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Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality

Health Insurance/Access to Care

Tools & Resources

Checkup on Health Insurance Choices
Health Care Disparities in Rural Areas
Health Insurance Coverage
Improving Health Care for Rural Populations
Medical Expenditure Survey Panel (MEPS)
Questions and Answers About Health Insurance: A Consumer Guide
Serving the Uninsured: Safety-Net Hospitals, 2003—HCUP Fact Book No. 8
Theory and Reality of Value-Based Purchasing: Lessons from the Pioneers

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Meetings & Conferences

Addressing the Needs of the Uninsured in a Challenging Economic Environment
Web-Assisted Teleconference, March 12-14, 2002
Individual Health Insurance: Are You Ready for a Change?
Web-Assisted Teleconference, April 24, 2002

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Research Findings

Agency Press Releases

Date   Title
10/21/08 More than 2 Million Children with Insured Parents Are Uninsured; Most Are Low or Middle Income
3/3/08 Modest Health Care Quality Gains Outpaced by Spending

News and Numbers

Date   Title
8/20/08 Workers at Small Companies Less Likely to Kick In Cash for Health Coverage
8/7/08 Health Insurance Premiums Have More Than Doubled Since 1996

Research Activities, August 2008:
Low-income adults with physical disabilities face transportation, accessibility, and privacy barriers
Breast screenings are lower in counties with high rates of uninsured people
University's open season shows embrace of preferred provider organizations but no backlash against HMOs

Research Activities, July 2008:
Elderly Asian Americans in traditional fee-for-service Medicare receive fewer needed services than their white counterparts
Housing instability and food insecurity among low-income children are linked to diminished access to health care
Children with private insurance have better access to specialty care than those with public and no insurance
Children often lose Medicaid coverage when their parents do, even though they are still eligible
As parents gain a job with private health insurance coverage, their children may lose public coverage
The financial burden of health care felt by low-income families a decade ago may now affect middle-income families
Public health insurance coverage continues to play an important role for working families with children
Hospital emergency departments treat mostly poor children

Research Activities, June 2008:
Telepsychiatrists and in-person therapists deliver similar therapy to veterans suffering from posttraumatic stress disorder
Serious mood disorders may be underdiagnosed or undertreated among impoverished blacks
A collaborative approach to diabetes care in community health centers can cost-effectively improve that care
Premiums rise 18 percent for nonemployer health insurance

Research Activities, May 2008:
Leaving hospitals against medical advice puts heart attack patients at substantial risk for rehospitalization or death within 2 years
Worries about finances often prompt patients with HIV disease to skimp on their antiretroviral medication
Trio of factors affects low-income parents' ability to purchase health care for their families
Health improves when previously uninsured adults become eligible for Medicare
Nursing home residents likely to receive diagnosis and pills for depression but not psychotherapy

Research Activities, April 2008:
White children are about twice as likely to use stimulants as black and Hispanic children
Concerns about SCHIP expansions crowding out private insurance are not borne out in New York
Despite lack of evidence of benefit, PSA testing for prostate cancer screening has increased dramatically
Conference on assisted living reveals its evolution, dearth of research, and quality of life for residents
Poverty-related factors rather than frequency of primary care visits underlie racial disparities in preventive care
Studies examine the HIV/AIDS epidemic in the South

Research Activities, March 2008:
Most employers review but do not use quality data when selecting health care plans
A short homeless period among youth "aged out" of the foster care system affects care access, but not health

Research Activities, February 2008:
Children with special health care needs seem to benefit from Medicaid managed care programs with case managers
Nurse midwives deliver more babies in hospitals than homes in Washington State
Medicare drug plans cover a good selection of drugs for nursing home residents, but plan vigilance should continue
Three-tier formularies increase cost sharing for retirees in generous plans, with little effect on continued drug use
Hospitals serving the uninsured and underserved need help with public reporting and pay-for-performance measures
Managed care helps the elderly avoid preventable hospitalizations more than traditional Medicare

