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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.
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1 to 25 of 28 Research Studies Displayed
Taylor K, Compton S, Kolenic GE
Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018.
Financial hardship affects health care access and health outcomes among peripartum women. The objective of this study was to evaluate the prevalence of financial hardship among peripartum women over time and by insurance type and income. The investigators concluded that financial hardship among peripartum women in the United States was common from 2013 to 2018, including 24% of pregnant and postpartum women reporting unmet health care need and 60% reporting health care unaffordability.
AHRQ-funded; HS023784; HS025465.
Citation:
Taylor K, Compton S, Kolenic GE .
Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018.
JAMA Netw Open 2021 Oct;4(10):e2132103. doi: 10.1001/jamanetworkopen.2021.32103..
Keywords:
Pregnancy, Healthcare Costs, Women, 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
Martin BI, Brodke DS, Wilson FA
The impact of halting elective admissions in anticipation of a demand surge due to the coronavirus pandemic (COVID-19).
This study’s objective was to estimate excess demand for hospital beds due to COVID-19 and the net financial impact of eliminating elective admissions to meet demand. An economic simulation was conducted combining epidemiological reports, the US Census, American Hospital Association Annual Survey, and the National Inpatient Sample. The base case used relied on a hospital admission rate reported by the CDC of 137.6 per 100,000, with the highest rates in people aged 65 year and older and 50-64 years. Elective admissions accounted for 20% of total hospital admissions, with an average rate of 30% unoccupied beds across hospitals. Hospitals that restricted elective care due to a COVID surge was only financial favorable if capacity was filled by a high proportion of COVID-19 cases among hospitals with low rates of elective admissions. There is a substantial financial risk to hospitals that restrict elective care.
AHRQ-funded; HS024714.
Citation:
Martin BI, Brodke DS, Wilson FA .
The impact of halting elective admissions in anticipation of a demand surge due to the coronavirus pandemic (COVID-19).
Med Care 2021 Mar;59(3):213-19. doi: 10.1097/mlr.0000000000001496..
Keywords:
Healthcare Cost and Utilization Project (HCUP), COVID-19, Hospitals, Healthcare Costs, Access to Care, Public 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
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
Myong C, Hull P, Price M
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
This retrospective study examined the impact of funding for federally qualified health centers (FQHCs) on utilization and emergency department (ED) visits in Massachusetts. The authors theorized that greater funding for FQHCs could increase the local availability of clinic-based care and reduce more costly resource use, such as ED visits. Data from the Massachusetts All Payer Claims Database (APCD) 2010-2013 was used that included enrollees in 559 Massachusetts ZIP codes (2010 numbers 6,173,563). They calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year. They found that a standard deviation increase in prior year FQHC funding (31%) was associated with a 2.3% increase in enrollees with FQHC visits and a 1.3% decrease in enrollees at EDs. However, there were no significant changes in emergent ED visit rates.
AHRQ-funded; HS025378.
Citation:
Myong C, Hull P, Price M .
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
PLoS One 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279..
Keywords:
Community-Based Practice, Healthcare Utilization, Emergency Department, Healthcare Costs, Access to Care, Vulnerable Populations, 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
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
Bernard D, Fang Z
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
Researchers examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Using MEPS data, they found that public insurance provides protection against high burdens but not against forgoing or delaying care. They recommended that future research investigate whether, and to what extent, barriers to care are associated with worse health outcomes and higher costs in the long term.
AHRQ-authored.
Citation:
Bernard D, Fang Z .
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
J Am Heart Assoc 2019 Dec 17;8(24):e008831. doi: 10.1161/jaha.118.008831..
Keywords:
Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Heart Disease and Health, Cardiovascular Conditions, 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
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
Beckman AL, Bilinski A, Boyko R
New hepatitis C drugs are very costly and unavailable to many state prisoners.
This study found that in the forty-one states whose departments of corrections reported data, 106,266 inmates (10 percent of their prisoners) were known to have hepatitis C on or about January 1, 2015. Only 949 of those inmates were being treated. Prices for a twelve-week course of direct-acting antivirals such as sofosbuvir and the combination drug ledipasvir/sofosbuvir varied widely as of September 30, 2015 ($43,418-$84,000 and $44,421-$94,500, respectively).
AHRQ-funded; HS000055.
Citation:
Beckman AL, Bilinski A, Boyko R .
New hepatitis C drugs are very costly and unavailable to many state prisoners.
Health Aff 2016 Oct;35(10):1893-901. doi: 10.1377/hlthaff.2016.0296.
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Keywords:
Access to Care, Healthcare Costs, Hepatitis, Medication, Vulnerable Populations
Haidari LA, Brown ST, Constenla D
The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique.
