HEALTH SERVICES RESEARCH卫生服务研究
HEALTH SERVICES RESEARCH(英文缩写 HEALTH SERV RES),ISSN 0017-9124,eISSN 1475-6773,中文译名:卫生服务研究 是一本学术期刊。本页汇总该期刊的最新影响因子、分区信息以及最新收录于 PubMed 的文献,帮助您快速了解期刊全貌。
发文量统计区间：2025-09-27 至 2026-09-27，按本站收录文献的发表日期统计。
期刊介绍
历年影响因子趋势
| JCR 数据年份 | 影响因子 | JCR 分区 |
|---|---|---|
| 2021 | 3.734 | Q1 |
| 2022 | 3.400 | Q2 |
| 2023 | 3.100 | Q1 |
| 2024 | 3.200 | Q1 |
| 2025 | 3.000 | Q2 |
HEALTH SERVICES RESEARCH 最新收录文献
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1. Hospital and Community Attributes Associated With Charity Care Policy Generosity.
PMID:日期:2026-10-01To evaluate hospital and community characteristics associated with attributes of charity care policies. Charity care is a highly utilized avenue for medical debt relief. Hospitals are allowed some discretion when setting charity care policies, yielding heterogeneity in charity care generosity and availability to patients. We conducted a cross-sectional study using data on charity care policies from US hospitals collected through hospital websites and direct email and phone contact between September 2023 and April 2025 by the Lown Institute. We reviewed 2418 hospitals from 50 US states, including non-profit, for-profit, and government-owned hospitals. The primary outcomes were the likelihood that certain hospital characteristics were associated with offering fully or partially discounted care and income limits for patient eligibility. Additional outcomes include eligibility for the underinsured, patients with large bills, residency requirements, and use of presumptive eligibility screening. System affiliation was positively associated with offering fully discounted (Est, 90.5%; 95% CI, 88.9%-92.0% compared with Est, 78.9%; 95% CI, 76.4%-81.5% for non-affiliated hospitals) and partially discounted care (Est, 85.5%; 95% CI, 83.5%-87.2% compared with Est, 77.1%; 95% CI, 74.2%-80.0% for non-affiliated hospitals), and was associated with a significant percentage-point increase in charity care income thresholds (32.69, 95% CI, 25.20-40.17; for fully discounted care). Non-profit hospitals reported the highest likelihood of offering both fully (Est, 96.7%; 95% CI, 95.8%-97.7%) and partially discounted care (Est, 85.5%; 95% CI, 83.5%-87.2%), and were significantly more likely to use presumptive eligibility screening (Est, 82.7%; 95% CI, 80.8%-84.6%) compared with for-profit hospitals. Overall, tax-exemption status, system affiliation, and community socio-economic and legislative factors were associated with more expansive and generous charity care policies. Policymakers can consider hospital incentives and capabilities when designing policies to address medical debt.
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2. The Financial Impact of Pregnancy and Childbirth Among Louisiana Medicaid Beneficiaries.
PMID:日期:2026-10-01To measure the impact of pregnancy and childbirth on debt and personal credit scores by race, ethnicity, and geography. We used Medicaid claims data, credit report data, and the Callaway Sant'Anna difference-in-differences method to compare relative changes in credit score, medical debt, and nonmedical debt between women moving through their pregnancies and women who weren't pregnant. Louisiana Medicaid claims data (January 2017 to December 2020). While outcomes were not adversely impacted for non-Hispanic White women, non-Hispanic Black women experienced worsening financial measures following their pregnancies: credit scores decreased from Month 4 to 14 (4 points, 95% CI: -5.65 to -1.81, p < 0.01), medical debt increased from Month 8 to 12 ($41, 95% CI: $6-$75, p = 0.02), and nonmedical debt increased from Month 2 to 21 ($44, 95% CI: $15-$74, p < 0.01). Pregnancy and childbirth were associated with worsening financial outcomes among low-income Medicaid-enrolled mothers, particularly among non-Hispanic Black women. These findings highlight the importance of broader economic supports to reduce financial disruption associated with pregnancy and childbirth among low-income families and address disparities in maternal and child well-being.
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3. How Should We Identify Home- and Community-Based Services (HCBS) in Medicaid Claims Data? An Evaluation and Synthesis of Algorithms.
