Health Services Research最新文献

{"title":"Navigating New Waters: How Did MACRA 2015 Transform Practices Among Medicare Part B Physicians?","authors":"Mahmoud Manouchehri Amoli, Bassam Dahman","doi":"10.1111/1475-6773.14631","DOIUrl":"https://doi.org/10.1111/1475-6773.14631","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether physicians participating in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) exhibit different billing behaviors and practice patterns compared to non-participating physicians after MACRA implementation.</p><p><strong>Study setting and design: </strong>A quasi-experimental staggered difference-in-difference design was used to compare pre-and post-MACRA changes among participants and non-participants from 2013 to 2021. Primary outcomes included annual submitted charges, annual Medicare payments, and charge-to-payment ratios. Secondary outcomes were average charges and payments per beneficiary, total services, and the number of beneficiaries served.</p><p><strong>Data sources and analytic sample: </strong>The study analyzed secondary data from Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service Provider Utilization and Payment Data (2013-2021), providing outcome measures and control variables; Quality Payment Program (QPP) Experience Reports (2017-2021), the National Plan and Provider Enumeration System, and Medicare Geographic Variation Public Use File. The analytic sample included 4,924,118 physician-year observations (749,129 unique physicians), with 50.2% participating in MACRA.</p><p><strong>Principal findings: </strong>MACRA participation was associated with significant annual increases of $36,677 (95% CI: 28,918, 44,436) in total submitted charges and $9164 (95% CI: 7288, 11,041) in total Medicare payments compared to non-participation. However, these increases appeared primarily driven by a substantial increase in the total number of Medicare beneficiaries served per physician (29.77 beneficiaries; 95% CI: 20.75, 32.79) rather than by increases in spending per beneficiary, which were modest (average payment increase per beneficiary of $2.10; 95% CI: 0.22, 3.97). The charge-to-payment ratio decreased by 0.04 percentage points (95% CI: -0.08, -0.00) among MACRA participants, suggesting potential improvements in billing efficiency.</p><p><strong>Conclusions: </strong>MACRA participation is associated with increased billing and payment among Medicare Part B physicians, primarily driven by physicians treating a greater number of Medicare beneficiaries. However, modest changes in per-beneficiary spending suggest limited changes in care intensity. Further research is needed to explore factors influencing patient volumes and payer mix under MACRA.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14631"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten Healthcare Delivery Trends and Their Measurement and Methodological Implications for Cancer Health Services Research.","authors":"Sallie J Weaver, Sandra A Mitchell","doi":"10.1111/1475-6773.14637","DOIUrl":"https://doi.org/10.1111/1475-6773.14637","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14637"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Coding Intensity in Medicare Advantage Through Switchers.","authors":"Paul D Jacobs, Timothy J Layton","doi":"10.1111/1475-6773.14628","DOIUrl":"https://doi.org/10.1111/1475-6773.14628","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the extent of differential coding of health risk in traditional Medicare (TM) compared with Medicare Advantage (MA).</p><p><strong>Study setting and design: </strong>Payments to MA plans are based on reported medical conditions, and research has shown the number and severity of diagnoses are larger when beneficiaries are enrolled in MA plans rather than TM. We compare the risk scores of Medicare beneficiaries who switch from TM into MA over the 2013-2021 period to the scores of beneficiaries who stay in TM, incorporating heterogeneous treatment effects across switching cohorts and over time.</p><p><strong>Data sources and analytic sample: </strong>We use a 10% sample of Centers for Medicare and Medicaid Services data containing individual risk scores and enrollment status for 2012-21. After applying exclusion criteria, our sample consists of 1,911,968 beneficiaries with data available for each year. We also link administrative data to the Medicare Current Beneficiary Survey to assess measures of health status.</p><p><strong>Principal findings: </strong>We find the risk scores of switchers to MA were 0.120 points (12.4%; 95% confidence interval [CI]: 12.0%-12.8%) higher than stayers in the second year, 0.166 points (17.2%; 95% CI: 16.7%-17.6%) higher in the third year, and 0.216 points (22.3%; 95% CI: 21.7%-22.9%) higher by the sixth year after switching. Averaged over all MA enrollees in 2021, our estimates suggest coding intensity in MA led to risk scores that were 18.6% higher than for comparable enrollees in TM.</p><p><strong>Conclusions: </strong>Our estimates of coding intensity are at the higher end of the range in the prior literature while addressing concerns of endogenous switching. Our estimates of increasing coding over time and across enrollment cohorts can help inform decisions regarding adjustments to MA payments for coding intensity.