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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 124 Research Studies Displayed
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.
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
Jacobs PD, Hill SC
AHRQ Author: Jacobs PD, Hill SC
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
This study calculated Marketplace premiums as a percentage of family income among middle-class families with incomes of 401-600% of poverty. The ACA premiums have been increasing since inception, with half of this population paying at least 7.7% of their income for the lowest-cost bronze plan, increasing to 11.3% in 2019. By 2019 half of the near elderly ages 55-64 would have paid at least 18.9% of their income for the lowest-cost bronze plan in their area. Results suggest that after the American Rescue Plan Act which temporarily expanded tax credit eligibility for 2021 and 2022 runs out, families will again face substantial financial burdens.
Citation: Jacobs PD, Hill SC . ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly. Health Aff 2021 Nov;40(11):1713-21. doi: 10.1377/hlthaff.2021.00945..
Keywords: Health Insurance, Healthcare Costs
Aouad M, Brown TT, Whaley CM
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Investigators examined the heterogeneous effects of reference pricing, a health insurance reform introduced by the California Public Employees' Retirement System (CalPERS), on the distribution of spending by patients and insurers. Using the changes-in-changes approach to estimate the quantile treatment effects (QTE) of the program across different medical procedures, they found that the QTE vary across the patient spending distributions, with a range of positive and negative estimates of the QTE, depending on the medical procedure considered.
Citation: Aouad M, Brown TT, Whaley CM . Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program. Health Econ 2021 Nov;30(11):2780-93. doi: 10.1002/hec.4410..
Keywords: Health Insurance, Healthcare Costs
AHRQ Author: Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
Citation: Abdus S . Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans. J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Hero JO, Sinaiko AD, Peltz A
In New England, partisan differences In ACA marketplace participation and potential financial harm.
This study examined how political orientation was associated with decisions to use the Affordable Care Act Marketplaces to enroll in nongroup health insurance plans and whether it was also associated with adverse financial consequences. Using data from a large insurer in New England, findings showed that Republican enrollees were less likely than Democratic enrollees of comparable subsidy eligibility to enroll through the Marketplaces and receive subsidies. Among income-eligible enrollees, Republican subscribers received $66 per month less in premium subsidies than Democratic subscribers. However, results suggested that party effects on decision making may inversely relate to the magnitude of the financial consequence.
Citation: Hero JO, Sinaiko AD, Peltz A . In New England, partisan differences In ACA marketplace participation and potential financial harm. Health Aff 2021 Sep;40(9):1420-29. doi: 10.1377/hlthaff.2021.00624..
Keywords: Health Insurance, Healthcare Costs
Moloci NM, Si Y, Norton EC
Predicting losses from Medicare Shared Savings Program departures.
Researchers conducted an observational study to understand how accountable care organization (ACO) exit could affect Shared Savings Program (SSP) financial performance. They found that nearly 80% of ACOs were still active at the end of 2016. Among the subset that faced contract renewal in 2019, 40% were known to have exited the SSP. By 2022, ACOs that exited in 2019 could cost the SSP $186.9 million in lost savings. If the exit rate observed in 2019 continues, the SSP could suffer $396.8 million in lost savings by 2022.
AHRQ-funded; HS024525; HS024728.
Citation: Moloci NM, Si Y, Norton EC . Predicting losses from Medicare Shared Savings Program departures. J Gen Intern Med 2021 Aug;36(8):2490-91. doi: 10.1007/s11606-020-06424-7..
Keywords: Medicare, Health Insurance, Healthcare Costs
Eisenberg MD, Meiselbach MK, Bai G
Large self-insured employers lack power to effectively negotiate hospital prices.
This study examined the ability of self-insured employers to negotiate hospital prices and investigated the relationship between hospital prices and employer market power in the United States. Findings showed that employer market power was low in most metropolitan statistical areas. Recommendations included encouraging self-insured employers to consider building purchase alliances with state and local government employee groups in order to enhance their market power and to lower negotiated prices for hospital services.
Citation: Eisenberg MD, Meiselbach MK, Bai G . Large self-insured employers lack power to effectively negotiate hospital prices. Am J Manag Care 2021 Jul;27(7):290-96. doi: 10.37765/ajmc.2021.88702..
Keywords: Health Insurance, Medicare, Medicaid, Healthcare Costs, Hospitals
Roberts ET, Desai SM
Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries?
