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
351 to 375 of 434 Research Studies DisplayedVistnes J, Selden TM, Zawacki A
AHRQ Author: Vistnes J, Selden TM
Several factors responsible for the recent slowdown in premium growth in employer-sponsored insurance.
Researchers have been seeking to identify which factors behind the recent spending slowdown . This study found that the slowdown in premium growth that preceded the recession reflected declining growth rates in per policyholder premiums. For 2009-11, however, the dominant contributors to the slowdown were factors underlying declining employee enrollment: a sharp downturn in employment in 2009, followed by eroding offer and eligibility rates.
AHRQ-authored.
Citation: Vistnes J, Selden TM, Zawacki A .
Several factors responsible for the recent slowdown in premium growth in employer-sponsored insurance.
Health Aff 2015 Dec;34(12):2036-43. doi: 10.1377/hlthaff.2015.0436..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Health Insurance
Robinson JC, Brown TT, Whaley C
Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications.
The researchers ascertained the effect of reference payment on facility choice, insurer spending, consumer cost sharing, and procedural complications for colonoscopy. They concluded that Implementation of reference payment for colonoscopy was associated with reduced spending and no change in complications.
AHRQ-funded; HS022098.
Citation: Robinson JC, Brown TT, Whaley C .
Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications.
JAMA Intern Med 2015 Nov;175(11):1783-9. doi: 10.1001/jamainternmed.2015.4588..
Keywords: Colonoscopy, Healthcare Costs, Adverse Events, Health Insurance
Abdus S, Mistry KB, Selden TM
AHRQ Author: Mistry KB, Selden TM
Racial and ethnic disparities in services and the Patient Protection and Affordable Care Act.
The researchers examined pre-reform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). They found that minorities were disproportionately represented among those targeted by the coverage provisions of the ACA.
AHRQ-authored.
Citation: Abdus S, Mistry KB, Selden TM .
Racial and ethnic disparities in services and the Patient Protection and Affordable Care Act.
Am J Public Health 2015 Nov;105(Suppl 5):S668-75. doi: 10.2105/ajph.2015.302892..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Disparities, Racial and Ethnic Minorities, Access to Care
Ndumele CD, Sommers BD, Trivedi AN
The ACA's 65th birthday challenge: moving from Medicaid to Medicare.
Following the Affordable Care Act’s coverage expansion, many newly-insured older enrollees will lose Medicaid coverage on their 65th birthday and transition from Medicaid to Medicare as their primary insurer. This article discusses the transition in primary health insurance coverage that includes changes to benefits, patient cost-sharing, and provider reimbursement, which could have profound consequences on the use of health services and associated health outcomes for low-income seniors.
AHRQ-funded; HS021291.
Citation: Ndumele CD, Sommers BD, Trivedi AN .
The ACA's 65th birthday challenge: moving from Medicaid to Medicare.
J Gen Intern Med 2015 Nov;30(11):1704-6. doi: 10.1007/s11606-015-3328-0..
Keywords: Health Insurance, Medicare, Elderly, Low-Income
Garcia Mosqueira A, Hua LM, Sommers BD
Racial differences in awareness of the Affordable Care Act and application assistance among low-income adults in three Southern states.
The researchers explored potential factors related to racial/ethnic differences in ACA enrollment - awareness of the law and receipt of application assistance such as navigator services. Their results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations to close existing disparities in coverage.
AHRQ-funded; HS021291.
Citation: Garcia Mosqueira A, Hua LM, Sommers BD .
Racial differences in awareness of the Affordable Care Act and application assistance among low-income adults in three Southern states.
Inquiry 2015 Oct 8;52. doi: 10.1177/0046958015609607.
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Keywords: Disparities, Health Insurance, Low-Income, Medicaid, Racial and Ethnic Minorities
Golberstein E, Gonzales G, Sommers BD
California's early ACA expansion increased coverage and reduced out-of-pocket spending for the state's low-income population.
The researchers used data from the National Health Interview Survey to examine the impact of California’s Low Income Health Program. Their study demonstrates that the county-by-county rollout of expanded public insurance coverage in California significantly increased coverage, by 7 percentage points, and significantly reduced the likelihood of any family out-of-pocket medical spending in the previous year, by 10 percentage points, among low-income adults.
AHRQ-funded; HS021291.
Citation: Golberstein E, Gonzales G, Sommers BD .
California's early ACA expansion increased coverage and reduced out-of-pocket spending for the state's low-income population.
Health Aff 2015 Oct;34(10):1688-94. doi: 10.1377/hlthaff.2015.0290..
