Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey

Abstract

Patients with Commonwealth Care and Medicaid, the two forms of insurance most often newlyacquired under the reform, reported similar or higher utilization of and access to outpatient visits and rates of having a usual source of care, compared with the privately insured. Compared with the privately insured, a significantly higher proportion of patients with Medicaid or Commonwealth Care Type 1 (minimal cost sharing) reported delaying or not getting dental care (42.2 % vs. 27.1 %) or medication (30.0 % vs. 7.0 %) due to cost; those with Medicaid also experienced costrelated barriers to seeing a specialist (14.6 % vs. 3.5 %) or getting recommended tests (15.6 % vs. 5.9 %). Those with Commonwealth Care Types 2 and 3 (greater cost sharing) reported significantly more costrelated barriers to obtaining care than the privately insured (45.0 % vs. 16.0 %), to seeing a primary care doctor (25.0 % vs. 6.0 %) or dental provider (58.3 % vs. 27.1 %), and to obtaining medication (20.8 % vs. 7.0 %). No differences in cost-related barriers to preventive care were found between the privately and publicly insured.CONCLUSIONS: Access to care improved less than access to insurance following Massachusetts' health care reform. Many newly insured residents obtained Medicaid or state subsidized private insurance; costrelated barriers to access were worse for these patients than for the privately insured.KEY WORDS: access to care; health insurance; health disparities; health care reform; health care policy.

Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care

“…These measures have been widely used in other national and state-specific surveys. 32,33 Lack of a usual source of care was indicated by a "no" response to the question of whether respondents had a regular place to go for medical care (excluding emergency department visits). We assessed lack of confidence in getting needed care by the question of how confident respondents were that they could get the health care they need, with 4 response options ranging from very confident to not confident at all.…”

Universal Health Insurance Coverage in Massachusetts Did Not Change the Trajectory of Arthroplasty Use or Costs

“…Despite growth in procedure rates among younger persons, the mean age of TJA recipients remains older than 60 years. Researchers have found that the newly insured in Massachusetts under Medicaid and state-subsidized private insurance after the introduction of health reform faced costrelated obstacles in obtaining care [16]. A similar concern was raised regarding cost pressures potentially resulting in reduced access to arthroplasties as physicians consider opting out of Medicare and Medicaid owing to reduced reimbursement by these health plans [9], although this has not occurred to any meaningful degree.…”

Has Massachusetts health care reform worked for the working poor? Results from an analysis of opportunity

“…This also allowed us to examine the net effect of health care reform among a population that may move in and out of eligibility for free or subsidized care [31]. As such, the gains observed seem even more impressive in this context, despite persistent gaps in coverage between the disadvantaged and others [12]. …”

“…Through these initiatives, the law sought to allow eligible poor adults to purchase affordable, low-cost insurance despite barriers to coverage [10,12]. Despite substantial uptake of these programs, a significant number of low-income MA adults remain uninsured as of mid-2011 [13,14].…”

“…We focused our investigation on the WP, who, despite being targeted as potential beneficiaries of MA health care reform, continue to lack insurance coverage and access to care following reform implementation [10,12]. Stratifying by two periods to reflect the pre/during-reform implementation period and the post-implementation period, we sought to determine whether the mandate resulted in increased insurance coverage both overall and among WP.…”