Research Activities, January 2008:
Medicaid-insured parents could benefit from educational programs to promote more judicious use of antibiotics
Some women with breast cancer do not receive adjuvant treatments recommended by guidelines
Disadvantaged newly immigrant Hispanic women have much better birth outcomes than disadvantaged U.S. black women
Use of antidepressants by low-income pregnant women has jumped more than twofold, raising questions about fetal risks
For patients with melanoma, longer distance to a provider means later stage of diagnosis
Journal supplement explores alternative research approaches to test drug safety and effectiveness
New studies reveal the impact of drug copayment and coinsurance policies on statin and beta-blocker therapy after heart attack
Use of complementary and alternative medicine is common among persons who have been hospitalized for coronary artery disease

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Research Activities, December 2007:
Over 5 million eligible children remain uninsured, despite SCHIP enrollment gains
Many underinsured U.S. children are not getting needed vaccines due to the current vaccine financing system
Family-centered, high quality primary care is linked to fewer nonurgent emergency department visits by children
Women leaving the hospital against medical advice after delivering a baby should be targeted for more services
Many seniors will pay double the monthly copay for angiotensin receptor blockers under the Medicare Part D drug plan compared with their previous plans

Research Activities, November 2007:
AHRQ expands therapeutics education and research centers and adds new topics: Health IT, economics, and formularies
Study documents the health costs of being a woman
Premature infants with chronic lung disease can be safely cared for by community-based providers coordinating with a nurse specialist
Caregivers of children with special health care needs rate Medicaid managed care as having better care access than fee-for-service
Postdischarge care management that integrates medical and social care can improve outcomes of the low-income elderly
Insurers save with incentive-based formularies, but consumers pay more out of pocket
Mexicans' access to primary care is limited overall, but worse in nonmetropolitan areas
Patients who were uninsured use more medical services once they enroll in Medicare

Research Activities, October 2007:
AHRQ and FDA to collaborate in the largest study ever of possible heart risks with ADHA medications
Health literacy is not associated with how minorities perceive their physical or mental health status
Studies show lower colorectal cancer screening rates and access to surgery among the poor, minority, and uninsured
Barriers to timely diagnosis and treatment of prostate cancer in black men arise from lower socioeconomic status
Studies examine medication adherence and group medical visits among persons with high blood pressure

Research Activities, September 2007:
Elderly black men are less likely than white men to seek and receive care for lower urinary tract symptoms
Women in Medicare and private managed care plans receive worse care than men for cardiovascular disease and diabetes
Women with coronary heart disease are less likely than men to use aspirin to prevent further problems
The potency of laws equalizing coverage for mental health care varies between States
Medicare Part D provides coverage protection for mental health-related drugs, but certain drugs still may not be covered

Research Activities, August 2007:
Price competition induced by HMOs and other managed care plans in California has not diminished hospital quality of care
Medication therapy management programs varied widely after initial implementation of the Medicare Part D drug benefit
Socioeconomically disadvantaged patients with lupus have less access to and use of health care

Research Activities, July 2007:
Greater access to physician services may narrow mortality differences among the black and white elderly
Urinary incontinence is common among residents of Southeastern nursing homes, especially among black residents
Studies examine the surge capacity of U.S. hospitals to respond to bioterrorism or other public health disasters
Supportive housing may be a feasible and appropriate model of care for chronically homeless persons

Research Activities, June 2007:
The State Children's Health Insurance Program can improve care access, use, and quality for children with special health care needs and adolescents
Multidisciplinary programs increase patient access to comprehensive melanoma care

Research Activities, May 2007:
The shortage of pediatric rheumatologists limits residency training in pediatric rheumatology among general pediatricians
Study provides the first national estimates of the average distances that children travel to see a pediatric subspecialist
Women with disabilities report poorer health and more problems accessing health care than other women
Elderly Medicare patients with low health literacy receive little tangible support for their health care needs
Transfer of health care funding from California State to counties maintained commitment to social service spending for the indigent

Research Activities, April 2007:
Education, income, and net worth explain more U.S. racial/ethnic health disparities than health behaviors and insurance
Community health centers provide poorer quality of care to the uninsured with chronic disease
Prescription drug coverage does not assure long-term adherence to beta-blocker therapy following a heart attack
Extending health insurance coverage to older working adults may substantially improve their health