Keywords: Low-Income, Healthcare Costs, Health Insurance, Uninsured
Gray SH, Trudell EK, Emans SJ
Total direct medical expenses and characteristics of privately insured adolescents who incur high costs.
This study assessed health care expenditures for high-cost adolescents and described the patient characteristics associated with high medical costs. It concluded that total direct medical expenses for privately insured high-cost adolescents are associated with medical complexity, mental health conditions, and obesity. Cost reduction strategies in similar populations should be tailored to these cost drivers.
AHRQ-funded; HS023092.
Citation: Gray SH, Trudell EK, Emans SJ .
Total direct medical expenses and characteristics of privately insured adolescents who incur high costs.
JAMA Pediatr 2015 Oct;169(10):e152682. doi: 10.1001/jamapediatrics.2015.2682..
Keywords: Access to Care, Children/Adolescents, Healthcare Costs, Health Insurance
Portela M, Sommers BD
On the outskirts of national health reform: a comparative assessment of health insurance and access to care in Puerto Rico and the United States.
This article presents an overview of Puerto Rico’s health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States. It found that uninsured rates were significantly lower in Puerto Rico;. Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year.
AHRQ-funded; HS021291.
Citation: Portela M, Sommers BD .
On the outskirts of national health reform: a comparative assessment of health insurance and access to care in Puerto Rico and the United States.
Milbank Q 2015 Sep;93(3):584-608. doi: 10.1111/1468-0009.12138..
Keywords: Health Insurance, Access to Care, Policy, Medicaid, Uninsured
Davidoff AJ, Hill SC, Bernard D
AHRQ Author: Hill SC, Bernard D
The Affordable Care Act and expanded insurance eligibility among nonelderly adult cancer survivors.
The researchers examined potential improvements in access to insurance for cancer survivors through adult Medicaid expansions and premium tax credits in the new insurance marketplaces under the Affordable Care Act (ACA). They found that under the ACA, many of the uninsured and a larger proportion of survivors facing financial hardship will be eligible for Medicaid or premium tax credits in the Marketplaces.
AHRQ-authored.
Citation: Davidoff AJ, Hill SC, Bernard D .
The Affordable Care Act and expanded insurance eligibility among nonelderly adult cancer survivors.
J Natl Cancer Inst 2015 Sep;107(9):djv181. doi: 10.1093/jnci/djv181..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicaid
Rivera-Hernandez M, Galarraga O
Type of insurance and use of preventive health services among older adults in Mexico.
The main purpose of this study was to assess the differences between Seguro Popular (SP) and employer-based health insurance in the use of preventive services,. It found that SP enrollees were more likely to use screening tests for diabetes, cholesterol, hypertension, and cervical cancer than the uninsured; however, those in employment-based and private insurances had higher odds of using preventive care for most services.
AHRQ-funded; HS0000011.
Citation: Rivera-Hernandez M, Galarraga O .
Type of insurance and use of preventive health services among older adults in Mexico.
J Aging Health 2015 Sep;27(6):962-82. doi: 10.1177/0898264315569457..
Keywords: Health Insurance, Health Insurance, Prevention, Screening
Hudson JL, Abdus S
AHRQ Author: Hudson JL
Coverage and care consequences for families in which children have mixed eligibility for public insurance.
The researchers used data from the Medical Expenditure Panel Survey (MEPS) Household Component for 2001–12 to examine insurance coverage, access to care, and health care use for eligible children in families with mixed eligible siblings compared to those in families where all siblings were eligible for one program. They found that mixed eligibility has a significant dampening effect for eligible children.
AHRQ-authored
Citation: Hudson JL, Abdus S .
Coverage and care consequences for families in which children have mixed eligibility for public insurance.
Health Aff 2015 Aug;34(8):1340-8. doi: 10.1377/hlthaff.2015.0128..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Health Insurance, Access to Care, Healthcare Utilization
DeVoe JE, Crawford C, Angier H
The association between Medicaid coverage for children and parents persists: 2002-2010.
The researchers assessed the likelihood of children’s having public health insurance coverage and their parents’ maintenance, gain, or loss of public coverage. The study found that, despite differing eligibility requirements, strong associations persisted between coverage continuity for parents and children in Oregon’s public health insurance program.
AHRQ-funded; HS018569
Citation: DeVoe JE, Crawford C, Angier H .
The association between Medicaid coverage for children and parents persists: 2002-2010.
Matern Child Health J. 2015 Aug;19(8):1766-74. doi: 10.1007/s10995-015-1690-5..