PMID:日期:2026-10-01To assess existing algorithms for measuring Home- and Community-Based Services (HCBS) in Medicaid claims, and to develop and evaluate a unified, modified algorithm. Using Transformed Medicaid Statistical Information System Analytic Files (TAF), we compared two existing algorithms for identifying and classifying 1915(c) waiver and state plan HCBS. Informed by that analysis, we developed a third, unified and modified algorithm. Using each algorithm, we constructed annual state-level estimates of HCBS use per 100,000 residents, which we compared from 2021 to 2023. National 20% sample of TAF data. The sample included continuously enrolled, full-benefit Medicaid beneficiaries age 19 or older in 2021 for primary analyses, and 2022-2023 to compare counts over time. The existing algorithms showed a high level of concordance (observed agreement, P = 93% and kappa = 0.77). Disagreement resulted from missing or inconclusive program type codes, differences in service-related codes used to classify HCBS, and differences in classifying claims for capitated payments. Our algorithm addressed some of this disagreement with the novel use of waiver identification numbers and modification of some TAF data elements and codes. HCBS user counts were mostly consistent across algorithms, with our algorithm identifying the broadest population of users. However, some states exhibited inconsistent counts depending on the algorithm, implausibly high counts (Pennsylvania and Illinois), or implausibly low counts (Mississippi). In several states, HCBS user counts varied substantially from 2021 to 2023 (> 50% in absolute value), suggesting changes in data quality or reporting in those states across years. Our algorithm resolves some discordances between two existing algorithms for measuring HCBS use in TAF. However, in certain states and years, inconsistent or implausible HCBS user counts suggest variations in data reliability and coding patterns that could limit accurate measurement of HCBS, regardless of the algorithm used.
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4. Proof of Citizenship at the Point of Care: Documentation Requests and Forgone Care Among California Immigrants, 2019-2022.
PMID:日期:2026-10-01To estimate how often immigrant adults are asked for a Social Security number or proof of citizenship to obtain care or enroll in school, who is asked for these documents, and whether being asked relates to health care access. Cross-sectional analysis of four pooled waves (2019-2022) of a population-based, multilingual survey of California adults. The exposure was the documentation request; outcomes were lacking a usual source of care and delaying or forgoing care. California Health Interview Survey public-use files were used. The documentation item is asked only of foreign-born respondents, yielding 21,133 immigrant adults (15,313 naturalized, 5820 noncitizen). Survey-weighted logistic models with jackknife variance reported average marginal effects. Overall, 15.7% (95% CI: 14.9-16.5) reported being asked. After adjustment, noncitizens were 5.3 percentage points more likely than naturalized citizens (3.5-7.1) and limited-English-proficient adults 5.8 points more likely (3.5-8.1) to be asked. Being asked was associated with delaying or forgoing care (6.1 points; 4.2-8.0) but not with lacking a usual source of care (0.2 points; -1.9 to 2.3). Documentation requests were common, concentrated among noncitizen and limited-English-proficient immigrants, and associated with forgone care. The cross-sectional design cannot establish causation.
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5. Use of Brokers in Medicare Advantage and Standalone Part D Plans.
PMID:日期:2026-10-01To compare the use of brokers in Medicare Advantage plans and standalone Part D plans. We used plan-level broker enrollment data from 2014 to 2023 to compare the rates of broker use in Medicare Advantage and standalone Part D plans. We used broker enrollment data obtained from the Centers for Medicare and Medicaid Services through a Freedom of Information Act request and data from the Medicare Master Beneficiary Summary File. Our sample included 47,862 plan-years from 2014 to 2023. In 2023, new enrollees in Medicare Advantage plans were more likely to be enrolled by a broker than those in standalone part D plans (35.6% compared to 27.1%). These results were generally consistent over time, within insurers, and across states. Broker use is more common in Medicare Advantage plans than in standalone Part D plans. Given that brokers are often paid more to enroll beneficiaries in Medicare Advantage plans than in standalone Part D plans, these results suggest that brokers may play a key role in driving Medicare Advantage enrollment growth.
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6. Suicide Prevention in the US Military: Assessing the Impact of the Brandon Act.
