Study examines impact of Massachusetts health reform on inpatient care use

The findings were published in the journal Health Services Research.

Most inpatient care for the uninsured and other vulnerable subpopulations occurs in safety-net hospitals. Dr. Manze explains, “This is one in a series of studies investigating how the Massachusetts health insurance reform (the basis for the Affordable Care Act) affected patient care and health outcomes. Because health insurance expanded, hospital choice may have also changed for previously uninsured patients cared for by safety-net hospitals.” The research team examined if Massachusetts health reform was 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.

Discussing the findings, Dr. Manze explains, “There were no significant changes in inpatient care use as safety-net and non-safety-net hospitals due to health reform, but further research is needed to understand if this is due to patient preference or other factors.”

Hanchate, A. D., McCormick, D., Lasser, K. E., Feng, C., Manze, M. G. and Kressin, N. R. (2017), Impact of Massachusetts Health Reform on Inpatient Care Use: Was the Safety-Net Experience Different Than in the Non-Safety-Net?. Health Serv Res, 52: 16471666. doi:10.1111/1475-6773.12542