Governor Mitt Romney’s Massachusetts health reforms appear to have provided expanded coverage as well as expanded access to care in this study of elective surgeries. However, disparities may still persist for Blacks.
As we have highlighted before, analyzing the health care reforms accomplished in Massachusetts around 2006-2008 proves to be an invaluable tool in predicting the possible effects of the Affordable Care Act (ACA) of 2010. We look from this angle again, using the new point of view of a recent article in Medical Care which suggests that the ACA will not only increase insurance coverage, but also this increased coverage will indeed translate into greater access to the health care system for low-income and minority populations.
One way of measuring access to outpatient care, in particular outpatient specialist care, is to measure the rate of surgeries done that would likely need to be set up after having had an office appointment with a specialist and not necessarily through an emergency department visit. Using hospital administration data and state census data, this study looked at the number of these types of surgeries done on adults aged 40-60 for which the outpatient referral rate was on average 90 percent. The study compared the rates of these surgeries for almost two years before and two years after the Massachusetts health care reform. This study also compared use of these surgeries among groups based on ethnicity and income (measured by the median income of the patient’s zip code) before and after reform.
To make sure the changes measured would be due to the health care reform, the researchers compared changes for adults aged 40-60 to patients over age 65 (i.e. those generally insured by Medicare).
This study suggests that as a result of health care reform, Massachusetts residents in the low- and medium-income groups increased their use of high-referral rate surgeries by 13 percent and 15 percent, respectively, compared to no significant increase in use by high-income residents. In addition, health care reform also correlated with an increase in use of these same types surgeries by Hispanic and white Massachusetts residents by 22 percent and 7 percent, respectively, compared to no significant increase in use by black residents.
It is commonly questioned whether or not increasing insurance coverage actually means increasing access to the health care system. In other words, if your doctor doesn’t have any appointments for two months, or if the specialist you want to see does not accept your insurance, what good is coverage? This study suggests that Massachusetts residents who saw an increase in insurance coverage from 2006 to 2008 also were able to access surgical specialists in the office setting and arrange for elective surgeries, an advanced way to access the health care system. This also demonstrated a provocative point for hospital administrators and hospital-based physicians across the country; hospitals are going to be full once the ACA implements similar changes. As we have seen from previous analyses, in the initial years following expanded insurance coverage there will likely be a temporary increase in the number of ER visits. ERs will not only have to be able to tackle this surge in visits and patients requiring rooms in the hospital, but they will also have to compete for hospital beds with people admitted for elective surgery, referred from surgeons now accepting their insurance.
Lisa Maurer, MD