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14628"},"PeriodicalIF":3.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHOICE: A Comprehensive and Coordinated Colorectal Cancer Screening Program in a Large Urban Health System.","authors":"Emma Ghalili, Tsion Tmariam, Parth D Trivedi, Lina Jandorf","doi":"10.1111/1475-6773.14629","DOIUrl":"https://doi.org/10.1111/1475-6773.14629","url":null,"abstract":"<p><strong>Objective: </strong>To develop a coordinated colorectal cancer (CRC) screening program within a large urban health system, with the ultimate goal of increasing system-wide screening rates of eligible patients and reducing no-show rates while increasing colonoscopy completion rates.</p><p><strong>Study setting: </strong>A large urban academic health system comprising 8 hospitals and over 400 ambulatory practices.</p><p><strong>Study design: </strong>The CHOICE Program combined patient navigation, electronic medical record (EMR) optimization, and system-wide practice changes to improve CRC screening completion by colonoscopy. The program incorporates provider and patient education, standardization of documentation and protocols, increased outreach by navigators, and streamlining of patient scheduling. The primary outcome is colonoscopy completion.</p><p><strong>Data collection: </strong>All health system patients between the ages of 45 and 75 and at average risk of CRC are the target population for the intervention. A review of screen-eligible patients' completion of colonoscopy was performed to assess program success.</p><p><strong>Principal findings: </strong>During a 2-year period (March 2022 to February 2024), 18,119 people were referred into the program, and 79% of scheduled patients completed the colonoscopy. The CHOICE program operationalized and standardized the CRC screening efforts of a large health system and offers a template that can be implemented or adapted by other hospital systems and provider networks.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14629"},"PeriodicalIF":3.1,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “SIREN 2025 National Research Meeting: Advancing the Science of Social Care”","authors":"","doi":"10.1111/1475-6773.14630","DOIUrl":"https://doi.org/10.1111/1475-6773.14630","url":null,"abstract":"<p>Health Services Research, 2025; 60(Suppl. 1): e14614.</p><p>The copyright lines for all articles in this issue have been updated online to 2025 Wiley Periodicals LLC. This is to reflect the change in the ownership which took effect before the issue was published. We apologize for this error.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"60 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.14630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician and Patient Responses to US Health Insurers' Policies: A Qualitative Study of Higher Risk Patients","authors":"Tammy L. Eaton,&nbsp;Valerie Danesh,&nbsp;Abigail C. Jones,&nbsp;Christine C. Kimpel,&nbsp;Carla M. Sevin,&nbsp;Han Su,&nbsp;Kelly M. Toth,&nbsp;Thomas S. Valley,&nbsp;Theodore J. Iwashyna,&nbsp;Leanne M. Boehm,&nbsp;Joanne McPeake","doi":"10.1111/1475-6773.14615","DOIUrl":"10.1111/1475-6773.14615","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To identify specific ways in which US health insurance triggered changes in care and interrupted the encounter between clinicians and patients in post-intensive care unit (ICU) clinics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Setting and Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This naturalistic qualitative study was nested within a randomized controlled trial that evaluated the feasibility and preliminary efficacy of a telemedicine ICU recovery clinic intervention. Adult participants were referred to a multidisciplinary ICU recovery clinic after septic shock or acute respiratory distress syndrome (ARDS) in a Southeastern US academic medical center.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources and Analytic Sample&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data were collected from 2019 to 2021. Telemedicine ICU recovery visits within the intervention group were used in this analysis. ICU recovery visits at 3- and 12-week intervals after hospital discharge were recorded and analyzed based upon the constant comparative method. Responses were initially open coded and then consolidated with the Donabedian Model of assessing healthcare quality by two investigators to organize themes and subthemes, with discrepancies in coding resolved by consensus.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Principal Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Thirty-three clinic visit transcripts from 19 patients revealed health insurance-related issues commonly elicited by clinicians. One in three patients raised health insurance-related issues during their clinical encounter. Structural barriers to ICU recovery included high out-of-pocket spending, the complexity of interfacing with health insurance companies, and health insurance literacy. Patients initiated modifications to intended care to overcome insurance-related barriers to recovery, including nonadherence to prescribed medications and treatments and crafting unsafe “workarounds” to recommended healthcare, with consequences to their recovery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We found that health insurance complexity and high out-of-pocket costs compromise the quality of care and recovery experienced by ICU survivors. These findings emphasize the need for solutions at the policy, payor, and healthcare system levels to mitigate barriers to ICU recovery created by health insurance, which can adversely influence affordable, timely, and appropriate critical illness survivor care.