National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (9)
- Antibiotics (1)
- Behavioral Health (5)
- Blood Pressure (1)
- Cardiovascular Conditions (2)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (2)
- Children/Adolescents (4)
- Chronic Conditions (2)
- Clostridium difficile Infections (1)
- Community-Based Practice (1)
- Community Partnerships (1)
- Diabetes (1)
- Disparities (5)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (12)
- Healthcare Delivery (3)
- Healthcare Utilization (1)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (2)
- Health Insurance (16)
- Health Services Research (HSR) (6)
- Home Healthcare (1)
- Hospitalization (2)
- Hospital Readmissions (1)
- Hospitals (1)
- Kidney Disease and Health (2)
- Labor and Delivery (1)
- Low-Income (6)
- Medicaid (11)
- Medical Expenditure Panel Survey (MEPS) (5)
- Medical Liability (1)
- Medicare (3)
- Medication (2)
- Nutrition (2)
- Obesity (1)
- Opioids (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (4)
- Patient Safety (1)
- Payment (6)
- (-) Policy (50)
- Pregnancy (1)
- Prevention (2)
- Primary Care (2)
- Public Health (3)
- Quality Measures (2)
- Quality of Care (3)
- Racial and Ethnic Minorities (6)
- Registries (1)
- Social Stigma (1)
- Substance Abuse (2)
- Surgery (1)
- Transplantation (3)
- Uninsured (7)
- Young Adults (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 50 Research Studies DisplayedSelden TM, Lipton BJ, Decker SL
AHRQ Author: Selden TM, Lipton BJ, Decker SL
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
The researchers found that as of 2015, adults with incomes of 100-138 percent of the federal poverty level had experienced large declines in uninsurance rates in both expansion and nonexpansion states. Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost.
AHRQ-authored.
Citation: Selden TM, Lipton BJ, Decker SL .
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
Health Aff 2017 Dec;36(12):2069-77. doi: 10.1377/hlthaff.2017.0830.
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Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Kumar K, Holscher CM, Luo X
Persistent regional and racial disparities in nondirected living kidney donation.
Nondirected living donors (NDLDs) are an important and growing source of kidneys to help reduce the organ shortage. The authors of this study hypothesized that the initial geographic clustering and racial disparities may have improved due to an increase in NDLDs. The authors found that despite the increased number of NDLDs, racial disparities have worsened and the center-level distribution of NDLD transplants has narrowed in recent years.
AHRQ-funded; HS024600.
Citation: Kumar K, Holscher CM, Luo X .
Persistent regional and racial disparities in nondirected living kidney donation.
Clin Transplant 2017 Dec;31(12). doi: 10.1111/ctr.13135..
Keywords: Disparities, Health Services Research (HSR), Policy, Transplantation, Racial and Ethnic Minorities
Yu H, Greenberg M, Haviland A
The impact of state medical malpractice reform on individual-level health care expenditures.
This study aims to fill the evidence gap concerning the effect of different types of malpractice reform by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. It found that only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures.
AHRQ-funded; HS023336.
Citation: Yu H, Greenberg M, Haviland A .
The impact of state medical malpractice reform on individual-level health care expenditures.
Health Serv Res 2017 Dec;52(6):2018-37. doi: 10.1111/1475-6773.12789.
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Keywords: Healthcare Costs, Policy, Medical Liability, Policy
Henderson ML, Thomas AG, Shaffer A
The national landscape of living kidney donor follow-up in the United States.
The purpose of this study was to understand the impact of the 2013 policy the Organ Procurement and Transplantation Network/United Network for Organ Sharing issued. The policy required that transplant centers collect data on living kidney donors (LKDs) at 6 months, 1 year, and 2 years postdonation, with policy-defined thresholds for the proportion of complete living donor follow-up data submitted in a timely manner (60 days before or after the expected visit date).
AHRQ-funded; HS024600.
Citation: Henderson ML, Thomas AG, Shaffer A .
The national landscape of living kidney donor follow-up in the United States.
Am J Transplant 2017 Dec;17(12):3131-40. doi: 10.1111/ajt.14356..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Policy, Registries, Transplantation
Hsuan C, Ryan-Ibarra S, DeBurgh K
Association of paid sick leave laws with foodborne illness rates
This mixed-methods study examined whether laws requiring employers to provide paid sick leave (PSL) are associated with decreased foodborne illness rates, particularly laws that are more supportive of employees taking leave. The study concluded that although the results suggest an association between more supportive PSL laws and decreased foodborne illness rates, they should be interpreted cautiously because the trend is driven by campylobacteriosis, which has low person-to-person transmission.
AHRQ-funded; HS024247.
Citation: Hsuan C, Ryan-Ibarra S, DeBurgh K .