Research Activities, March 2007:
Efforts to improve chronic disease management quality yield better care delivery but not better intermediate outcomes
Children are more likely to attend a weight management program if location and time are convenient for parents
State Children's Health Insurance Programs have improved access to care for previously uninsured children
Urban influence codes reveal more about children's patterns of health care use and coverage
The financial burden of health care for people under age 65 increased between 1996 and 2003
Forty percent of families who leave welfare for work have no health insurance 19 months later

Research Activities, February 2007:
Many children do not receive recommended well-child visits during the year, especially disadvantaged children
Modest levels of cost-sharing for emergency department care decrease emergency department visits without worsening health
Employer-sponsored insurance coverage of smoking cessation treatments could save employers and insurers money
Growth in local jobs that offer health insurance can move the working poor off the Medicaid program

Research Activities, January 2007:
American Indians and Alaska Natives are difficult to reach by mail for research or health care reasons
State children's health insurance and premium-subsidy programs do not always provide a bridge to private health insurance
Increased use of prescription medicines is changing health care spending patterns
Clinical and social factors predict application for Social Security disability benefits by workers with back injuries
People with significant health needs or barriers to care access are more likely to use the Internet for health information

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Research Activities, December 2006:
Journal supplement reviews evidence for the efficacy of telemedicine and telecare
Lack of health care options in rural communities poses substantial barriers to care for rural disabled adults
Tax subsidies for employer-sponsored health insurance will exceed $200 billion in 2006

Research Activities, November 2006:
Studies examine influence of patient race on primary care quality and hospital discharge against medical advice
Women's self-report of mammography use conflicts with verified reports using claims data
Uninsured children's access to care is influenced by the availability and capacity of a local safety net
Pay-for-performance incentives were adopted by half of U.S. HMOs, but their use depends on health plan type and physician payment arrangements

Research Activities, October 2006:
Rural children with special health care needs are more likely than their urban counterparts to lack needed dental care
Severity of illness and rural location affect the willingness of elderly people to travel longer distances to the hospital

Research Activities, September 2006:
Health insurance coverage for mental health specialists is still lower than for other medical visits
Study identifies factors contributing to growth in hospital inpatient costs since 1998

Research Activities, August 2006:
Studies examine the prevalence, impact, and disclosure of domestic violence among women
Studies highlight the value of the Medical Expenditure Panel Survey to inform trends in care costs, coverage, use, and access
Older veterans need to become more actively involved in hospital discharge planning for their post-hospital needs
U.S. hospitals treat many uninsured victims of car crashes, violence, and other injuries
Job-related health insurance premiums vary widely between States

Research Activities, July 2006:
Puerto Rican children are diagnosed with asthma more often than other children
Aggressive Medicaid and SCHIP outreach programs are needed to enroll Latino children
Enrollment in New York's State Children's Health Insurance Program improves asthma care quality and access
Reductions in primary and preventive care use under Medicaid primary care case management are more dramatic for minority children
Workers who have health insurance are less likely to miss work than uninsured workers

Research Activities, June 2006:
Limited health care access impairs blood sugar control among low-income urban blacks with type 2 diabetes
A year after leaving jail, half of women lack health insurance or use primary care
Insuring adults in late middle age may reduce the costs of paying for health problems later

Research Activities, May 2006
Parents of children with special health care needs identify multiple barriers to accessing care for their children
Medicaid managed care plans with case management programs may benefit children with disabilities more than fee-for-service plans
Study examines national trends in the costs of bariatric surgery
Employers are least likely to offer insurance coverage for preventive care services that provide the financial return they seek

Research Activities, April 2006
Increasing specialization of generalist surgeons confounds workforce projections
Higher insurance premiums and expanded Medicaid eligibility have reduced family coverage in employer-related health plans
One-fourth of America's non-elderly poor go years without the protection of health insurance