The objective of this paper was to assess changes in physicians' provision of care to duals (low-income individuals with Medicare and Medicaid) in response to a policy that required Medicaid to fully pay Medicare's cost sharing for office visits with these patients. This policy-a provision of the Affordable Care Act-effectively increased payments for office visits with duals by 0%-20%, depending on the state, in 2013 and 2014.
AHRQ-funded; HS026727; HS026980.
Citation: Roberts ET, Desai SM . Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries? Health Serv Res 2021 Jun;56(3):528-39. doi: 10.1111/1475-6773.13650..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care, Healthcare Costs, Low-Income
Lyu PF, Chernew ME, McWilliams JM
Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions.
Using commercial claims and data on health system membership and Medicare accountable care organizations (ACOs) participation, investigators found some abrupt, large price increases for independent primary care practices that joined health system-led ACOs but were not acquired by systems. These price jumps were rare, however, increasing prices by just 4 percent, on average, among all independent practices in system-led ACOs. The price jumps were more consistent with an extension of existing pricing power from systems to some independent practices than with a major expansion of system market power.
AHRQ-funded; HS024072; HS027531.
Citation: Lyu PF, Chernew ME, McWilliams JM . Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions. Health Aff 2021 Jun;40(6):979-88. doi: 10.1377/hlthaff.2020.02449..
Keywords: Medicare, Health Insurance, Healthcare Costs
Chhabra KR, Fan Z, Chao GF
The role of commercial health insurance characteristics in bariatric surgery utilization.
The goal of this study was to understand relationships among insurance plan type, out-of-pocket cost sharing, and the utilization of bariatric surgery among commercially insured patients. Over 73,000 commercially insured members of the IBM MarketScan commercial claims database who underwent bariatric surgery from 2014-17 were retroactively reviewed. Findings showed that insurance plan types with higher cost sharing have lower utilization of bariatric surgery.
AHRQ-funded; HS025778; HS000053.
Citation: Chhabra KR, Fan Z, Chao GF . The role of commercial health insurance characteristics in bariatric surgery utilization. Ann Surg 2021 Jun;273(6):1150-56. doi: 10.1097/sla.0000000000003569..
Keywords: Health Insurance, Obesity, Obesity: Weight Management, Surgery, Healthcare Costs, Healthcare Utilization
Powell D, Goldman D
Disentangling moral hazard and adverse selection in private health insurance.
This study used claims data from a large firm which changed health insurance plan options to isolate moral hazard from plan selection to estimate a discrete choice model to predict household plan preferences and attrition. The authors found the estimates imply that 53% of the additional medical spending observed in the most generous plan in their data relative to the least generous is due to adverse selection. They found that quantifying adverse selection by using prior medical expenditures overstates the true magnitude of selection due to mean reversion.
Citation: Powell D, Goldman D . Disentangling moral hazard and adverse selection in private health insurance. J Econom 2021 May;222(1):141-60. doi: 10.1016/j.jeconom.2020.07.030..
Keywords: Health Insurance, Healthcare Costs
Roberts ET, Glynn A, Cornelio N
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance, resulting in a supplemental coverage cliff. The authors estimated that Medicaid beneficiaries affected by this cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55 percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. They recommended expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies to lessen cost-related barriers to health care among near-poor Medicare beneficiaries.
Citation: Roberts ET, Glynn A, Cornelio N . Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries. Health Aff 2021 Apr;40(4):552-61. doi: 10.1377/hlthaff.2020.02272..
Keywords: Medicaid, Medicare, Healthcare Costs, Low-Income, Health Insurance
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
The authors assessed how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. The study sample included beneficiaries enrolled in both MA and Part D from 2008-2015; Medicare claims and drug utilization data for Traditional Medicare beneficiaries were used to calibrate an independent measure of health risk. The authors found that, while coding intensity increased taxpayers' costs of the MA program, enrollees and plans both benefitted but with larger gains for plans. They concluded that the adoption of policies to adjust more completely for coding intensity would likely affect both beneficiaries and plan profits.
Citation: Jacobs PD, Kronick R . The effects of coding intensity in Medicare Advantage on plan benefits and finances. Health Serv Res 2021 Apr;56(2):178-87. doi: 10.1111/1475-6773.13591..
Keywords: Medicare, Health Insurance, Healthcare Costs, Policy
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.
