Demont C
Clostridium difficile infection increases acute and chronic morbidity and mortality.
The goal of this study was to quantify short- and long-term outcomes of Clostridium difficile infection in the elderly, using 2011 Medicare claims data. The claims records of 174,903 patients coded for Clostridium difficile infection were compared with those of 1,318,538 control patients. The authors concluded that Clostridium difficile infection was associated with increased risk of short- and long-term adverse outcomes, including transfer to short- and long-term care facilities, hospitalization, and all-cause mortality.
AHRQ-funded; HS019455.
Citation: Olsen MA, Stwalley D, Demont C .
Clostridium difficile infection increases acute and chronic morbidity and mortality.
Infect Control Hosp Epidemiol 2019 Jan;40(1):65-71. doi: 10.1017/ice.2018.280..
Keywords: Clostridium difficile Infections, Elderly, Medicare, Outcomes
Ody C, Msall L, Dafny LS
Decreases in readmissions credited to Medicare's program to reduce hospital readmissions have been overstated.
This study examines the assumption that Medicare's Hospital Readmissions Reduction Program (HRRP) can lower risk-adjusted readmission rates at general acute care hospitals for targeted conditions. Prior studies of HRRP have relied upon the control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. After adjustment for differences in pre-HRRP readmission rates across samples, the study found that declines for targeted conditions were statistically indistinguishable from declines for two control samples. The authors conclude that either the HRRP had no effect on readmissions, or it has led to a systemwide reduction in readmissions roughly half as large as prior estimates have suggested.
AHRQ-funded; HS024072.
Citation: Ody C, Msall L, Dafny LS .
Decreases in readmissions credited to Medicare's program to reduce hospital readmissions have been overstated.
Health Aff 2019 Jan;38(1):36-43. doi: 10.1377/hlthaff.2018.05178..
Keywords: Hospital Readmissions, Medicare, Patient-Centered Outcomes Research
Starr P, Agarwal A, Singh G
Obstructive sleep apnea with chronic obstructive pulmonary disease among Medicare beneficiaries.
This research letter describes a claims-based study of Medicare beneficiaries conducted by the authors that examined the diagnosed prevalence and trend of overlap syndrome (the coexistence of chronic obstructive pulmonary disease [COPD] and obstructive sleep apnea [OSA] in a single individual). A total of 159,084 patients with COPD were included in the study; 11 percent had coexisting OSA. Data were gathered from multiple files: the Medicare Denominator File, the Medicare Provider Analysis and Review File, the Outpatient Standard Analytic File, the 100% Physician/Supplier Data File, and the Durable Medical Equipment File. Medicare enrollment files were used to gather information on patient characteristics and categorize subjects by age, sex, race, and socioeconomic status. The authors note that the prevalence of diagnosed overlap syndrome has increased fourfold during the 10-year study period.
AHRQ-funded; HS020642; HS022134.
Citation: Starr P, Agarwal A, Singh G .
Obstructive sleep apnea with chronic obstructive pulmonary disease among Medicare beneficiaries.
Ann Am Thorac Soc 2019 Jan;16(1):153-56. doi: 10.1513/AnnalsATS.201712-932OC..
Keywords: Sleep Problems, Respiratory Conditions, Medicare, Chronic Conditions
Desai NR, Ross JS, Kwon JY
Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions.
This study compared trends in readmission rates for target and nontarget conditions, stratified by hospital penalty status after the announcement of the Hospital Readmission Reduction Program (HRRP). It found that Medicare fee-for-service patients at hospitals subject to penalties under the HRRP had greater reductions in readmission rates compared with those at nonpenalized hospitals. Changes were greater for target vs nontarget conditions for patients at the penalized hospitals but not at the other hospitals.
AHRQ-funded; HS022882; HS023000.
Citation: Desai NR, Ross JS, Kwon JY .
Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions.
