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Showing content from https://pubmed.ncbi.nlm.nih.gov/24320165/ below:

Improvements in health status after Massachusetts health care reform

doi: 10.1111/1468-0009.12029. Improvements in health status after Massachusetts health care reform

Affiliations

Affiliation

¹ Harvard Medical School; Scientific Institute for Quality of Healthcare, Radboud University Medical Center.

PMID: 24320165
PMCID: PMC3876186
DOI: 10.1111/1468-0009.12029

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Improvements in health status after Massachusetts health care reform

Philip J Van Der Wees et al. Milbank Q. 2013 Dec.

doi: 10.1111/1468-0009.12029. Affiliation

¹ Harvard Medical School; Scientific Institute for Quality of Healthcare, Radboud University Medical Center.

PMID: 24320165
PMCID: PMC3876186
DOI: 10.1111/1468-0009.12029

Item in Clipboard

Abstract

Context: Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.

Methods: We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.

Findings: The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.

Conclusions: Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.

Keywords: health care delivery; health care reform; health status; quality of health care.

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Figures
FIGURE 1

Age-adjusted outcomes (%) for self-reported…

FIGURE 1

Age-adjusted outcomes (%) for self-reported health status and health care access. Notes :…

FIGURE 1

Age-adjusted outcomes (%) for self-reported health status and health care access. Notes: MA denotes Massachusetts; NE denotes other New England states. The dashed lines in all panels indicate the addition of cell phone data and the new weighting technique by the Centers for Disease Control and Prevention. Data for physical health and mental health were not collected in 2002, and data for cost barriers were not collected in 2001 and 2002.