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
Rabideau B, Eisenberg MD, Reid R
Effects of employer-offered high-deductible plans on low-value spending in the privately insured population.
Enrollment in plans with high deductibles has increased more than seven-fold in the last decade. This study uses individual-level insurance claims data (2008-2013) and plausibly exogenous changes in plan offerings within firms over time to estimate the intent-to-treat and local-average treatment effects of high-deductible plan offerings on spending on 24 low-value services received in the outpatient setting.
Citation: Rabideau B, Eisenberg MD, Reid R . Effects of employer-offered high-deductible plans on low-value spending in the privately insured population. J Health Econ 2021 Mar;76:102424. doi: 10.1016/j.jhealeco.2021.102424..
Keywords: Health Insurance, Healthcare Costs
Chen G, Lewis VA, Gottlieb D
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
This study looked at the effects of accountable care organizations (ACOs) on lowering health care costs and reducing the rate of hospital readmissions. The authors used Medicare fee-for-service claims data from 2009-2014 to estimate the heterogenous effects of Medicare ACO programs on hospital admissions across hospital referral regions and provider groups. The results suggested that the ACO programs reduced the rate of readmission to hospitals, and that the effect of joining an ACO varied considerably across medical groups.
Citation: Chen G, Lewis VA, Gottlieb D . Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations. Health Serv Outcomes Res Methodol 2021 Mar;21(1):54-68. doi: 10.1007/s10742-020-00230-8..
Keywords: Medicare, Policy, Healthcare Costs, Hospital Readmissions, Health Insurance
Polsky D, Wu B
Provider networks and health plan premium variation.
The purpose of this study was to examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act's Health Insurance Marketplaces in all 50 states and the DC in 2016. The investigators concluded that physician network breadth and hospital network breadth contributed positively to plan premiums.
Citation: Polsky D, Wu B . Provider networks and health plan premium variation. Health Serv Res 2021 Feb;56(1):16-24. doi: 10.1111/1475-6773.13447..
Keywords: Health Insurance, Healthcare Costs, Policy, Access to Care
AHRQ Author: Jacobs PD
The impact of Medicare on access to and affordability of health care.
Jacobs used MEPS data and the National Health Interview Survey to test for changes in access to care and affordability around age sixty-five and found that Medicare eligibility is associated with a reduction in reports of being unable to get necessary care as well as a reduction in not being able to get needed care because of the cost. The author concluded that incremental Medicare expansions could have positive access and affordability benefits for enrollees compared with the insurance options available to them before they turn sixty-five.
Citation: Jacobs PD . The impact of Medicare on access to and affordability of health care. Health Aff 2021 Feb;40(2):266-73. doi: 10.1377/hlthaff.2020.00940..
Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Healthcare Costs, Health Insurance
Hill CE, Reynolds EL, Burke JF
Increasing out-of-pocket costs for neurologic care for privately insured patients.
This study examined out-of-pocket (OOP) costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients. Patients with a neurologist visit or diagnostic test from 2001 to 2016 were identified from a large, privately insured health care claims database. Inflation-adjusted OOP costs were assessed. The database identified 3,724,342 patients. The most frequent services used were E/M (78.5%), EMG/nerve conduction studies (NCS) (7.7%), MRIs (5.3%), and EEGs (4.5%). Mean OOP cost increased over time, most substantially for EEG, MRI, and E/M. The range of OOP costs in 2016 varied considerably. For example, for an MRI, the 50th percentile paid $103.10 and the 95th percentile paid $875.40.
Citation: Hill CE, Reynolds EL, Burke JF . Increasing out-of-pocket costs for neurologic care for privately insured patients. Neurology 2021 Jan 19;96(3):e322-e32. doi: 10.1212/wnl.0000000000011278..
Keywords: Healthcare Costs, Health Insurance, Neurological Disorders
Fung V, Price M, Hull P
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
The purpose of this study was to examine the association between the Affordable Care Act (ACA) fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Medicare claims data from 2012 to 2016 was used. Findings showed that the ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Additionally, visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.
AHRQ-funded; HS024725; HS025378.
Citation: Fung V, Price M, Hull P . Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries. JAMA Netw Open 2021 Jan;4(1):e2033424. doi: 10.1001/jamanetworkopen.2020.33424..