Association of paid sick leave laws with foodborne illness rates
Am J Prev Med 2017 Nov;53(5):609-15. doi: 10.1016/j.amepre.2017.06.029..
Keywords: Policy, Prevention, Policy, Public Health
Leider JP, Tung GJ, Lindrooth RC
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, the researchers constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending.
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AHRQ-funded; HS024959
Citation: Leider JP, Tung GJ, Lindrooth RC .
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
J Public Health Manag Pract 2017 Nov/Dec;23(6):e1-e9. doi: 10.1097/phh.0000000000000493.
Keywords: Healthcare Costs, Policy, Hospitals
Fairbrother G, Dougherty D, Pradhananga R
AHRQ Author: Dougherty D
Road to the future: priorities for child health services research.
The researchers sought to develop and disseminate a robust, domestically focused, policy-oriented health services research agenda. Among the six priority domains identified for future research, including both enduring and emerging emphases were: 1) framing children's health issues so that they are compelling to policy-makers; 2) addressing poverty and other social determinants of child health and wellbeing; and 3) promoting equity in population health and health care.
AHRQ-authored; AHRQ-funded.
Citation: Fairbrother G, Dougherty D, Pradhananga R .
Road to the future: priorities for child health services research.
Acad Pediatr 2017 Nov - Dec;17(8):814-24. doi: 10.1016/j.acap.2017.04.015.
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Keywords: Children/Adolescents, Health Services Research (HSR), Health Services Research (HSR), Policy
Jump RLP, Gaur S, Katz MJ
Template for an antibiotic stewardship policy for post-acute and long-term care settings.
To support compliance with Centers for Medicare and Medicaid services (CMS) requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at the American Medical Directors Association -The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the long-term care setting. This paper describes that policy template.
AHRQ-funded; HS022465; HS023779.
Citation: Jump RLP, Gaur S, Katz MJ .
Template for an antibiotic stewardship policy for post-acute and long-term care settings.
J Am Med Dir Assoc 2017 Nov;18(11):913-20. doi: 10.1016/j.jamda.2017.07.018..
Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Policy, Prevention
Hiratsuka VY, Beans JA, Robinson RF
Self-determination in health research: an Alaska native example of tribal ownership and research regulation.
Southcentral Foundation (SCF), an Alaska Native-owned and operated health care organization, is transforming the relationship between researchers and the tribal community by making trust and accountability required features of health research in Alaska Native (AN) and American Indian (AI) communities. This review evaluates research through the lens of tribal principles, practices, and priorities. The SCF example provides a framework for other tribes and organizations seeking to reshape the future of health research in AN/AI communities.
AHRQ-funded; HS000079.
Citation: Hiratsuka VY, Beans JA, Robinson RF .
Self-determination in health research: an Alaska native example of tribal ownership and research regulation.
Int J Environ Res Public Health 2017 Oct 31;14(11). doi: 10.3390/ijerph14111324.
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Keywords: Health Services Research (HSR), Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Policy, Racial and Ethnic Minorities
Allen CD, McNeely CA
Do restrictive omnibus immigration laws reduce enrollment in public health insurance by Latino citizen children? A comparative interrupted time series study.
This study uses nationally-representative data from the National Health Interview Survey (2005-2014) and comparative interrupted time series methods to assess whether passage of state omnibus immigration laws reduced access to Medicaid/CHIP for US citizen Latino children. The authors found that law passage did not reduce enrollment for children with noncitizen parents and actually resulted in temporary increases in coverage among Latino children with at least one citizen parent.
AHRQ-funded; HS024248.
Citation: Allen CD, McNeely CA .
Do restrictive omnibus immigration laws reduce enrollment in public health insurance by Latino citizen children? A comparative interrupted time series study.
Soc Sci Med 2017 Oct;191:19-29. doi: 10.1016/j.socscimed.2017.08.039..
Keywords: Access to Care, Children/Adolescents, Children's Health Insurance Program (CHIP), Policy, Racial and Ethnic Minorities
Charles EJ, Johnston LE, Herbert MA
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. It concluded that Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes.
AHRQ-funded; HS022535.
Citation: Charles EJ, Johnston LE, Herbert MA .
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
Ann Thorac Surg 2017 Oct;104(4):1251-58. doi: 10.1016/j.athoracsur.2017.03.079.
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Keywords: Patient-Centered Outcomes Research, Medicaid, Surgery, Cardiovascular Conditions, Policy
Huguet N, Hoopes MJ, Angier H
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Rates of uninsured visits decreased pre- to post- Affordable Care Act with greater drops in expansion (-57 percent) versus nonexpansion (-20 percent) states. Medicaid-insured visits increased 60 percent in expansion states while remaining unchanged in nonexpansion states.
