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 16 of 16 Research Studies DisplayedBernard DM, Selden TM, Fang Z
AHRQ Author: Bernard
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
This AHRQ-authored paper examined the joint distribution of three financial problems related to healthcare: high out-of-pocket burdens, medical debt, and financial barriers to needed care. The authors applied relatively strict definitions of financial problems to data from the 2018-2019 MEPS and found that 27% of nonsenior adults lived in families with at least one of the three financial strains assessed. The percentage of participants who faced more broadly defined financial problems was 45.5%. This prevalence varied across sociodemographic characteristics, families' health care needs, insurance coverage, and financial resources.
AHRQ-authored.
Citation: Bernard DM, Selden TM, Fang Z .
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
Health Aff 2023 Nov; 42(11):1517-26. doi: 10.1377/hlthaff.2023.00604..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Access to Care, Health Insurance
Levine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA .
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care
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
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
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.
AHRQ-funded; HS025976.
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
Jacobs PD
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.
AHRQ-authored.
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
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
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.
AHRQ-funded; HS024866.
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
Wisk LE, Peltz A, Galbraith AA
Changes in health care-related financial burden for US families with children associated with the Affordable Care Act.
The Affordable Care Act (ACA) sought to improve access and affordability of health insurance. Although most ACA policies targeted childless adults, the extent to which these policies also impacted families with children remains unclear. The purpose of this study was to examine changes in health care-related financial burden for US families with children before and after the ACA was implemented based on income eligibility for ACA policies.
AHRQ-funded; HS024700.
Citation: Wisk LE, Peltz A, Galbraith AA .
Changes in health care-related financial burden for US families with children associated with the Affordable Care Act.
JAMA Pediatr 2020 Nov;174(11):1032-40. doi: 10.1001/jamapediatrics.2020.3973..
Keywords: Children/Adolescents, Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Health Insurance, Policy, Access to Care
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
AHRQ-authored.
Citation: Cook BL, Flores M, Zuvekas SH .
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
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.
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
Moniz MH, Soliman AB, Kolenic GE
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Investigators evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. Using the Clinformatics Data Mart, they found that cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. They concluded that reducing out-of-pocket costs for the most effective forms of contraception may increase use.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Soliman AB, Kolenic GE .
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Womens Health Issues 2019 Nov - Dec;29(6):465-70. doi: 10.1016/j.whi.2019.07.006..
Keywords: Women, Health Insurance, Healthcare Costs, Access to Care
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Nguyen KH, Trivedi AN, Shireman TI
Lesbian, gay, and bisexual adults report continued problems affording care despite coverage gains.
This study’s investigators used data from three waves of the Behavioral Risk Factor Surveillance System to examine access to a personal doctor, affordability of care, type of health insurance coverage, and self-reported health in LGB adults in the period January 2014-February 2017 in thirty-one states that implemented the Affordable Care Act system's sexual orientation module.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN, Shireman TI .
Lesbian, gay, and bisexual adults report continued problems affording care despite coverage gains.
Health Aff 2018 Aug;37(8):1306-12. doi: 10.1377/hlthaff.2018.0281.
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Keywords: Access to Care, Healthcare Costs, Health Insurance, Uninsured, Vulnerable Populations
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
Scott JW, Sommers BD, Tsai TC
Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients.
The Affordable Care Act (ACA) allows young adults to remain covered under their parents’ plans until age 26. This study conducted a difference-in-differences analysis of coverage rates among trauma patients ages 19-25 (compared to patients ages 26 to 34) and examined trauma-relevant outcomes. It found a 3.4 percent decrease in uninsurance status among younger trauma patients following the ACA policy change.
AHRQ-funded; HS000055
Citation: Scott JW, Sommers BD, Tsai TC .
Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients.
Health Aff. 2015 Jan;34(1):125-33. doi: 10.1377/hlthaff.2014.0880..
Keywords: Access to Care, Healthcare Costs, Health Insurance, Outcomes