nach oben

Erschienen in:

01.12.2010 | Original Research

Massachusetts Health Reform and Disparities in Coverage, Access and Health Status

verfasst von: Jane Zhu, BS, Phyllis Brawarsky, MPH, Stuart Lipsitz, ScD, Haiden Huskamp, PhD, Jennifer S. Haas, MD, MSPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 12/2010

Einloggen, um Zugang zu erhalten

ABSTRACT

Background

Massachusetts health reform has achieved near-universal insurance coverage, yet little is known about the effects of this legislation on disparities.

Objective

Since racial/ethnic minorities and low-income individuals are over-represented among the uninsured, we assessed the effects of health reform on disparities.

Design

Cross-sectional survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS), 2006–2008.

Participants

Adults from Massachusetts (n = 36,505) and other New England states (n = 63,263).

Main Measures

Self-reported health coverage, inability to obtain care due to cost, access to a personal doctor, and health status. To control for trends unrelated to reform, we compared adults in Massachusetts to those in all other New England states using multivariate logistic regression models to calculate adjusted predicted probabilities.

Key Results

Overall, the adjusted predicted probability of health coverage in Massachusetts rose from 94.7% in 2006 to 97.7% in 2008, whereas coverage in New England remained around 92% (p < 0.001 for difference-in-difference). While cost-related barriers were reduced in Massachusetts, there were no improvements in access to a personal doctor or health status. Although there were improvements in coverage and cost-related barriers for some disadvantaged groups relative to trends in New England, there was no narrowing of disparities in large part because of comparable or larger improvements among whites and the non-poor.

Conclusions

Achieving equity in health and health care may require additional focused intervention beyond health reform.

Steinbrook R. Health care reform in Massachusetts–expanding coverage, escalating costs. N Engl J Med. 2008;358(26):2757–60.CrossRefPubMed

McDonough JE, Rosman B, Butt M, Tucker L, Howe LK. Massachusetts health reform implementation: major progress and future challenges. Health Aff (Millwood). 2008;27(4):w285–97.CrossRef

McDonough JE, Rosman B, Phelps F, Shannon M. The third wave of Massachusetts health care access reform. Health Aff (Millwood). 2006;25(6):w420–31.CrossRef

Health Care in Massachusetts. Key Indicators. Boston, MA: Massachusetts Division of Health Care Finance and Policy (assessed July 21, 2010 at http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/09/key_indicators_02-09.pdf).

Long SK, Stockley K. Health insurance coverage and access to care in Massachusetts: detailed tabulations based on the 2008 Massachusetts Health Insurance Survey (assessed July 21, 2010 at http://www.mass.gov/Eeohhs2/docs/dhcfp/r/survey/08his_detailed_tabulations.pdf).

Long SK. On the road to universal coverage: impacts of reform in Massachusetts at one year. Health Aff (Millwood). 2008;27(4):w270–84.CrossRef

Long SK, Masi PB. Access and affordability: an update on health reform in Massachusetts, fall 2008. Health Aff (Millwood). 2009;28(4):w578–87.CrossRef

Long SK, Stockley K, Yemane A. Another look at the impacts of health reform in Massachusetts: evidence using new data and a stronger model. Am Econ Rev. 2009;99(2):508–11.CrossRef

Lillie-Blanton M, Hoffman C. The role of health insurance coverage in reducing racial/ethnic disparities in health care. Health Aff (Millwood). 2005;24(2):398–408.CrossRef

10.

Emmons KM, Lobb R, Puleo E, Bennett G, Stoffel E, Syngal S. Colorectal cancer screening: prevalence among low-income groups with health insurance. Health Aff (Millwood). 2009;28(1):169–77.CrossRef

11.

Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA. 2002;287(10):1288–94.CrossRefPubMed

12.

Schneider EC, Cleary PD, Zaslavsky AM, Epstein AM. Racial disparity in influenza vaccination: does managed care narrow the gap between African Americans and whites? JAMA. 2001;286(12):1455–60.CrossRefPubMed

13.

Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Relationship between quality of care and racial disparities in Medicare health plans. JAMA. 2006;296(16):1998–2004.CrossRefPubMed

14.

Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured findings from a national sample. Med Care. 2002;40(1):52–9.CrossRefPubMed

15.

Kuo TM, Gavin NI, Adams EK, Ayadi MF. Racial disparities in Medicaid enrollment and prenatal care initiation among pregnant teens in Florida: comparisons between 1995 and 2001. Med Care. 2008;46(10):1079–85.CrossRefPubMed

16.

Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.

17.

Summary of the New Health Reform Law. Kaiser Family Foundation, 2010. (Accessed July 26, 2010, at http://www.kff.org/healthreform/upload/8061.pdf.)

18.

Health Risks and Preventive Behavior among Massachusetts Adults, 1996. Results from the Behavioral Risk Factor Surveillance System. Boston, MA: Massachusetts Department of Public Health; 1998 (assessed July 21, 2010 at http://www.mass.gov/Eeohhs2/docs/dph/behavioral_risk/report_1996.pdf).

19.

Brook D, Clements K, Brawarsky P, Mucci L, Bradbury B, Yeaw J. A Profile of Health Among Massachusetts Adults, 1999. Results from the Behavioral Risk Factor Surveillance System. Boston, MA: Massachusetts Department of Public Health; 2001 (assessed July 21, 2010 at http://www.mass.gov/Eeohhs2/docs/dph/behavioral_risk/report_1999.pdf).

20.