The researchers assessed how well tetanus toxoid (TT) immunization locations meet population demand in Mozambique. They found that TT immunization locations are not geographically accessible by a significant proportion of pregnant women, resulting in substantial healthcare and productivity costs that could potentially be averted by adding or reconfiguring TT immunization locations.
AHRQ-funded; HS023317.
Citation:
Haidari LA, Brown ST, Constenla D .
The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique.
Vaccine 2016 Jul 29;34(35):4161-65. doi: 10.1016/j.vaccine.2016.06.065.
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Keywords:
Access to Care, Healthcare Costs, Health Services Research (HSR), Pregnancy, Vaccination
Bernard D, Selden T, Yeh S
Financial burdens and barriers to care among nonelderly adults: the role of functional limitations and chronic conditions.
The researchers examined the financial burdens and barriers to care among nonelderly adults, focusing on the role of functional limitations and chronic conditions. Functional limitations and chronic conditions were associated with increased prevalence of burdens and financial barriers in all insurance categories, with the exception that an association between functional limitations and the prevalence of burdens was not observed for public coverage.
AHRQ-authored.
Citation:
Bernard D, Selden T, Yeh S .
Financial burdens and barriers to care among nonelderly adults: the role of functional limitations and chronic conditions.
Disabil Health J 2016 Apr;9(2):256-64. doi: 10.1016/j.dhjo.2015.09.003.
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Keywords:
Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Chronic Conditions, Access to Care, Health Services Research (HSR)
Sommers BD, Blendon RJ, Orav EJ
Both the 'private option' and traditional Medicaid expansions improved access to care for low-income adults.
This study found that other than coverage type and trouble paying medical bills (which decreased more in Kentucky than in Arkansas), there were no significant differences between Kentucky's traditional Medicaid expansion and Arkansas's private option, which suggests that both approaches improved access among low-income adults.
AHRQ-funded; HS021291.
Citation:
Sommers BD, Blendon RJ, Orav EJ .
Both the 'private option' and traditional Medicaid expansions improved access to care for low-income adults.
Health Aff 2016 Jan;35(1):96-105. doi: 10.1377/hlthaff.2015.0917.
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Keywords:
Medicaid, Low-Income, Healthcare Costs, Access to Care, Policy
Guy GP, Jr., Yabroff KR, Ekwueme DU
Healthcare expenditure burden among non-elderly cancer survivors, 2008-2012.
This study presented nationally representative estimates of annual out-of-pocket (OOP) burden among non-elderly cancer survivors and assessed the association between high OOP burden and access to care and preventive service utilization. It found that, among cancer survivors, high OOP burden was associated with being unable to obtain necessary medical care, delaying necessary medical care, and lower breast cancer screening rates among women.
AHRQ-authored.
Citation:
Guy GP, Jr., Yabroff KR, Ekwueme DU .
Healthcare expenditure burden among non-elderly cancer survivors, 2008-2012.
Am J Prev Med 2015 Dec;49(6s5):S489-s97. doi: 10.1016/j.amepre.2015.09.002.
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Keywords:
Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Cancer, Access to Care
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
Silverberg JI
Health care utilization, patient costs, and access to care in US adults with eczema: a population-based study.
This study examined the out-of-pocket costs, health care access and utilization in adult eczema in the United States. It found that adults with eczema had $371 to $489 higher out-of-pocket costs per person-year compared with those without eczema, with higher odds of increased out-of-pocket costs.
AHRQ-funded; HS023011.
Citation:
Silverberg JI .
Health care utilization, patient costs, and access to care in US adults with eczema: a population-based study.
JAMA Dermatol 2015 Jul;151(7):743-52. doi: 10.1001/jamadermatol.2014.5432.
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Keywords:
Access to Care, Healthcare Costs, Healthcare Utilization, Skin Conditions
Malecki K, Wisk LE, Walsh M
Oral health equity and unmet dental care needs in a population-based sample: findings from the Survey of the Health of Wisconsin.
The authors explored individual-, psychosocial-, and community-level predictors of oral health status in the Survey of the Health of Wisconsin Oral Health Screening project. Their results suggested that costs were a primary predictor of access to care and poor oral health status, underscoring the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers and promoting preventive health behaviors.
AHRQ-funded; HS000063.
Citation:
Malecki K, Wisk LE, Walsh M .
Oral health equity and unmet dental care needs in a population-based sample: findings from the Survey of the Health of Wisconsin.
Am J Public Health 2015 Jul;105 Suppl 3:S466-74. doi: 10.2105/ajph.2014.302338.
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Keywords:
Access to Care, Dental and Oral Health, Disparities, Healthcare Costs, Health Services Research (HSR)
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