JAMA 2016 Dec 27;316(24):2647-56. doi: 10.1001/jama.2016.18533.
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Keywords: Heart Disease and Health, Hospital Readmissions, Hospitals, Medicare, Pneumonia
Raval AD, Mattes MD, Madhavan S
Association between metformin use and cancer stage at diagnosis among elderly Medicare beneficiaries with preexisting Type 2 diabetes mellitus and incident prostate cancer.
The researchers examined the association between metformin use and cancer stage at diagnosis among elderly men with preexisting diabetes mellitus and incident prostate cancer. They found a significantly lower percentage of metformin users were diagnosed with advanced prostate cancer as compared to nonusers (4.7 percent versus 6.7 percent.
AHRQ-funded; HS018622.
Citation: Raval AD, Mattes MD, Madhavan S .
Association between metformin use and cancer stage at diagnosis among elderly Medicare beneficiaries with preexisting Type 2 diabetes mellitus and incident prostate cancer.
J Diabetes Res 2016;2016:2656814. doi: 10.1155/2016/2656814.
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Keywords: Cancer: Prostate Cancer, Medication, Elderly, Diabetes, Medicare
Raval AD, Madhavan S, Mattes MD
Association between types of chronic conditions and cancer stage at diagnosis among elderly Medicare beneficiaries with prostate cancer.
The current retrospective observational study was conducted to examine the association between types of chronic conditions and cancer stage at diagnosis among elderly Medicare beneficiaries with prostate cancer. It found that those with none of the 3 types of chronic conditions (cardiometabolic, mental health, and respiratory) were 44 percent more likely to be diagnosed with advanced prostate cancer compared to men with all 3 types of chronic conditions.
AHRQ-funded; HS018622.
Citation: Raval AD, Madhavan S, Mattes MD .
Association between types of chronic conditions and cancer stage at diagnosis among elderly Medicare beneficiaries with prostate cancer.
Popul Health Manag 2016 Dec;19(6):445-53. doi: 10.1089/pop.2015.0141.
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Keywords: Cancer, Cancer: Prostate Cancer, Elderly, Medicare
Jones CA, Acevedo J, Bull J
Top 10 tips for using advance care planning codes in palliative medicine and beyond.
This article highlights 10 tips to effectively using the new advance care planning codes reimbursable under Medicare and addresses the importance of documentation, proper billing, and nuances regarding coding.
AHRQ-funded; HS023681.
Citation: Jones CA, Acevedo J, Bull J .
Top 10 tips for using advance care planning codes in palliative medicine and beyond.
J Palliat Med 2016 Dec;19(12):1249-53. doi: 10.1089/jpm.2016.0202.
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Keywords: Medicare, Palliative Care
Jayadevappa R, Chhatre S
Association between age, substance use, and outcomes in Medicare enrollees with prostate cancer.
The authors analyzed the association between age, substance use, and outcomes in fee-for-service Medicare enrollees with advanced prostate cancer. As they found age-specific results, they recommend an integrated and multidisciplinary approach to screen, refer, and treat substance use in patients with prostate cancer to improve outcomes and reduce costs.
AHRQ-funded; HS024106.
Citation: Jayadevappa R, Chhatre S .
Association between age, substance use, and outcomes in Medicare enrollees with prostate cancer.
J Geriatr Oncol 2016 Nov;7(6):444-52. doi: 10.1016/j.jgo.2016.06.007.
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Keywords: Elderly, Medicare, Outcomes, Cancer: Prostate Cancer, Substance Abuse
Hollingsworth JM, Funk RJ, Garrison SA
Association between physician teamwork and health system outcomes after coronary artery bypass grafting.
The researchers tested whether teamwork (assessed with the bipartite clustering coefficient) among multiple providers dispersed across many care locations is a determinant of surgical outcomes by examining national Medicare data from patients undergoing CABG. They found that health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality.
AHRQ-funded; HS020927.
