Dr. Meredith G. Manze, professor at the CUNY Graduate School of Public Health and Health Policy and colleagues examined the impact of Massachusetts health reform on inpatient care use. The findings were published in the journal Health Services Research.
[Photo: Dr. Meredith G. Manze]
Most inpatient care for the uninsured and other vulnerable subpopulations occurs in safety-net hospitals. As insurance expansion increases the choice of hospitals for the previously uninsured, the research team examined if Massachusetts health reform were associated with shifts in the volume of inpatient care from safety-net to non-safety-net hospitals overall, or among other vulnerable sociodemographic (racial/ethnic minority, low socioeconomic status, high uninsured rate area) and clinical subpopulations (emergent status, diagnosis).
The study used discharge records for adults discharged from all nonfederal acute care hospitals in Massachusetts compared to New Jersey, New York, and Pennsylvania for the years 2004 to 2010. The team used a difference-in-differences design, comparing pre-/post-reform changes in safety-net and non-safety-net hospital discharge outcomes in Massachusetts among adults 18 – 64 with corresponding changes in comparisons states with no reform, overall, and by subpopulations.
Reform was not associated with changes in inpatient care use at safety-net and non-safety-net hospitals across all discharges or in most subpopulations examined.
The team concluded that demand for inpatient care at safety-net hospitals may not decrease following insurance expansion, but whether this was due to other access barriers or patient preference needs further exploration.