Research Activities, March 2006
Fewer visits to the doctor contribute to the higher mortality rates among black Medicare patients in Tennessee
Inmates who are released from prison often join the ranks of the homeless
SCHIP significantly decreases uninsurance and increases public insurance for children in low-income families
Medi-Cal changes in the 1990s shifted newborn deliveries from large public hospitals to smaller community hospitals

Research Activities, February 2006:
Low-income Hispanics and blacks use alternative health care as a substitute for conventional care
People with diabetes take less diabetes medication when costs increase
Expansion in public health insurance for children lessens the financial burden of health care for low-income families
Employer-offered health coverage affects plan uptake by workers, but has less effect on overall worker and family coverage rates

Research Activities, January 2006:
Studies examine the impact of Medicaid managed care programs on access to and use of care
Insurance status influences patients' access to urgent followup appointments after emergency department care
State-subsidized health insurance programs provide both benefits and difficulties for low-income children

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Research Activities, December 2005:
Studies examine barriers to self-management for patients with chronic illness and interventions that improve care
Long waits for providers and lack of access are the most common frustrations among urban primary care patients
Randomized trial reveals community-based case managers increase public insurance enrollment of uninsured Latino children
Neither patient HMO membership nor physician HMO participation is greatly associated with racial disparities in primary care
Regional availability of specialists affects outcomes for patients with peripheral arterial disease
Caps on malpractice awards increase the State supply of physicians, especially in rural areas
Study strengthens argument against implementing rollbacks in the State Children's Health Insurance Program

Research Activities, November 2005:
Rural residents lack timely access to trauma centers that could save their lives
Studies detail the impact of costs on drug and health care use

Research Activities, October 2005:
Greater access to primary care may reduce emergency department use

Research Activities, September 2005:
Greater access to care at VA clinics lessens disparities in blood pressure control among black men
Acculturation plays a pivotal role in the health status and behaviors of Latinos in the United States
Studies highlight the importance of providing interpreter and translating services for minorities
Studies reveal variations in preventive care and parental guidance among pediatric and family medicine practices
Survey reveals shortage of radiologists and certified mammography technologists at U.S. community mammography facilities
Out-of-pocket health care expenses pose a significant financial burden for low-income families with children
At least one-fourth of older adults will be uninsured at some point during the years preceding eligibility for Medicare

Research Activities, August 2005:
Efforts beyond expanding health coverage may be needed to improve access and quality for low-income and minority children
Patients most likely to benefit from stroke rehabilitation are least likely to be selected
Cancer survival is lower among Medicaid than non-Medicaid patients, especially for those enrolled after cancer diagnosis
Study calls for reform of policies that reject candidates for cardiac transplantation due to lack of insurance or finances

Research Activities, July 2005:
Some care disparities among blacks may be due to low technology use in hospitals that treat mostly black patients
Access to transportation substantially influences rural residents' use of health care services

Research Activities, June 2005:
Researchers find racial and socioeconomic disparities in compensation for work-related back injuries
Black/white disparities in time to treatment for heart attack patients depend on the admitting hospital
Study reveals racial/ethnic and income-related disparities in use of Web-based health services
High managed care penetration boosts breast and cervical cancer screening, with spillover effects to non-managed care patients

Research Activities, May 2005:
Medicaid policies and other local factors may affect disparities in use of diabetes-related health care services
Use of an asthma kiosk in the emergency department can educate parents and improve clinician/patient communication
Children with special health care needs generally use more health services and have higher costs than other children
Children of working poor parents continue to be at a disadvantage for health care access and use
Homeless youths have numerous health and access to care problems that vary between street and shelter-based youths

Research Activities, April 2005:
More frequent placements of foster children increase their reliance on emergency departments for outpatient care
Being organized as a group/staff HMO generally has a stronger impact on care access and quality than capitation

Research Activities, March 2005:
Health plans take action to improve services for members with limited English proficiency
Rural workers have less employment-related health insurance for several reasons, including low wages and smaller employers

Research Activities, February 2005:
Policies that have a deductible inserted in the middle instead of at the front expose enrollees to more risk
Policies are being considered to extend medical malpractice tort reforms to the nursing home sector