Citation: Hollingsworth JM, Funk RJ, Garrison SA .
Association between physician teamwork and health system outcomes after coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2016 Nov;9(6):641-48. doi: 10.1161/circoutcomes.116.002714.
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Keywords: Teams, Outcomes, Medicare, Surgery, Hospital Readmissions, Cardiovascular Conditions
Harrison KL, Adrion ER, Ritchie CS
Low completion and disparities in advance care planning activities among older Medicare beneficiaries.
The researchers investigated the strength and magnitude of the relationship between sociodemographic and health characteristics of older adults and engagement in advance care planning (ACP)using logistic regression analysis and predicted probabilities. Their findings suggest that, in 2012, more than a quarter of older Medicare beneficiaries had not engaged in ACP. Those who were Latino, African American, poorly educated, or low income were at highest risk.
AHRQ-funded; HS000053.
Citation: Harrison KL, Adrion ER, Ritchie CS .
Low completion and disparities in advance care planning activities among older Medicare beneficiaries.
JAMA Intern Med 2016 Oct 31;176(12):1872-75. doi: 10.1001/jamainternmed.2016.6751.
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Keywords: Elderly, Medicare, Disparities, Social Determinants of Health
Pradarelli JC, Healy MA, Osborne NH
Variation in Medicare expenditures for treating perioperative complications: the cost of rescue.
The researchers evaluated differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. After 4 selected inpatient operations, substantial variation was observed across hospitals regarding Medicare episode payments for patients rescued from perioperative complications. Notably, higher Medicare payments were not associated with improved clinical performance.
AHRQ-funded; HS017765.
Citation: Pradarelli JC, Healy MA, Osborne NH .
Variation in Medicare expenditures for treating perioperative complications: the cost of rescue.
JAMA Surg 2016 Oct 5:e163340. doi: 10.1001/jamasurg.2016.3340.
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Keywords: Medicare, Adverse Events, Surgery, Healthcare Costs, Patient Safety
Peiris D, Phipps-Taylor MC, Stachowski CA
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
The researchers examined differences between commercial accountable care organizations (ACOs) and noncommercial ACOs. They found that among all ACOs, there was low uptake of quality and efficiency activities; commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods; and about two-thirds of the ACOs had established processes for distributing any savings accrued. They concluded that ACO delivery systems remain at a nascent stage.
AHRQ-funded; HS024075.
Citation: Peiris D, Phipps-Taylor MC, Stachowski CA .
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
Health Aff 2016 Oct;35(10):1849-56. doi: 10.1377/hlthaff.2016.0387.
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Keywords: Healthcare Costs, Payment, Health Systems, Medicaid, Medicare
Raji MY, Chen NW, Raji M
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
The authors sought to examine rate and correlates of switching from exclusive nurse practitioner (NP) primary care to receiving some or all primary care from physicians. The study group consisted of Medicare beneficiaries with diabetes, congrestive heart failure, or chronic obstructive pulmonary disease. The researchers found that about half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period.
AHRQ-funded; HS022134; HS020642.
Citation: Raji MY, Chen NW, Raji M .
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
J Prim Care Community Health 2016 Oct;7(4):249-57. doi: 10.1177/2150131916659674.
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Keywords: Elderly, Medicare, Primary Care, Practice Patterns
Carey K, Lin MY
Hospital readmissions reduction program: safety-net hospitals show improvement, modifications to penalty formula still needed.
This study addressed the fundamental question of whether the Medicare's Hospital Readmissions Reduction Program (HRRP) has been an effective tool for reducing thirty-day readmissions in safety-net hospitals. It found that in the first three years of the program, these hospitals reduced readmissions for heart attack by 2.86 percent, heart failure by 2.78 percent, and pneumonia by 1.77 percent.
AHRQ-funded; HS024853.
Citation: Carey K, Lin MY .
Hospital readmissions reduction program: safety-net hospitals show improvement, modifications to penalty formula still needed.
