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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 7 of 7 Research Studies DisplayedEliason Gordon, Gordon SH
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
This study assessed the association between postpartum insurance instability and access to postpartum mental health services. The authors used data from the 2018-2019 Colorado Health eMoms survey, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified at each time point as stably insured or unstable insured based on postpartum insurance status. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage. Respondents were more likely to experience unstable postpartum insurance if they were younger, had incomes of less than $50,000, and were of Hispanic ethnicity. Respondents who experienced postpartum insurance instability had lower odds of reporting that they discussed mental health at a postpartum check-up and received postpartum mental health services.
AHRQ-funded; HS000011.
Citation: Eliason Gordon, Gordon SH .
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
Womens Health Issues 2022 Nov-Dec;32(6):550-56. doi: 10.1016/j.whi.2022.06.010..
Keywords: Maternal Care, Access to Care, Women, Behavioral Health, Health Insurance
Ellison J, Wang C, Yarrington C
Insurance and geographic variations in non-invasive prenatal testing.
The purpose of this study was to estimate the population-level rate of non-invasive prenatal testing (NIPT) uptake in Massachusetts and identify disparities based on patient zip-code and insurance type. The researchers identified pregnant patients aged 35 years or older at their delivery between 7/1/2015 to 12/31/2015 who were eligible for NIPT use, to assess the role of area‐level sociodemographic characteristics and NIPT uptake. The study reported that considerable geographic variation was discovered. Patients living in zip‐codes within and surrounding the Boston metropolitan area were more likely to receive NIPT, as were those living in Eastern MA. The observed NIPT rate (per 1000 pregnant individuals aged 35 and over) was 48.7 for Medicaid enrollees and 272.1 for commercial enrollees; 123.0 and 223.2 for patients living in a zip‐code with a high versus low proportion of Black/Hispanic residents; and 107.7 and 218.4 for those in a zip‐code with a high versus low proportion of low‐income residents. The researchers reported that birthing people covered by Medicaid were over five times less likely to receive NIPT than their counterparts with commercial coverage. Lower NIPT rates in zip‐codes with a high proportion of low‐income or Black/Hispanic residents also suggests that geographic variations in uptake may reflect racial/ethnic and income disparities independent of insurance coverage. The researchers concluded that the study findings emphasize the presence of substantial disparities in NIPT uptake based on insurance and zip-code of residence, and that further research is needed to identify barriers and facilitators to uptake and to evaluate interventions to address inequities in NIPT use.
AHRQ-funded; HS000011.
Citation: Ellison J, Wang C, Yarrington C .
Insurance and geographic variations in non-invasive prenatal testing.
Prenat Diagn 2022 Jul;42(8):1004-07. doi: 10.1002/pd.6155..
Keywords: Pregnancy, Maternal Care, Women, Health Insurance, Screening
Eliason EL, Daw JR, Steenland MW
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
The purpose of this study was to examine changes in postpartum insurance loss or changes (churn) in Medicaid-insured pregnant people during the COVID-19 pandemic. The researchers utilized the 2019 to 2021 Current Population Survey, Annual Social and Economic Supplement
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
AHRQ-funded; HS000011; HS027464.
Citation: Eliason EL, Daw JR, Steenland MW .
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
JAMA Health Forum 2022 Apr;3(4):e220688. doi: 10.1001/jamahealthforum.2022.0688..
Keywords: COVID-19, Health Insurance, Maternal Care, Women, Pregnancy
Cliff BQ
Do high-deductible health plans affect price paid for childbirth?
The purpose of this study was to test whether out-of-pocket costs and negotiated hospital prices for childbirth change after enrollment in high-deductible health plans (HDHPs) and whether price effects differ in markets with more hospitals. Administrative medical claims data from three large commercial insurers with plans in all U.S. states was provided by the Health Care Cost Institute. Findings showed that prices for childbirth in markets with more hospitals decreased after HDHP switch due to lower hospital prices for HDHPs relative to prices at those same hospitals for non-HDHPs.
AHRQ-funded; HS025614.
Citation: Cliff BQ .
Do high-deductible health plans affect price paid for childbirth?
Health Serv Res 2022 Feb;57(1):27-36. doi: 10.1111/1475-6773.13702..
Keywords: Labor and Delivery, Health Insurance, Healthcare Costs, Women
Cham S, Landrum MB, Keating NL
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
The authors examined commercially insured populations to identify patient-, physician-, and practice-level characteristics associated with ovarian cancer testing rates. They found that only 33.9% of patients with commercial insurance were tested during the time period studied. Medical and gynecologic oncologists had similar rates of testing, while other physicians tested less often. Although independent practices often lack access to genetic counselors, women in this study had insurance coverage for in-person and telephonic counseling.
AHRQ-funded; HS024072.
Citation: Cham S, Landrum MB, Keating NL .
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
JAMA Netw Open 2022 Jan 4;5(1):e2142703. doi: 10.1001/jamanetworkopen.2021.42703..
Keywords: Cancer: Ovarian Cancer, Cancer, Screening, Genetics, Health Insurance, Women
Moniz MH, Peahl AF, Fendrick AM
Cost sharing, postpartum contraceptive use, and short interpregnancy interval rates among commercially insured women.
This study compared postpartum contraceptive use among women who had high, low, or no cost sharing for different types of contraception. The authors conducted a retrospective cohort analysis of commercially insured women undergoing childbirth from 2014 to 2018 using Optum's (Eden Prairie, MN) de-identified Clinformatics Data Mart database. The women were included if they had continuous enrollment for 12 months postpartum. Among 25,298 plans with cost sharing data, 172,941 women were identified, including 47.7% with no cost sharing, 13.1% in low cost sharing, and 39.2% in high cost sharing plans. Women in no cost sharing plans had a higher predicted probability of using long-acting reversible contraceptives and a lower predicted probability of no prescription method use than those in low or high cost sharing plans. There was no difference in short interpregnancy intervals between the plan cost sharing types.
AHRQ-funded; HS025465.
Citation: Moniz MH, Peahl AF, Fendrick AM .
Cost sharing, postpartum contraceptive use, and short interpregnancy interval rates among commercially insured women.
Am J Obstet Gynecol 2021 Mar;224(3):282.e1-82.e17. doi: 10.1016/j.ajog.2020.08.109..
Keywords: Healthcare Costs, Women, Health Insurance, Access to Care, Sexual Health
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization