National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (4)
- Asthma (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Diabetes (1)
- (-) Disparities (7)
- Elderly (1)
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- Healthcare Cost and Utilization Project (HCUP) (1)
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- Stroke (1)
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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 DisplayedZachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Roberts ET, Kwon Y, Hames AG
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
The purpose of this study was to examine whether exceeding the income threshold for Medicaid, which causes a sudden loss of Medicaid eligibility, is related with higher racial and ethnic disparities in access to and use of care. The researchers evaluated Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities related with the loss of Medicaid eligibility, the researchers compared discontinuities in outcomes among Black and Hispanic beneficiaries and White beneficiaries. Analyses were conducted between January 1, 2022, and October 1, 2022. The primary outcomes were patient-reported challenges accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data. The study included 8,144 participants representing 151,282, 957 weighted person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% of the federal poverty level (FPL). Study findings indicate that exceeding the Medicaid eligibility threshold was related with a 43.8 percentage point (pp) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care, lower outpatient use, and fewer medication fills, but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use and medication fills among Black and Hispanic vs White beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Kwon Y, Hames AG .
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
JAMA Intern Med 2023 Jun; 183(6):534-43. doi: 10.1001/jamainternmed.2023.0512..
Keywords: Disparities, Racial and Ethnic Minorities, Medicaid, Access to Care, Health Insurance, Low-Income, Access to Care
Moriya AS, Chakravarty S
AHRQ Author: Moriya AS
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, Medicaid, Health Insurance, Access to Care
Markovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Warrier A .
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords: Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial and Ethnic Minorities
Schechter SB, Pantell MS, Parikh K
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
The objective of this study was to assess whether disparities in asthma care and outcomes based on insurance type existed before a national quality improvement (QI) collaborative, and to determine the effects of the collaborative on these disparities. The investigators concluded that at baseline, children with public insurance had higher asthma health care utilization than those with private insurance, despite receiving more evidence-based care.
AHRQ-funded; HS026383; HS024554; HS024592.
Citation: Schechter SB, Pantell MS, Parikh K .
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
Acad Pediatr 2021 Aug;21(6):1018-24. doi: 10.1016/j.acap.2021.02.009..
Keywords: Children/Adolescents, Asthma, Chronic Conditions, Disparities, Quality Improvement, Quality of Care, Health Insurance
McCoy RG, Van Houten HK, Deng Y
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
Investigators sought to compare trends in initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage vs commercial health plans. They found that Medicare Advantage beneficiaries may be less likely than commercially insured beneficiaries to be treated with newer medications to lower glucose levels, with greater disparities among lower-income patients. They recommended further investigation of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management.
AHRQ-funded; HS025164.
Citation: McCoy RG, Van Houten HK, Deng Y .
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
JAMA Netw Open 2021 Feb;4(2):e2035792. doi: 10.1001/jamanetworkopen.2020.35792..
Keywords: Elderly, Diabetes, Chronic Conditions, Medication, Medicare, Health Insurance, Disparities, Low-Income
Hammad Mrig E
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
This paper proposes that Pierre Bourdieu's theories of capital and symbolic power can be integrated with fundamental cause theory to address limitations in the latter theory, making it more useful in health disparities research. This work deepens appreciation for the durable relationship between socioeconomic status and health. Study results reveal the multiple and complex mechanisms that play a role in access to healthcare services, which has significant implications for how we think about the role of health policy in addressing health disparities.
AHRQ-funded; HS017589.
Citation: Hammad Mrig E .
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
Sociol Health Illn 2021 Jan;43(1):133-48. doi: 10.1111/1467-9566.13195..
Keywords: Social Determinants of Health, Disparities, Health Insurance, Access to Care, Genetics, Policy