Poverty Guidelines, Research, and Management. 2009. (Accessed July 26, 2010, at http://aspe.hhs.gov/POVERTY/.)

21.

Behavioral Risk Factor Surveillance System. Centers for Disease Control and Prevention; 2005–2008. (Accessed July 26, 2010, at www.cdc.gov/BRFSS/.)

22.

The Kaiser Commission on Medicaid and the Uninsured. States Moving Toward Comprehensive Reform. In: The Henry J. Kaiser Family Foundation; 2009 (assessed July 21, 2010 at http://www.kff.org/uninsured/statehealthreform/ct.cfm).

23.

Moore CG, Lipsitz SR, Addy CL, Hussey JR, Fitzmaurice G, Natarajan S. Logistic regression with incomplete covariate data in complex survey sampling: application of reweighted estimating equations. Epidemiology. 2009;20(3):382–90.CrossRefPubMed

24.

Barber C, Miller M. Revisiting Massachusetts Health Reform: 18 Months Later. Boston, MA: Community Catalyst; 2007 (assessed July 25, 2010 at http://www.communitycatalyst.org/doc_store/publications/revisiting_MA_health_reform_dec07.pdf).

25.

Katz SJ, Hofer TP. Socioeconomic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United States. JAMA. 1994;272(7):530–4.CrossRefPubMed

26.

Banks J, Marmot M, Oldfield Z, Smith JP. Disease and disadvantage in the United States and in England. Jama. 2006;295(17):2037–45.CrossRefPubMed

27.

Smedley BD. Moving beyond access: achieving equity in state health care reform. Health Aff (Millwood). 2008;27(2):447–55.CrossRef

28.

Massachusetts Medical Society. Physician's Workforce Study: Executive Summary: (assessed July 24, 2010 at http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=23165).

29.

Freeman JD, Kadiyala S, Bell JF, Martin DP. The causal effect of health insurance on utilization and outcomes in adults: a systematic review of US studies. Med Care. 2008;46(10):1023–32.CrossRefPubMed

30.

Weinick RM, Zuvekas SH, Cohen JW. Racial and ethnic differences in access to and use of health care services, 1977 to 1996. Med Care Res Rev. 2000;57(Suppl 1):36–54.PubMed

31.

Hargraves JL, Hadley J. The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv Res. 2003;38(3):809–29.CrossRefPubMed

32.

McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: US trends from 1999 to 2006 and effects of Medicare coverage. Ann Intern Med. 2009;150(8):505–15.PubMed

33.

Kang-Kim M, Betancourt JR, Ayanian JZ, Zaslavsky AM, Yucel RM, Weissman JS. Access to care and use of preventive services by Hispanics: state-based variations from 1991 to 2004. Med Care. 2008;46(5):507–15.CrossRefPubMed

34.

Richman BD. Insurance expansions: do they hurt those they are designed to help? Health Aff (Millwood). 2007;26(5):1345–57.CrossRef

35.

Rutledge MS, McLaughlin CG. Hispanics and health insurance coverage: the rising disparity. Med Care. 2008;46(10):1086–92.CrossRefPubMed

36.

Hawley ST, Volk RJ, Krishnamurthy P, Jibaja-Weiss M, Vernon SW, Kneuper S. Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients. Med Care. 2008;46(9 Suppl 1):S10–6.CrossRefPubMed

37.

Ku L, Jones E, Finnegan B, Shin P, Rosenbaum S. How Is the Primary Care Safety Net Faring in Massachusetts? Community Health Centers in the Midst of Health Reform. Menlo Park: The Henry J. Kaiser Family Foundation; 2009 (assessed July 24, 2010 at http://www.kff.org/healthreform/upload/7878.pdf).

38.

Vesely R. Mass. Safety net frays. Insurance mandate costly for providers. Mod Healthc. 2008;38(12):12.

39.

Trivedi AN, Gibbs B, Nsiah-Jefferson L, Ayanian JZ, Prothrow-Stith D. Creating a state minority health policy report card. Health Aff (Millwood). 2005;24(2):388–96.CrossRef

40.

Youdelman MK. The medical tongue: US laws and policies on language access. Health Aff (Millwood). 2008;27(2):424–33.CrossRef

41.

Governor's Office of Health Policy and Finance. Reform History and Outline: Dirigo Reform History (assessed July 25, 2010 at http://www.dirigohealth.maine.gov/Pages/policy_history.html).

42.

State of Vermont. Catamount Health Plan (assessed July 25, 2010 at http://hcr.vermont.gov/green_mountain_care/catamount_health).

43.

Finch BK, Hummer RA, Reindl M, Vega WA. Validity of self-rated health among Latino(a)s. Am J Epidemiol. 2002;155(8):755–9.CrossRefPubMed

Titel: Massachusetts Health Reform and Disparities in Coverage, Access and Health Status
verfasst von: Jane Zhu, BS
Phyllis Brawarsky, MPH
Stuart Lipsitz, ScD
Haiden Huskamp, PhD
Jennifer S. Haas, MD, MSPH
Publikationsdatum: 01.12.2010
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 12/2010
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-010-1482-y

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

ABSTRACT

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2010

Training Residents in Outpatient HIV Care

Erratum to: Having a Say: Agency and End-of-Life Decision-making in The Chaneysville Incident

Between-Visit Workload in Primary Care

First Night on Call in Emergency Psychiatry

Intravascular Hemolysis Secondary to Aorto-atrial Fistula Presenting as Red Urine