PMID:日期:2026-10-01To evaluate whether the Brandon Act, a 2021 legislation establishing confidential, self-initiated mental health referral pathways for US military service members, was associated with reductions in medically attended suicide attempts among active duty service members (ADSMs). We employed an interrupted time series design using person-quarter panel data from the Military Health System (MHS) from 2018 to 2024. Segmented regression and event study specifications estimated immediate and trajectory effects of the Brandon Act on suicide attempt rates. Data were drawn from the MHS Data Repository, comprising 39.1 million person-quarters from 2.5 million ADSMs aged 18-64. Suicide attempts were identified from inpatient, outpatient, and emergency department claims. Prior to the Brandon Act, suicide attempt rates increased by 4.29 per 100,000 per quarter (95% CI: 3.56, 5.02). Enactment in December 2021 was associated with an immediate reduction of 6.51 per 100,000 (95% CI: -10.54, -2.47) and a downward trajectory shift of 2.25 per 100,000 per quarter (95% CI: -3.81, -0.70). Official implementation in May 2023 was associated with a further immediate reduction of 21.19 per 100,000 (95% CI: -26.83, -15.55) relative to the projected trend, with a compounding decline of 1.50 per 100,000 per quarter (95% CI: -2.34, -0.66). The policy was associated with approximately 3800 prevented suicide attempts over 3 years. Effects were largest among junior enlisted, female service members, and Army and Marine Corps personnel. The Brandon Act is associated with a sustained, compounding decline in medically attended suicide attempts among ADSMs. Immediate reductions upon enactment suggest a signaling effect, while intensifying effects following implementation underscore the role of confidential pathways in addressing structural barriers to care-seeking. These findings highlight the importance of non-financial policy levers in military mental health and offer a replicable model for other health systems where stigma limits care utilization.
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7. Risk Adjustment in the Medicare Advantage Population Using Encounter Data.
PMID:日期:2026-10-01To estimate the Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk model using Medicare Advantage (MA) encounter data, as an initial step toward recalibrating risk-adjusted MA payments. A 20% sample of Traditional Medicare (TM) claims and MA encounter data for 2016-2022. Standardized fee schedules provide a measure of resource use in TM claims and MA encounters. Ordinary least squares regression replication of the CMS HCC version 28 model for relative resource use among community-dwelling, non-dual aged and disabled individuals. Robustness testing includes replication with version 22 model structure, sensitivity to MA chart review records, MA contracts with complete encounter data, and patterns of care during the COVID pandemic. Using TM data from 2016 to 2022 results in modest changes in estimated coefficients and 1.7% lower average HCC scores, relative to 2018-2019 TM data used for CMS's HCC model v28. Using MA data result in 8.9% lower average scores than TM-based scores. The differences between MA- and TM-based HCC scores vary across the distribution of scores. When re-estimating HCC v28 coefficients, increasing trends in TM and MA diagnosis prevalence are associated with smaller (diluted) coefficients in TM and MA-based HCC risk models. Trends in medical technology can increase (e.g., high-cost targeted cancer therapies) or decrease (e.g., lower-cost biosimilars) HCC model coefficients, with evidence of larger technology-related decreases in an MA-based model. The decrease in MA-based scores does not create new disincentives to enroll beneficiaries who are racial/ethnic minorities or rural residents. We make an important contribution to the policy debate about MA risk adjustment. Any changes in risk-adjusted MA payment need to be reviewed in the full context of MA payment policy and MA plan enrollment incentives.
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8. Veterans' Urgent Care Use and Subsequent Utilization in the Community.
PMID:日期:2026-10-01To evaluate the impact of Veterans' urgent care use in non-Veterans Health Administration (VHA) clinics on their later use of specialty and emergency care. A retrospective cohort study analyzing urgent care, specialty care, and emergency department (ED) visits using VHA administrative and claims data. Veterans' first urgent care visit was the index visit, and subsequent utilization was tracked for up to 1 year. We used an instrumental variable (IV) approach to estimate the effect of non-VHA urgent care visits on the proportion of subsequent visits in non-VHA clinics. We used VHA administrative and community care claims data (2021-2022) obtained from the Corporate Data Warehouse. Our sample comprised VHA enrollees with at least one urgent care visit at a VHA or non-VHA urgent care clinic in 2021. Of the 111,898 Veterans in the sample, 90,651 (81%) had their urgent care visit in the VHA, while 21,247 (19%) visited a non-VHA clinic. IV models showed that Veterans using non-VHA urgent care had 40 percentage points higher proportions of non-VHA specialty care within 30 days compared to those using VHA (95% CI: 37, 43). Effects stabilized at 28 percentage points within 365 days post urgent care visit (95% CI: 26, 30). In contrast, the effect of community urgent care on subsequent ED use outside the VHA system after 30 days of urgent care use was negligible and statistically insignificant. Veterans' use of non-VHA urgent care can lead to increased subsequent use of non-VHA specialty care but has no effect on non-VHA emergency care utilization within 60 to 365 days after urgent care visit. While expanded community care improves access in the short run, it also introduces care coordination challenges throughout an episode of care that may negatively affect health outcomes.