Health Aff 2016 Oct 1;35(10):1918-23. doi: 10.1377/hlthaff.2016.0537.
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Keywords: Hospital Readmissions, Hospitals, Medicare
Doll JA, Hellkamp AS, Goyal A
Treatment, outcomes, and adherence to medication regimens among dual Medicare-Medicaid-eligible adults with myocardial infarction.
The purpose of the study was to examine the association of dual-eligible status with clinical outcomes and adherence to medication regimens among older adults after MI. The investigators found that compared with Medicare-only patients, older adults with dual Medicare-Medicaid eligibility presenting with MI had superior rates of medication adherence but higher rates of postdischarge readmission and adverse cardiovascular outcomes.
AHRQ-funded; HS021092.
Citation: Doll JA, Hellkamp AS, Goyal A .
Treatment, outcomes, and adherence to medication regimens among dual Medicare-Medicaid-eligible adults with myocardial infarction.
JAMA Cardiol 2016 Oct 1;1(7):787-94. doi: 10.1001/jamacardio.2016.2724..
Keywords: Elderly, Medicaid, Medicare, Medication, Heart Disease and Health, Outcomes, Patient Adherence/Compliance
Ellimoottil C, Ryan AM, Hou H
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Using Medicare claims for patients in Michigan who underwent lower extremity joint replacement in the period 2011-13, the researchers applied payment methods analogous to those CMS intends to use in determining annual bonuses or penalties (reconciliation payments) to hospitals. Their findings suggest that CMS should include risk adjustment in the Comprehensive Care for Joint Replacement program and in future bundled payment programs.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H .
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Health Aff 2016 Sep;35(9):1651-7. doi: 10.1377/hlthaff.2016.0263.
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Keywords: Medicare, Payment, Healthcare Costs, Orthopedics, Provider Performance
Alpert A
The anticipatory effects of Medicare Part D on drug utilization.
While health care policies are frequently signed into law well before they are implemented, such lags are ignored in most empirical work. This paper demonstrates the importance of implementation lags in the context of Medicare Part D, the prescription drug benefit that took effect two years after it was signed into law.
AHRQ-funded; HS019681.
Citation: Alpert A .
The anticipatory effects of Medicare Part D on drug utilization.
J Health Econ 2016 Sep;49:28-45. doi: 10.1016/j.jhealeco.2016.06.004..
Keywords: Policy, Medicare, Medication, Policy, Policy
Burns ME, Huskamp HA, Smith JC
The effects of the transition from Medicaid to Medicare on health care use for adults with mental illness.
The researchers estimated the effect of dual coverage after Medicaid enrollment during the required waiting period among adults with serious mental illness on health care use, overall and related to mental health and substance use disorders. They found that after 12 months of dual coverage, the probability of outpatient care use increased in both states from 4 percent to 9 percent.
AHRQ-funded; HS018577.
Citation: Burns ME, Huskamp HA, Smith JC .
The effects of the transition from Medicaid to Medicare on health care use for adults with mental illness.
Med Care 2016 Sep;54(9):868-77. doi: 10.1097/mlr.0000000000000572.
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Keywords: Behavioral Health, Medicaid, Medicare, Hospitalization, Healthcare Utilization
Tajeu GS, Kent ST, Kronish IM
Trends in antihypertensive medication discontinuation and low adherence among Medicare beneficiaries initiating treatment from 2007 to 2012.
The authors analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. They found that low adherence decreased and was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in, and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90-day prescription fill, with dementia, a history of stroke, and those who reached the Medicare Part D coverage gap in the previous year. They concluded that although low adherence has decreased, rates of discontinuation and low adherence remain high.
AHRQ-funded; HS024262.
Citation: Tajeu GS, Kent ST, Kronish IM .
Trends in antihypertensive medication discontinuation and low adherence among Medicare beneficiaries initiating treatment from 2007 to 2012.