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;\u0000 &lt;b&gt;Trial Registration:&lt;/b&gt; NCT","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"60 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.14615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the Impact of ACA Medicaid Expansion on Insurance Coverage, Access to Care and Health of Low-Income Parents.","authors":"Elena Andreyeva, Hannah I Rochford, Daniel J Marthey","doi":"10.1111/1475-6773.14625","DOIUrl":"https://doi.org/10.1111/1475-6773.14625","url":null,"abstract":"<p><strong>Objective: </strong>To examine longer-term effects of Medicaid expansion on insurance coverage, access to care, and health, and investigate heterogeneous effects across demographic characteristics of low-income parents.</p><p><strong>Study setting and design: </strong>We estimated linear probability models for having healthcare coverage and access to care and reporting days of not good physical and mental health in the past 30 days. We adjusted for individual- and state-level factors, and state and year fixed effects. Our treatment group included low-income parents residing in Medicaid expansion states, and our control group included high-income parents residing in Medicaid expansion states and ineligible for any Affordable Care Act (ACA) subsidies. We used difference-in-differences and event-study designs.</p><p><strong>Data sources and analytic sample: </strong>Nationally representative secondary data on self-reported insurance, access, and health status from the core component (2011-2019) of the Behavioral Risk Factor Surveillance System (BRFSS) among respondents aged 26-54 with at least one child living in the household.</p><p><strong>Principal findings: </strong>Medicaid expansion was associated with a 13.4 percentage point (pp) increase in the probability of reporting any health insurance (p < 0.001), an 11.3 pp decline in the probability of reporting a cost barrier (p < 0.001), and a 2.4 pp decrease in the probability of reporting days in poor mental health (p = 0.028) among low-income parents. Our results also suggest parents who were married and those identifying as non-Hispanic white (relative to Hispanic and non-Hispanic other/multiple race) experienced the largest increases in health insurance coverage.</p><p><strong>Conclusions: </strong>While Medicaid expansions improved insurance coverage, access to care, and health status among low-income parents, disparities persisted and, in some cases, widened. These findings have significant implications for policymakers as they consider policies aimed at increasing access to care.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14625"},"PeriodicalIF":3.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic Neurokinin-1 Receptor Antagonist Use Pre- and Post-Choosing Wisely Initiative Among Women With Invasive Breast Cancer.","authors":"Shweta Kamat, Britny R Brown, Steven A Cohen, Ami Vyas","doi":"10.1111/1475-6773.14626","DOIUrl":"https://doi.org/10.1111/1475-6773.14626","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of Choosing Wisely (CW) on prophylactic NK1-RA use among women with breast cancer.</p><p><strong>Study setting and design: </strong>This was a retrospective cohort study conducted using administrative claims data. The exposure variable was the start of chemotherapy relative to the implementation date for the CW antiemetic measure. The outcome was prophylactic NK1-RA use. Interrupted time series using segmented regression was used to assess the effect of CW on prophylactic NK1-RA use.</p><p><strong>Data sources and analytic sample: </strong>Optum's de-identified Clinformatics Data Mart Database (2010-2018) was used. This study included women aged ≥ 18 years with breast cancer with at least one newly initiated claim for low/minimal/moderate emetic risk chemotherapy (n = 25,549).</p><p><strong>Principal findings: </strong>The prophylactic use of NK1-RAs among patients with breast cancer receiving low/minimal/moderate emetic risk chemotherapy decreased from 11.1% pre-CW to 7.7% post-CW. Segmented regression analysis showed a significant increase of 0.11 per 100 patients per quarter in the use of prophylactic NK1-RAs prior to CW recommendation (95% CI = 0.10-0.12; p < 0.0001). However, immediately after the CW (occurred in Q4 2013), there was a significant decline in the prophylactic NK1-RA use by 1.03 per 100 patients in Q2 2014 (-0.93 to -1.13; p < 0.0001). For the time after intervention, there was a significant decline in NK1-RA use by 0.37 per 100 patients per quarter in the post-CW period compared to the pre-CW period (95% CI = -0.36 to -0.38; p < 0.0001).</p><p><strong>Conclusion: </strong>This study highlights a significant but modest decline in the use of prophylactic NK1-RAs. Educational efforts for the dissemination of CW recommendations are needed to facilitate appropriate prophylactic NK1-RAs use.