Keywords: Medicaid, Children/Adolescents, Health Insurance
Jacobs PD, Buntin MB
AHRQ Author: Jacobs PD
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
This study evaluated the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. It found that Medicare Advantage enrollees are relatively insensitive to premiums, but more responsive to reductions in medical cost sharing in their benefit packages.
AHRQ-authored.
Citation: Jacobs PD, Buntin MB .
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
Am J Manag Care 2015 Jul;21(7):498-504..
Keywords: Medicare, Health Insurance, Healthcare Costs
Trish EE, Herring BJ
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
The authors examined the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. They found that premiums are higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration.
AHRQ-funded; HS000046.
Citation: Trish EE, Herring BJ .
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
J Health Econ 2015 Jul;42:104-14. doi: 10.1016/j.jhealeco.2015.03.009.
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Keywords: Health Insurance, Healthcare Costs, Payment, Health Insurance, Hospitals
Dusetzina SB, Ellis S, Freedman RA
How do payers respond to regulatory actions? The case of bevacizumab.
This study examined payer-specific trends in bevacizumab use after the FDA's regulatory actions in granting and revoking an approved indication for metastatic breast cancer. It concluded that although insurers varied in public statements regarding coverage intentions, bevacizumab use declined similarly among all payers, suggesting that provider decision making, rather than payer-specific coverage policies, drove reductions.
AHRQ-funded; HS0189960.
Citation: Dusetzina SB, Ellis S, Freedman RA .
How do payers respond to regulatory actions? The case of bevacizumab.
J Oncol Pract 2015 Jul;11(4):313-8. doi: 10.1200/jop.2015.004218.
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Keywords: Policy, Medication, Health Insurance, Policy
Herring B, Trish E
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
The authors discuss a provision of the ACA that will introduce a 40 percent excise tax on health benefits exceeding a $10,200 threshold for single coverage and a $27,500 threshold for family coverage, annually. They argue that the low-income workers receive a relatively smaller subsidy to offset a portion of the Cadillac tax while the high-income workers receive a relatively larger subsidy to offset a portion of the Cadillac tax. All this adds up to a regressive effect.
AHRQ-funded; HS000046.
Citation: Herring B, Trish E .
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
AMA J Ethics 2015 Jul;17(7):672-9. doi: 10.1001/journalofethics.2015.17.7.sect1-1507..
Keywords: Healthcare Costs, Health Insurance, Policy
Zuvekas SH
AHRQ Author: Zuvekas SH
The take-up of employer-sponsored insurance among Americans with mental disorders: Implications for health care reform.
This study used data from the 2004-2008 Medical Expenditure Panel Survey to examine differences in offers and take-up of employer-sponsored health insurance (ESI) coverage among adults aged 27-54 by mental health status. It found little difference in the take-up of offers of ESI coverage between those with and without mental disorders.
AHRQ-authored
Citation: Zuvekas SH .
The take-up of employer-sponsored insurance among Americans with mental disorders: Implications for health care reform.
J of Behav Health Serv and Res. 2015 Jul;42(3):279-91. doi: 10.1007/s11414-015-9459-6..
Keywords: Behavioral Health, Medical Expenditure Panel Survey (MEPS), Health Insurance
Shih YC, Smieliauskas F, Geynisman DM
Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011.
This study sought to define and identify drivers of trends in cost and use of targeted therapeutics among privately insured nonelderly patients with cancer receiving chemotherapy between 2001 and 2011. It found a large increase in the use of targeted intravenous anticancer medications and a gradual increase in targeted oral anticancer medications; targeted therapies accounted for 63 percent of all chemotherapy expenditures in 2011.
AHRQ-funded; HS018535; HS020263.
Citation: Shih YC, Smieliauskas F, Geynisman DM .
Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011.
J Clin Oncol 2015 Jul 1;33(19):2190-6. doi: 10.1200/jco.2014.58.2320..
Keywords: Healthcare Costs, Cancer, Health Insurance, Medication
Akosa Antwi Y, Moriya AS, Simon K
AHRQ Author: Moriya AS
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
This study examined the effects of the Affordable Care Act’s expansion of family insurance coverage to include dependents up to the age of 26 on the use of the emergency department by 19 to 25 year young adults. It found a modest but statistically significant decrease in ED use related to weekday visits, nonurgent conditions and conditions treatable in other settings.
AHRQ Author
Citation: Akosa Antwi Y, Moriya AS, Simon K .
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
Ann Emerg Med. 2015 Jun;65(6):664-672.e2. doi: 10.1016/j.annemergmed.2015.01.010..
