The impact of health care reform on hospital and preventive care: Evidence from Massachusetts

Abstract

In April 2006, Massachusetts passed legislation aimed at achieving near-universal health insurance coverage. The key features of this legislation were a model for national health reform, passed in March 2010. The reform gives us a novel opportunity to examine the impact of expansion to near-universal coverage state-wide. Among hospital discharges in Massachusetts, we find that the reform decreased uninsurance by 36% relative to its initial level and to other states. Reform affected utilization by decreasing length of stay, the number of inpatient admissions originating from the emergency room, and preventable admissions. At the same time, hospital cost growth did not increase.

A potential new data source for assessing the impacts of health reform: Evaluating the Gallup-Healthways Well-Being Index

“…[9][10][11][12] For each survey, we used data from 2008 through the most recently available year at the time of our analysis, which differed by survey (2011 for ACS, CPS, BRFSS, and NHIS; 2009 for MEPS). Gallup-Healthways WBI data were obtained under contract with the Gallup Organization.…”

Access to health insurance and the use of inpatient medical care: Evidence from the Affordable Care Act young adult mandate

“…Studies on Medicaid and Medicare expansions, for instance, find that they lead to an increase in the consumption of inpatient medical care (Dafny and Gruber, 2005;Card, Dobkin, and Maestas, 2008;and Finkelstein et al, 2012). Evidence on the impact of a near-universal health insurance coverage expansion in Massachusetts finds a decrease in the use of emergency departments but no change in hospitalizations (Kolstad and Kowalski, 2012;and Miller, 2012). 5 Research especially relevant for our work studies the impact of health insurance on medical-care use by young adults.…”

“…Taken together, prior literature on the impact of health insurance expansions to Medicaid recipients, Medicare recipients, and residents of Massachusetts on inpatient care use is rather mixed, with some studies finding sizeable effects (Finkelstein et al, 2012;Dafny and Gruber, 6 2005; Card, Dobkin, and Maestas, 2008) and others finding no effects (Kolstad and Kowalski, 2012). For young adults, empirical evidence suggests a decrease in the use of medical care following the "aging out" of their parents' health insurance plans Gross, 2012 and and an increase in access following the ACA young adult mandate .…”

“…We also find a 4.5-percent increase in the number of non-ER admissions during the enactment periods. Direct hospital admissions tend to be scheduled 14 visits and are likely more sensitive to health insurance access, hence the larger percent increase is not surprising. Our results on the impact of the ACA dependent coverage expansion on overall non-pregnancy visits and by source of admission are consistent in direction with Anderson, Dobkin, and Gross (2012), who find that young adults decrease their ER and non-ER visits for non-pregnancy admissions when they age out of insurance.…”

“…The mechanisms by which the availability of health insurance is expected to affect medical-care use have been well covered in prior literature (Finkelstein et al, 2012;Kolstad and Kowalski, 2012;and Miller, 2012), thus our discussion of the hypotheses remains brief.…”