Hypertension 2016 Sep;68(3):565-75. doi: 10.1161/hypertensionaha.116.07720.
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Keywords: Blood Pressure, Medication, Medicare, Patient Adherence/Compliance
Jarlenski M, Hyon Baik S, Zhang Y
Trends in use of medications for smoking cessation in Medicare, 2007-2012.
This study investigated trends in utilization of smoking-cessation medications in Medicare from 2007 to 2012. It found that sixteen percent of tobacco users ever filled a prescription for a smoking-cessation medication. The proportion of beneficiaries who filled prescriptions for varenicline increased in 2007 but sharply declined corresponding to public warnings about adverse effects.
AHRQ-funded; HS018657.
Citation: Jarlenski M, Hyon Baik S, Zhang Y .
Trends in use of medications for smoking cessation in Medicare, 2007-2012.
Am J Prev Med 2016 Sep;51(3):301-8. doi: 10.1016/j.amepre.2016.02.018.
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Keywords: Medicare, Medication, Tobacco Use
Colla CH, Lewis VA, Kao LS
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
The purpose of this cohort study was to examine the effect of Medicare accountable care organization (ACO) contracts on both spending and high-cost institutional utilization for all Medicare beneficiaries and for clinically vulnerable beneficiaries. The main outcomes and measures for this study were total spending per beneficiary-quarter, spending categories, utilization of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. The study found that total spending decreased by $34 per beneficiary-quarter after implementation of ACO contracts across the overall Medicare population and decreased $114 in clinically vulnerable patients. In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively. Hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively. Variations in total spending related with ACOs did not differ by clinical condition of beneficiaries.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Kao LS .
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
JAMA Intern Med 2016 Aug;176(8):1167-75. doi: 10.1001/jamainternmed.2016.2827.
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Keywords: Medicare, Policy, Healthcare Costs, Payment, Vulnerable Populations
Wang SY, Hall J, Pollack CE
Associations between end-of-life cancer care patterns and Medicare expenditures.
The authors examined the extent to which patterns of intensive end-of-life care explain geographic variation in end-of-life care expenditures among cancer decedents. The mean expenditure per cancer decedent in the last month of life was $10,800, with considerable variation in the percentage of decedents receiving intensive end-of-life care intervention. Regional patterns of late chemotherapy or late hospice use explained only approximately 1% of the expenditure difference, while the proportion of decedents who had ICU admissions within 30 days of death was a major driver of variation, explaining 37.6% of the expenditure difference. They concluded that promoting appropriate end-of-life care has the potential to reduce geographic variation in end-of-life care expenditures.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Associations between end-of-life cancer care patterns and Medicare expenditures.
J Natl Compr Canc Netw 2016 Aug;14(8):1001-8.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Palliative Care
Berry SA, Fleishman JA, Yehia BR
AHRQ Author: Fleishman JA
Healthcare coverage for HIV provider visits before and after implementation of the Affordable Care Act.
The researchers compared HIV provider coverage pre (2011-2013) versus post (first half of 2014) ACA among a total of 28,374 persons living with HIV (PLWH) followed in 4 sites in Medicaid expansion states (CA, OR, MD), 4 in a state (NY) that expanded Medicaid in 2001, and 2 in non-expansion states (TX, FL). In expansion state sites, half of PLWH relying on Ryan White HIVAIDS Program(RWHAP)/Uncomp shifted to Medicaid, while in NY and non-expansion state sites, reliance on RWHAP/Uncomp remained constant.
AHRQ-authored.
Citation: Berry SA, Fleishman JA, Yehia BR .
Healthcare coverage for HIV provider visits before and after implementation of the Affordable Care Act.
Clin Infect Dis 2016 Aug 1;63(3):387-95. doi: 10.1093/cid/ciw278.
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Keywords: Human Immunodeficiency Virus (HIV), Medicaid, Medicare, Health Insurance