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14626"},"PeriodicalIF":3.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Cognitive-Behavioral Therapy in a Nation-Wide Veterans Health Administration Sample: The Role of Clinic, Therapist, and Patient Factors.","authors":"Alan McGuire, Mindy Flanagan, Madison E Stout, Jessica Coffing, Marina Kukla, Morgan Traylor, Laura Myers, Nancy Henry, Jessica Carter, Marianne Matthias","doi":"10.1111/1475-6773.14604","DOIUrl":"https://doi.org/10.1111/1475-6773.14604","url":null,"abstract":"<p><strong>Objective: </strong>To examine the use of CBT-CP (Cognitive-behavioral therapy for chronic pain) by CBT-CP-trained therapists to treat patients with pain over a five-year period (October 2015-February 2020).</p><p><strong>Data sources and study setting: </strong>CBT-CP is a core evidence-based practice that is central to multidisciplinary chronic pain care. However, research suggests that CBT-CP is underused. The current study used national Veterans Health Administration data to examine the use of CBT-CP by CBT-CP-trained therapists to treat patients with pain over a five-year period.</p><p><strong>Study design: </strong>Multilevel modeling was used to evaluate clinic, therapist, and patient-level factors as predictors of CBT-CP receipt.</p><p><strong>Data collection: </strong>Administrative data on 37,514 patients seen at a national sample of Veterans Health Administration locations for pain were collected from the U.S. Veterans Health Administration central data repository.</p><p><strong>Principal findings: </strong>Results indicated 38.4% of patients with pain seen by a CBT-CP-trained therapist received CBT-CP during the observation period. Patients were more likely to receive CBT-CP if more time elapsed since their therapist received CBT-CP training and if their therapist had a master's degree (vs. a doctorate). Patients with somatic symptom disorder and depressive disorders were more likely to receive CBT-CP, while patients with comorbid personality disorders or substance use disorders were less likely to receive CBT-CP. Patients seen in pain specialty, PTSD, biomedical, and mental health clinics were more likely to receive CBT-CP than those not seen in these clinics.</p><p><strong>Conclusions: </strong>Findings suggest that the reach of CBT-CP is substantively related to factors at each level. Future research is needed to better understand the therapy treatment decision-making processes and to address education gaps and other factors that impede the implementation of evidence-based practices.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14604"},"PeriodicalIF":3.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Arkansas Medicaid Work Requirements on Coverage and Employment: Estimating Effects Using National Survey Data.","authors":"Anuj Gangopadhyaya, Michael Karpman","doi":"10.1111/1475-6773.14624","DOIUrl":"https://doi.org/10.1111/1475-6773.14624","url":null,"abstract":"<p><strong>Objective: </strong>We examine the health insurance coverage and employment effects of an Arkansas Medicaid waiver establishing work requirements for adults with Medicaid.</p><p><strong>Study setting and design: </strong>Using 2016-2019 data from the American Community Survey, we assessed the effects of a Section 1115 waiver requiring adults ages 30-49 in Arkansas to work or participate in community engagement activities for 80 h per month to maintain Medicaid benefits. A difference-in-differences analysis compared changes in coverage and employment among likely nonexempt adults in Arkansas with peers in other Medicaid expansion states. We focused on changes between the 2016-2017 pretreatment and 2018-2019 posttreatment periods, using randomization inference (RI) for statistical inference.</p><p><strong>Data sources and analytic sample: </strong>Our study population included adults ages 30-49 likely nonexempt from the policy residing in Arkansas and other Medicaid expansion states. We focused on adults with incomes below 300% of the federal poverty level (FPL), with heterogeneity tests for those below 100% FPL, who were most exposed to the policy. We repeated our analysis for unaffected age groups (19-29 and 50-64) and potentially exempt groups (e.g., parents with dependent children) as placebo tests.</p><p><strong>Principal findings: </strong>From 2016 to 2019, the share of uninsured adults ages 30-49 in Arkansas increased from 22.6% to 29.9%. Work requirements were associated with a 4.4 percentage-point increase (RI p = 0.04) in uninsurance, concentrated among those with incomes below 100% FPL (7.4 percentage points) (RI p = 0.05). This occurred alongside a decline in reported Medicaid/private nongroup coverage and no significant change in employer coverage. No coverage impacts were observed for unaffected or exempt groups. The association between work requirements and employment among the affected age group (-0.7 points) (RI p = 0.62) was negative, small, and statistically insignificant.</p><p><strong>Conclusions: </strong>Implementation of Arkansas' work requirements policy was associated with an increase in uninsurance among the targeted age group and no significant change in employment or work effort.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14624"},"PeriodicalIF":3.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}