AHRQ-funded; HS024270.
Citation: Huguet N, Hoopes MJ, Angier H .
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
J Prim Care Community Health 2017 Oct;8(4):206-12. doi: 10.1177/2150131917709403.
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Keywords: Community Partnerships, Health Insurance, Policy, Medicaid, Uninsured
Kazi DS, Lu CY, Lin GA
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
In this research letter the investigators analyzed the June 2016 Centers for Medicare and Medicaid Services Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files for all Part D plans (except special-needs plans that may have had specialized formularies) and out-of-pocket cost requirements for PCSK9is (alirocumab and evolocumab) averaged across all plans by counties and states. The authors asserted that their findings suggest a need to lower out-of pocket costs to ensure affordability of PCSK9is for Medicare beneficiaries covered by Part D.
AHRQ-funded; HS016772.
Citation: Kazi DS, Lu CY, Lin GA .
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
JAMA Cardiol 2017 Oct;2(10):1164-66. doi: 10.1001/jamacardio.2017.3051..
Keywords: Healthcare Costs, Medicare, Medication, Policy
Gonzales G, Golberstein E, Hill SC
AHRQ Author: Hill, SC; Zuvekas, SH
Psychological distress and enrollment in Medicaid.
Adults with poor mental health may want and need insurance to obtain care, but symptoms may impede enrollment into public health insurance. The enrollment response to Medicaid expansions prior to the Affordable Care Act was stronger for adults symptomatic of psychological distress compared with adults without distress and compared to adults with chronic physical health problems.
AHRQ-authored.
Citation: Gonzales G, Golberstein E, Hill SC .
Psychological distress and enrollment in Medicaid.
J Behav Health Serv Res 2017 Oct;44(4):523-35. doi: 10.1007/s11414-016-9532-9.
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Keywords: Access to Care, Policy, Medicaid, Medical Expenditure Panel Survey (MEPS), Behavioral Health
Chen J, Vargas-Bustamante A, Novak P
Reducing young adults' health care spending through the ACA expansion of dependent coverage.
The researchers estimated health care expenditure trends among young adults ages 19-25 before and after the 2010 implementation of the Affordable Care Act (ACA) provision that extended eligibility for dependent private health insurance coverage. They found that increased health insurance enrollment as a consequence of the ACA provision for dependent coverage has successfully reduced spending and catastrophic expenditures, providing financial protections for young adults.
AHRQ-funded; HS022135.
Citation: Chen J, Vargas-Bustamante A, Novak P .
Reducing young adults' health care spending through the ACA expansion of dependent coverage.
Health Serv Res 2017 Oct;52(5):1835-57. doi: 10.1111/1475-6773.12555.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Policy, Young Adults
Cottrell EK, Hall JD, Kautz G
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. This study conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations. They identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment.
AHRQ-funded; HS022651.
Citation: Cottrell EK, Hall JD, Kautz G .
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
J Ambul Care Manage 2017 Oct/Dec;40(4):339-46. doi: 10.1097/jac.0000000000000198..
Keywords: Healthcare Delivery, Payment, Patient-Centered Healthcare, Policy, Primary Care
Markowitz S, Adams EK, Lewitt MJ
Competitive effects of scope of practice restrictions: public health or public harm?
This paper examined the case of scope of practice (SOP) restrictions for certified nurse midwives and evaluated the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. The authors found that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births.
AHRQ-funded; HS024530.
Citation: Markowitz S, Adams EK, Lewitt MJ .
Competitive effects of scope of practice restrictions: public health or public harm?
J Health Econ 2017 Sep;55:201-18. doi: 10.1016/j.jhealeco.2017.07.004..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Public Health, Policy
Hudson JL, Moriya AS
AHRQ Author: Hudson JL, Moriya AS
Medicaid expansion for adults had measurable 'welcome mat' effects on their children.
This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post Affordable Care Act (ACA). It estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
Medicaid expansion for adults had measurable 'welcome mat' effects on their children.
Health Aff 2017 Sep;36(9):1643-51. doi: 10.1377/hlthaff.2017.0347.
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Keywords: Children/Adolescents, Health Insurance, Policy, Low-Income
Friedman S, Xu H, Harwood JM
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
The purpose of this study was to determine whether Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with increased behavioral health expenditures and utilization among a population with substance use disorder (SUD) diagnoses. The investigators found that MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Harwood JM .
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
J Subst Abuse Treat 2017 Sep;80:67-78. doi: 10.1016/j.jsat.2017.06.006..
Keywords: Behavioral Health, Healthcare Costs, Healthcare Utilization, Health Insurance, Policy, Health Services Research (HSR), Substance Abuse
Ahluwalia SC, Damberg CL, Silverman M
What defines a high-performing health care delivery system: a systematic review.