Keywords: Access to Care, Medicaid, Medicare, Health Insurance, Healthcare Costs, Policy
Grosse SD, Ji X, Zuvekas
AHRQ Author: Zuvekas SH
Spending on young children with autism spectrum disorder in employer-sponsored plans, 2011-2017.
This study looked at spending trends on young children with autism spectrum disorder (ASD) in employer-sponsored plans from 2011 to 2017. This cross-section analysis examined claims data from large-employer-sponsored health plans and assessed changes in annual expenditures by service type for children ages 3-5 enrolled for 1 year or more, and with two or more claims with ASD billing codes within a calendar year and compared it to all children. Mean spending per children with ASD increased by 51% in 2017 US dollars in 2017, while for all children the increase was 8%. ASD spending accounted for 41% of spending growth for children ages 3-7 during 2011-2017. Outpatient behavioral intervention-related spending increased by 376% during the time period, while spending on all other services increased by 2%.
Citation: Grosse SD, Ji X, Zuvekas . Spending on young children with autism spectrum disorder in employer-sponsored plans, 2011-2017. Psychiatr Serv 2021 Jan;72(1):16-22. doi: 10.1176/appi.ps.202000099.
Keywords: Children/Adolescents, Autism, Health Insurance, Healthcare Costs
Friedman S, Xu H, Azocar F
Carve-out plan financial requirements associated with national behavioral health parity.
The authors examined changes in carve-out financial requirements following the Mental Health Parity and Addiction Equity Act (MHPAEA). They found that the MHPAEA was associated with increased generosity in most observed financial requirements, but increased use of deductibles may have reduced generosity for some patients.
Citation: Friedman S, Xu H, Azocar F . Carve-out plan financial requirements associated with national behavioral health parity. Health Serv Res 2020 Dec;55(6):924-31. doi: 10.1111/1475-6773.13542..
Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Access to Care, Policy
Henke RM, Karaca Z, Gibson TB
Medicaid Accountable Care Organizations and childbirth outcomes.
This study examined the impact of Accountable Care Organizations (ACOs) to childbirth outcomes. States that use Medicaid ACOs were compared with states that had not adopted ACO. Using HCUP data, the relationship between Medicaid ACO adoption and neonatal and maternal outcomes, and cost per birth was examined. Medicaid ACO implementation was associated with a moderate reduction in hospital costs per birth and decreased cesarean section rates with results varying by state. There was no association with other birth outcomes, including infant inpatient mortality, low birthweight, neonatal intensive care unit utilization and severe maternal morbidity.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB . Medicaid Accountable Care Organizations and childbirth outcomes. Med Care Res Rev 2020 Dec;77(6):559-73. doi: 10.1177/1077558718823132..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Health Insurance, Healthcare Costs, Labor and Delivery, Pregnancy, Women, Outcomes
Zhou RA, Beaulieu ND, Cutler D
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
The purpose of this study was to characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population. Investigators concluded that a growing share of physicians were part of a health system from 2012 to 2016.
Citation: Zhou RA, Beaulieu ND, Cutler D . Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states. Health Serv Res 2020 Dec;55(Suppl 3):1098-106. doi: 10.1111/1475-6773.13590.
Keywords: Primary Care, Quality of Care, Health Insurance, Healthcare Costs
Dalton VK, Moniz MH, Bailey MJ
Trends in birth rates after elimination of cost sharing for contraception by the Patient Protection and Affordable Care Act.
Researchers evaluated changes in birth rates by income level among commercially insured women before (2008-2013) and after (2014-2018) the elimination of cost sharing for contraception under the Patient Protection and Affordable Care Act (ACA). The analytic sample included over 4.5 million women enrolled in 47,721 health plans. In this cross-sectional study, the researchers found that the elimination of cost sharing for contraception under the ACA was associated with improvements in contraceptive method prescription fills and a decrease in births among commercially insured women. Women with low income had more precipitous decreases than women with higher income, suggesting that enhanced access to contraception may address well-documented income-related disparities in unintended birth rates.
AHRQ-funded; HS025465; HS023784.
Citation: Dalton VK, Moniz MH, Bailey MJ . Trends in birth rates after elimination of cost sharing for contraception by the Patient Protection and Affordable Care Act. JAMA Netw Open 2020 Nov 2;3(11):e2024398. doi: 10.1001/jamanetworkopen.2020.24398..
Keywords: Policy, Health Insurance, Women, Healthcare Costs, Pregnancy, Sexual Health