Massachusetts health reform and disparities in coverage, access and health status

Jane Zhu, Phyllis Brawarsky, Stuart Lipsitz, Haiden Huskamp, Jennifer S. Haas

Research output: Contribution to journalArticle

51 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1356-1362
Number of pages7
JournalJournal of general internal medicine
Volume25
Issue number12
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

Fingerprint

New England
Health Status
Health
Costs and Cost Analysis
Logistic Models
Universal Coverage
Insurance Coverage
Vulnerable Populations
Legislation
Cross-Sectional Studies
Delivery of Health Care

Keywords

  • health care reform
  • health coverage
  • Massachusetts

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Massachusetts health reform and disparities in coverage, access and health status. / Zhu, Jane; Brawarsky, Phyllis; Lipsitz, Stuart; Huskamp, Haiden; Haas, Jennifer S.

In: Journal of general internal medicine, Vol. 25, No. 12, 01.12.2010, p. 1356-1362.

Research output: Contribution to journalArticle

Zhu, Jane ; Brawarsky, Phyllis ; Lipsitz, Stuart ; Huskamp, Haiden ; Haas, Jennifer S. / Massachusetts health reform and disparities in coverage, access and health status. In: Journal of general internal medicine. 2010 ; Vol. 25, No. 12. pp. 1356-1362.
@article{5b0d596c923c4328be74f0a4f977107f,
title = "Massachusetts health reform and disparities in coverage, access and health status",
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.",
keywords = "health care reform, health coverage, Massachusetts",
author = "Jane Zhu and Phyllis Brawarsky and Stuart Lipsitz and Haiden Huskamp and Haas, {Jennifer S.}",
year = "2010",
month = "12",
day = "1",
doi = "10.1007/s11606-010-1482-y",
language = "English (US)",
volume = "25",
pages = "1356--1362",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "12",

}

TY - JOUR

T1 - Massachusetts health reform and disparities in coverage, access and health status

AU - Zhu, Jane

AU - Brawarsky, Phyllis

AU - Lipsitz, Stuart

AU - Huskamp, Haiden

AU - Haas, Jennifer S.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - 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.

AB - 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.

KW - health care reform

KW - health coverage

KW - Massachusetts

UR - http://www.scopus.com/inward/record.url?scp=78649909960&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649909960&partnerID=8YFLogxK

U2 - 10.1007/s11606-010-1482-y

DO - 10.1007/s11606-010-1482-y

M3 - Article

C2 - 20730503

AN - SCOPUS:78649909960

VL - 25

SP - 1356

EP - 1362

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 12

ER -