A systematic review was conducted to determine if there is a commonly used, agreed-on definition of what constitutes a "high-performing" health care delivery system. No consistent definition of a high-performing health care system or organization was identified. High performance was variably defined across different dimensions, including quality (93 percent of articles), cost (67 percent), access (35 percent), equity (26 percent), patient experience (21 percent), and patient safety (18 percent).
AHRQ-funded; HS024067.
Citation: Ahluwalia SC, Damberg CL, Silverman M .
What defines a high-performing health care delivery system: a systematic review.
Jt Comm J Qual Patient Saf 2017 Sep;43(9):450-59. doi: 10.1016/j.jcjq.2017.03.010.
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Keywords: Healthcare Delivery, Quality of Care, Policy, Quality Measures
Cook BL, Zuvekas SH, Chen J
AHRQ Author: Zuvekas SH
Assessing the individual, neighborhood, and policy predictors of disparities in mental health care.
This study assessed individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. It found that racial/ethnic disparities arise because minorities are more likely to live in neighborhoods where treatment initiation is low, rather than because of a differential influence of neighborhood disadvantage on treatment initiation for minorities compared with whites.
AHRQ-authored; AHRQ-funded; HS021486.
Citation: Cook BL, Zuvekas SH, Chen J .
Assessing the individual, neighborhood, and policy predictors of disparities in mental health care.
Med Care Res Rev 2017 Aug;74(4):404-30. doi: 10.1177/1077558716646898.
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Keywords: Disparities, Medical Expenditure Panel Survey (MEPS), Behavioral Health, Policy, Racial and Ethnic Minorities
Hatch B, Marino M, Killerby M
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
This study assessed changes in biomarkers of chronic disease among community health center (CHC) patients who gained Medicaid coverage with the Oregon Medicaid expansion (2008-2011). It found that patients with uncontrolled chronic conditions experienced objective health improvements over time. In two of three chronic disease cohorts, those who gained Medicaid coverage were more likely to achieve a controlled measurement than those who remained uninsured.
AHRQ-funded; HS024270.
Citation: Hatch B, Marino M, Killerby M .
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
J Gen Intern Med 2017 Aug;32(8):940-47. doi: 10.1007/s11606-017-4051-9.
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Keywords: Medicaid, Chronic Conditions, Access to Care, Policy
Novak P, Williams-Parry KF, Chen J
AHRQ Author: Novak P
Racial and ethnic disparities among the remaining uninsured young adults with behavioral health disorders after the ACA expansion of dependent coverage.
The objective of this study is to explore the population characteristics of the remaining uninsured individuals with and without behavioral health disorders (BHDs) and to examine whether the factors that contribute to racial and ethnic disparities in the likelihood of being uninsured were different after ACA. The major factor associated with the ethnic disparity among those with BHDs was the immigrant status of Latinos, and the major factor associated with racial disparity was geographic location.
AHRQ-authored; AHRQ-funded; HS022135.
Citation: Novak P, Williams-Parry KF, Chen J .
Racial and ethnic disparities among the remaining uninsured young adults with behavioral health disorders after the ACA expansion of dependent coverage.
J Racial Ethn Health Disparities 2017 Aug;4(4):607-14. doi: 10.1007/s40615-016-0264-6.
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Keywords: Behavioral Health, Disparities, Policy, Medical Expenditure Panel Survey (MEPS), Uninsured
Savage EL, Fairbanks RJ, Ratwani RM
Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison.
This study sought to compare government policies on usability and safety, and methods of examining compliance to those policies, across 3 federal agencies: the Office of the National Coordinator (ONC) and EHRs, the Federal Aviation Administration (FAA) and avionics, and the Food and Drug Administration (FDA) and medical devices. The goal was to identify whether differences in policies exist and, if they do exist, how policies and enforcement mechanisms from other industries might be applied to optimize EHR usability.
AHRQ-funded; HS023701.
Citation: Savage EL, Fairbanks RJ, Ratwani RM .
Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison.
J Am Med Inform Assoc 2017 Jul 1;24(4):769-75. doi: 10.1093/jamia/ocw185.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Policy
Heintzman J, Bailey SR, DeVoe J
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
This study compared the insurance status of low-income patients served in 23 community health centers (CHCs) in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion in 2014. It found that among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos.
AHRQ-funded; HS021522; HS024270.
Citation: Heintzman J, Bailey SR, DeVoe J .
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
J Racial Ethn Health Disparities 2017 Jun;4(3):329-36. doi: 10.1007/s40615-016-0232-1.
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Keywords: Disparities, Health Insurance, Policy, Low-Income, Racial and Ethnic Minorities