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 9 of 9 Research Studies DisplayedHassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Roberts ET, Mellor JM, McInerney M
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
The purpose of this study was to examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. The investigators concluded that characteristics of dual enrollees differed substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerney M .
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
Health Serv Res 2019 Dec;54(6):1233-45. doi: 10.1111/1475-6773.13205..
Keywords: Medicare, Medicaid, Social Determinants of Health
Keohane LM, Trivedi A, Mor V
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs. However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with an increase in the probability of switching to partial Medicaid and an increase in the probability of exiting Medicaid within 12 months. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi A, Mor V .
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Med Care Res Rev 2019 Dec;76(6):711-35. doi: 10.1177/1077558717737152..
Keywords: Vulnerable Populations, Low-Income, Medicaid, Medicare, Policy
Childrers CP, Dworsky JQ, Kominski G
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
The authors assessed differences in payments from government and commercial insurers to dialysis clinics through analysis of DaVita’s financial records. They found that, in 2017, commercial insurers paid one of the largest dialysis suppliers 4 times the rate of their government peers. They recommended that reducing payments from commercial insurers, perhaps through increased competition or fixing charges at a percent of Medicare reimbursement, may help alleviate excess spending on dialysis.
AHRQ-funded; HS025079.
Citation: Childrers CP, Dworsky JQ, Kominski G .
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
JAMA Intern Med 2019 Aug;179(8):1136-38. doi: 10.1001/jamainternmed.2019.0431..
Keywords: Payment, Health Insurance, Kidney Disease and Health, Medicare, Medicaid
Rasmussen PW, Kominski GF
Sources of success in California's individual marketplace under the Affordable Care Act.
When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. Although, the ACA has not been uniformly embraced, California has been a leader. In this paper, the authors discuss sources of success in California's individual marketplace under the Affordable Care Act.
AHRQ-funded; HS000046.
Citation: Rasmussen PW, Kominski GF .
Sources of success in California's individual marketplace under the Affordable Care Act.
J Health Polit Policy Law 2019 Aug 1;44(4):679-706. doi: 10.1215/03616878-7530849..
Keywords: Policy, Health Insurance, Uninsured, Medicaid, Medicare
Gorges RJ, Sanghavi P, Konetzka RT
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
The authors investigated the outcomes of expanding Medicaid funding for long-term care home and community-based services (HCBS). Using national Medicaid claims data on older adults enrolled in both Medicare and Medicaid, they found that overall hospitalization rates were similar for HCBS and nursing facility users. They concluded that home and community-based services need to be carefully targeted to avoid adverse outcomes and that the racial/ethnic disparities in access to high-quality institutional long-term care are also present in HCBS.
AHRQ-funded; HS000084.
Citation: Gorges RJ, Sanghavi P, Konetzka RT .
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
Health Aff 2019 Jul;38(7):1110-18. doi: 10.1377/hlthaff.2018.05409..
Keywords: Elderly, Medicaid, Medicare, Long-Term Care, Home Healthcare, Disparities, Racial and Ethnic Minorities
Roberts ET, Hayley Welsh J, Donohue JM
Association of state policies with Medicaid disenrollment among low-income Medicare beneficiaries.
This study examined the role that state policies play in Medicaid disenrollment among low-income Medicare beneficiaries. Medicaid disenrollment among fee-for-service Medicare beneficiaries was examined for the period 2012-2016. During that period, 18.2% of beneficiaries disenrolled for reasons other than death. Disenrollment was 24% lower in states that automatically enrolled recipients of the Supplemental Security Income program in full Medicaid, 33% lower in states with more generous provider payment policies, and 37% lower in states with less restrictive asset limits for partial Medicaid.
AHRQ-funded; HS026727.
Citation: Roberts ET, Hayley Welsh J, Donohue JM .
Association of state policies with Medicaid disenrollment among low-income Medicare beneficiaries.
Health Aff 2019 Jul;38(7):1153-62. doi: 10.1377/hlthaff.2018.05165..
Keywords: Medicare, Medicaid, Low-Income, Policy, Vulnerable Populations
Khandelwal N, White L, Curtis JR
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
The objective of this study was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and to examine how these costs vary by insurance coverage. Results showed that, across all categories of insurance coverage, out-of-pocket spending in the last 12 months of life was high and represented a significant portion of assets for many patients requiring intensive care and their families. Medicare fee-for-service alone did not insulate individuals from the financial burden of high-intensity care. Medicaid was found to provide the most complete hospital coverage of all the insurance groups, as well as significantly financing long-term care.
AHRQ-funded; HS022982.
Citation: Khandelwal N, White L, Curtis JR .
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
Crit Care Med 2019 Jun;47(6):749-56. doi: 10.1097/ccm.0000000000003723..
Keywords: Critical Care, Elderly, Health Insurance, Healthcare Costs, Intensive Care Unit (ICU), Medicaid, Medicare
Weech-Maldonado R, Lord J, Pradhan R
High Medicaid nursing homes: organizational and market factors associated with financial performance.
The purpose of this study was to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. Higher financial performing facilities were characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets.
AHRQ-funded; HS023345; HS013852.
Citation: Weech-Maldonado R, Lord J, Pradhan R .
High Medicaid nursing homes: organizational and market factors associated with financial performance.
Inquiry 2019 Jan-Dec;56:46958018825061. doi: 10.1177/0046958018825061..
Keywords: Nursing Homes, Medicaid, Medicare