The Impact of Health Care Reform On Hospital and Preventive Care: Evidence from Massachusetts

Kolstad, Jonathan T.; Kowalski, Amanda

doi:10.3386/w16012

Cited by 140 publications

(223 citation statements)

References 22 publications

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“…In creating the main independent variable of interest, we follow Kolstad and Kowalski [6] who acknowledge that some features of the law came into effect later than others, and therefore use two variables: one (called After) for the time periods after 2007 Q3, and a separate one (called During) for the time periods from 2006 Q3 to 2007 Q3. The main reason for doing this is that while the Medicaid expansion took place right after the law was signed, another important change, the individual requirement came into effect in July 2007.…”

Section: Methodsmentioning

confidence: 99%

“…As of 2008, Massachusetts had the highest health-insurance coverage rate in the USA. Several studies support the claims of increased enrollment as a result of the law [3][4][5][6]. The MHIC Authority claims to achieve this success without a significant replacement of private insurance with public insurance (crowd-out), and with high compliance.…”

Section: Introductionmentioning

confidence: 91%

“…The first study to analyze the impact of the Massachusetts mandate using inpatient hospital data is by Kolstad and Kowalski [6]. They use a difference-in-difference framework to compare various outcomes before and after the law was enacted relative to changes in other states.…”

Section: Introductionmentioning

confidence: 99%

“…She finds that the law has decreased ER visits that can be treated in a physician's office, and that it has increased visits for non-preventable emergency situations. Using different outcomes, Kolstad and Kowalski [6] and Cozad [7] find that Chapter 58 reduced ER utilization. Kolstad and Kowalski find that inpatient admissions originating from the ER declined (by 5.2 %) after the Massachusetts reform, which may indicate better use of preventive care, while Cozad finds that ambulance trips were reduced by 16 % in the wake of the law.…”

Section: Introductionmentioning

confidence: 99%

“…MDCs are created based on the principal International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses that are grouped into one of 23 mutually exclusive MDCs corresponding to a single organ system or into MDC 24 (trauma) or MDC 25 [Human immunodeficiency virus (HIV) infections]. Building on the work by Kolstad and Kowalski [6] we investigate whether the Massachusetts Health Care Reform had differential impact across MDCs (for a list of the MDCs see the Appendix). Examining the impact of the law by MDC allows for the possibility of uncovering more granular effects that may be masked by an analysis at a more aggregate level.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act

Cseh

Koford

Phelps

2015

Appl Health Econ Health Policy

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The Massachusetts Health Care Reform appears to have been effective at increasing insurance take-up rates. These increases may have come at the cost of lower private insurance coverage. The number of diagnoses per admission was increased by the policy across nearly all MDCs. Understanding the changes in length of stay as a result of the Massachusetts reform, and perhaps the Affordable Care Act, requires MDC-specific analysis. It appears that the most important distinction to make is to differentiate care related to new-born babies and neonates from that related to other diagnostic categories.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act

Cseh

Koford

Phelps

2015

Appl Health Econ Health Policy

View full text Add to dashboard Cite

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Massachusetts Health Care Reform and Reduced Racial Disparities in Minimally Invasive Surgery

et al. 2013

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Importance Racial disparities in receipt of minimally invasive surgery (MIS) persist in the United States and have been shown to also be associated with a number of driving factors, including insurance status. However, little is known as to how expanding insurance coverage across a population influences disparities in surgical care. Objective To evaluate the impact of Massachusetts health care reform on racial disparities in MIS. Design, Setting, and Participants A retrospective cohort study assessed the probability of undergoing MIS vs an open operation for nonwhite patients in Massachusetts compared with 6 control states. All discharges (n = 167 560) of nonelderly white, black, or Latino patients with government insurance (Medicaid or Commonwealth Care insurance) or no insurance who underwent a procedure for acute appendicitis or acute cholecystitis at inpatient hospitals between January 1, 2001, and December 31, 2009, were assessed. Data are from the Hospital Cost and Utilization Project State Inpatient Databases. Intervention The 2006 Massachusetts health care reform, which expanded insurance coverage for government-subsidized, self-pay, and uninsured individuals in Massachusetts. Main Outcomes and Measures Adjusted probability of undergoing MIS and difference-in-difference estimates. Results Prior to the 2006 reform, Massachusetts nonwhite patients had a 5.21–percentage point lower probability of MIS relative to white patients (P < .001). Nonwhite patients in control states had a 1.39–percentage point lower probability of MIS (P = .007). After reform, nonwhite patients in Massachusetts had a 3.71–percentage point increase in the probability of MIS relative to concurrent trends in control states (P = .01). After 2006, measured racial disparities in MIS resolved in Massachusetts, with nonwhite patients having equal probability of MIS relative to white patients (0.06 percentage point greater; P = .96). However, nonwhite patients in control states without health care reform have a persistently lower probability of MIS relative to white patients (3.19 percentage points lower; P < .001). Conclusions and Relevance The 2006 Massachusetts insurance expansion was associated with an increased probability of nonwhite patients undergoing MIS and resolution of measured racial disparities in MIS.

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Effect of Insurance Expansion on Utilization of Inpatient Surgery

et al. 2014

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Importance While the enthusiasm for the Affordable Care Act (ACA) revolves around its impact on access to preventive and primary care services, the effect of this reform on surgical care remains undefined. Objective Using Massachusetts (MA) healthcare reform as a natural experiment, we estimate the differential impact of insurance expansion on the utilization of discretionary versus non-discretionary inpatient surgery. Design We used the State Inpatient Databases from MA and two control states to identify nonelderly patients (19–64 years) who underwent discretionary (DS) versus non-discretionary surgery (NDS) during the years 2003–2010. We defined DS as elective, preference-sensitive procedures (e.g., joint replacement, back surgery), and NDS as imperative and potentially lifesaving procedures (e.g., cancer surgery, hip fracture repair). Using July 2007 as the transition point between pre and post-reform periods, we performed a difference-in-differences (DID) analysis to estimate the effect of insurance expansion on rates of DS vs NDS among the entire study population, and for subgroups defined by race, income and insurance status. We then extrapolated our results from MA to the entire US population. Main Outcome(s) and Measure(s) Rate of DS and NDS performed before and after the healthcare reform in Massachusetts. Results We identified a total of 836,311 surgeries during the study period. In contrast to NDS, post-reform rates of DS increased more in MA than in control states. Based on our DID analysis, insurance expansion was associated with a 9.3% increase in the use of DS in MA (p=0.021). Conversely, the rate of NDS decreased by 4.5% (p=0.009). We found similar effects for DS in all subgroups, with the greatest increase observed for non-whites (19.9%, p<0.001). Based on the findings in MA, we estimated that full implementation of national insurance expansion would yield an additional 465,934 discretionary surgeries by 2017. Conclusions and Relevance Insurance expansion in Massachusetts was associated with increased rates of discretionary surgery, and a concurrent decrease in utilization of nondiscretionary surgery. If similar changes are seen nationally, the value of insurance expansion for surgical care may depend on the relative balance between increased expenditures and potential health benefits of greater access to elective inpatient procedures.

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The Impact of Health Care Reform On Hospital and Preventive Care: Evidence from Massachusetts

Cited by 140 publications

References 22 publications

Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act

Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act

Massachusetts Health Care Reform and Reduced Racial Disparities in Minimally Invasive Surgery

Effect of Insurance Expansion on Utilization of Inpatient Surgery

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