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9. Analysis of the Utilization and Out-of-Pocket Costs of Authorized Generics and Independent Generics Among Medicare Beneficiaries.
PMID:日期:2026-10-01To assess the utilization trends of authorized generics (AGs) within Medicare, evaluate differences in out-of-pocket (OOP) costs for Medicare beneficiaries between AGs and independent generics (IGs) when both were simultaneously available in the market, and estimate the adjusted mean difference in OOP costs between these generic types while controlling for potential confounders such as benefit phase and Medicare plan. This retrospective analysis examined Medicare Part D claims from 2012 to 2020, focusing on prescription-level OOP expenditures. Claims were limited to periods in which both AGs and IGs for the same product were concurrently available. Three measures of cost were used: per claim, per 30 units dispensed, and per 30-day supply. Using the 5% national Medicare Part D sample, linked to the FDA National Drug Code (NDC) Directory, AGs, IGs, and their market availability were identified. Plan information was retrieved from Medicare Plan Characteristics files. Sensitivity analyses applied winsorized OOP costs for outliers and a two-part model for excess zeros. AGs comprised a small share of prescriptions and declined from 3.65% in 2012 to 2.30% in 2020. Compared to IGs, AGs incurred higher OOP costs across all measures. Median per 30-day supply costs were $3.19 for AGs and $1.96 for IGs. Multivariable regression showed IGs had lower adjusted mean OOP costs, with differences of $4.32 per claim, $8.99 per 30 units dispensed, and $6.49 per 30-day supply (all p < 0.0001). Results held across sensitivity analyses. Despite their smaller market share, AGs are associated with consistently higher OOP costs than IGs. These cost differences have important implications for Medicare affordability and generic market competition. Policies that ensure timely independent generic market entry and prevent anticompetitive delay tactics may help reduce beneficiary financial burden and improve access to lower-cost generics.
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10. Delivery Timing, Out-Of-Pocket Maternity Costs, and Postpartum Care Utilization: An Instrumental Variable Analysis Among Commercially Insured Women.
PMID:日期:2026-10-01To examine whether out-of-pocket costs during pregnancy and delivery affect use of postpartum care. Because health insurance deductibles and limits reset annually, the timing of childbirth within that year quasi-randomly assigns people to different levels of cost-sharing during pregnancy+delivery versus postpartum. We use a novel instrumental variable approach that leverages this variation to analyze whether higher maternity spending due to delivering early in the plan year affects postpartum care utilization. The exposure is maternity out-of-pocket spending, and the instrument is whether the delivery was in the first three versus last 3 months of the enrollee's health plan year; the primary outcome is use of any outpatient care postpartum. We analyze maternity episodes among Blue Cross Blue Shield of Massachusetts enrollees who gave birth, 2019-2023. Commercial health insurance enrollment and claims data for individuals with continuous enrollment during pregnancy, delivery, and 3-months postpartum (N = 51,337). Out-of-pocket costs for those delivering at the start versus the end of their health plan year were, on average, 21% higher for pregnancy+delivery care and 58% lower for postpartum care. A $100 increase in pregnancy+delivery out-of-pocket spending led to a 0.53 percentage point (95% CI [0.28, 0.79]) increase in use of any outpatient postpartum care (sample mean: 82.5%). Higher pregnancy+delivery out-of-pocket costs also led to significant increases in the number of outpatient contact days, visits for preventive/well care, visits for mental health, and other visits. Higher pregnancy+delivery out-of-pocket costs due to delivering early in the plan year corresponded to lower postpartum out-of-pocket costs and led to modest increases in postpartum care. This suggests that lower postpartum cost-sharing may increase postpartum care use. Policies that lower those costs may be effective in increasing use of postpartum care.