Research Activities, January 2005:
Study finds declining quality of primary care for elderly Medicare patients
Substantial barriers prevent cancer patients from obtaining optimal care at the end of life
Children with special needs often don't receive the health care services and assistive devices they need
Shortages of rural generalist physicians may be due to poor recruitment rather than retention problems
Elderly people who lack prescription drug coverage may not get needed medications for chronic conditions
Medicaid may be an important key to linking older individuals in rural areas with formal home health care
Medicare managed care enrollees make significant use of home health benefits, but low education limits use of medical equipment

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Research Activities, December 2004:
Inequities continue in reimbursement for mental health care compared with physical health care
Improved health insurance coverage may enhance access to care among rural Hispanic elders
When managed care market share increases in a geographic area, procedures decrease for Medicare fee-for-service patients

Research Activities, November 2004:
About 13 percent of U.S. children and 26 percent of those with disabilities or chronic illness see a specialist in a year
Service coordination for pregnant women in prison can improve their use of health services after release
Hospitals profit less from privately insured patients than from Medicare patients and profit least from Medicaid and self-pay patients

Research Activities, October 2004:
CHIRI™ study finds that SCHIP benefits low-income children, and vulnerable children share in the improvements
Large firms are more likely to offer health insurance plans with high quality ratings

Research Activities, September 2004:
Racial/ethnic composition of a county can affect residents' access to care
Half of doctors in State-sponsored financial support-for-service programs stay in underserved areas over 8 years, most working happily

Researchers examine trends in spending on drugs for Medicare beneficiaries and insurance coverage for children
Children with special health care needs in Medicaid managed care plans receive more needed care than those in Medicaid FFS plans
Expanded Medicaid eligibility reduced the risk of inadequate prenatal care in California during the 1990s
Individuals are unlikely to recommend an insurance plan if they do not like the provider choices or preventive services covered

Research Activities, August 2004:
Study uncovers major differences in the use and cost of health care for privately insured men and women with HIV
Hospital costs and length of stay for HIV patients depend in part on geographic area
Ethnicity, income, and public financing all influence medical safety net providers in large urban communities
Supplemental private insurance affects use of care and outcomes of Medicare patients who have heart attacks

Research Activities, July 2004:
Improved access to medication and therapy for depressed primary care patients improves 5-year outcomes
Higher income and coverage for dental care increase use of dental services among older adults
Children's health insurance coverage has increased, more care has shifted to outpatient sites, and expenditures have declined
People who switch health plans often do not have to change physicians
Studies reveal patient cost-sharing influences patients' use of cancer screening and emergency department care
Inner-city parents often have limited knowledge about managed care rules and practices
Medicare managed care is better at delivering preventive services, but traditional Medicare is better in other areas
More restrictive laws and consumer and investor anxiety have had an effect on managed care cost-cutting strategies

Research Activities, June 2004:
Many different subgroups make up the Hispanic population, and they have diverse health needs and barriers to care

Research Activities, May 2004:
Significant increases in drug copayments may reduce patients' use of needed medications
Referrals for physical therapy for musculoskeletal conditions vary and may indicate problems with access to care
Researchers find New York SCHIP improves health care access, continuity, and quality
Young and healthy individuals fare better than moderately sick individuals with consumer-directed health benefits

Research Activities, April 2004:
Researchers examine racial and ethnic disparities in emergency care
Health plan use of gatekeepers may improve use of recommended cancer screening
State reforms in the 1990s to guarantee health insurance for employees of small firms had little effect on offer rates

Research Activities, March 2004:
Many major teaching hospitals might not be able to offer adequate access to specialty care for uninsured patients
Researchers find SCHIP and Medicaid networks compete for physicians in some markets

Research Activities, February 2004:
Studies demonstrate high rates of assault and unmet health care needs among homeless women
Attitude toward risk does not fully explain sociodemographic disparities in health care use

Research Activities, January 2004:
Recent HCSUS studies focus on HIV infection in older individuals and women, use of complementary and alternative therapies, and insurance status
Changing health insurance plans might adversely affect a persons' care as well as increase care costs during the first year

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