Keywords: Healthcare Costs, Emergency Department, Health Insurance
Akosa Antwi Y, Moriya AS, Simon K
AHRQ Author: Moriya AS
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
The researchers evaluated the effect of the Patient Protection and Affordable Care Act insurance expansion on ED use among young adults. They found a modest decrease in ED use of young adults aged 19 to 25 years compared with those aged 27 to 29 years, particularly for less urgent conditions.
AHRQ-authored.
Citation: Akosa Antwi Y, Moriya AS, Simon K .
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
Ann Emerg Med 2015 Jun;65(6):664-72.e2. doi: 10.1016/j.annemergmed.2015.01.010..
Keywords: Emergency Department, Emergency Medical Services (EMS), Health Insurance
DeCamp M, Sugarman J, Berkowitz SA
Meaningfully engaging patients in ACO decision making.
In this article, the authors describe how ACOs can achieve meaningful system-level patient engagement. They specify a three-step engagement framework: identifying beneficiary representatives, cultivating relationships, and evaluating engagement. They conclude that their proposed three-step framework can help accountable care organizations (ACOs) conceptualize a plan for meaningfully engaging patients in ACO governance.
AHRQ-funded; HS023684.
Citation: DeCamp M, Sugarman J, Berkowitz SA .
Meaningfully engaging patients in ACO decision making.
Am J Accountable Care 2015 Jun;3(2):30-33.
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Keywords: Patient and Family Engagement, Decision Making, Health Insurance, Healthcare Delivery
Hirth RA, Gibson TB, Levy HG
New evidence on the persistence of health spending.
Using the MarketScan claims database, the researchers characterized the persistence of health care spending in the privately insured, under-65 population. They found that over a 6-year period,69.8 percent of enrollees never had annual spending in the top 10 percent of the distribution and the bottom 50 percent of spenders accounted for less than 10 percent of spending.
AHRQ-funded; HS017706.
Citation: Hirth RA, Gibson TB, Levy HG .
New evidence on the persistence of health spending.
Med Care Res Rev 2015 Jun;72(3):277-97. doi: 10.1177/1077558715572387..
Keywords: Healthcare Costs, Health Insurance, Data
Sommers BD, Maylone B, Nguyen KH
The impact of state policies on ACA applications and enrollment among low-income adults in Arkansas, Kentucky, and Texas.
The researchers surveyed nearly 3,000 low-income adults in late 2014 to compare experiences in three states with markedly different policies: Kentucky, Arkansas, and Texas. They found that application rates, successful enrollment, and positive experiences with the ACA were highest in Kentucky, followed by Arkansas, with Texas performing worst. Limited awareness remains a critical barrier: Fewer than half of adults had heard some or a lot about the coverage expansions.
AHRQ-funded; HS021291.
Citation: Sommers BD, Maylone B, Nguyen KH .
The impact of state policies on ACA applications and enrollment among low-income adults in Arkansas, Kentucky, and Texas.
Health Aff 2015 Jun;34(6):1010-8. doi: 10.1377/hlthaff.2015.0215..
Keywords: Policy, Low-Income, Medicaid, Health Insurance
Annis AM, Holtrop JS, Tao M
Comparison of provider and plan-based targeting strategies for disease management.
The researchers described and contrasted the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. They concluded that both provide advantages and that an optimal model may be to combine the strengths of each approach to maximize benefits in care management.
AHRQ-funded; HS020108.
Citation: Annis AM, Holtrop JS, Tao M .
Comparison of provider and plan-based targeting strategies for disease management.
Am J Manag Care 2015 May;21(5):344-51.
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Keywords: Care Management, Primary Care, Health Insurance, Healthcare Delivery
Hudson JL, Hill SC, Selden TM
AHRQ Author: Hudson JL, Hill SC, Selden TM
If rollbacks go forward, up to 14 million children could become ineligible for public or subsidized coverage by 2019.
This study investigated the potential health insurance options available to low-income children if federal CHIP funding ends in 2017 or if federal requirements change in 2019, allowing states to roll back Medicaid- and CHIP-eligibility thresholds to minimum levels. It found that the percentage of low-income children ineligible for public coverage or subsidized Marketplace coverage would increase from 22 percent in 2014 (12.5 million children) to 46 percent after 2019 (26.5 million children).
Citation: Hudson JL, Hill SC, Selden TM .
If rollbacks go forward, up to 14 million children could become ineligible for public or subsidized coverage by 2019.
Health Aff 2015 May;34(5):864-70. doi: 10.1377/hlthaff.2015.0004..
Keywords: Children's Health Insurance Program (CHIP), Children/Adolescents, Health Insurance, Low-Income