Karen E Lasser1, Amresh D Hanchate, Danny McCormick, Chieh Chu, Ziming Xuan, Nancy R Kressin. 1. *Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine †Department of Community Health Sciences, Boston University School of Public Health ‡VA Boston Healthcare System, Boston §Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
Abstract
BACKGROUND: Because of residential segregation and a lack of health insurance, minorities often receive care in different facilities than whites. Massachusetts (MA) health reform provided insurance to previously uninsured patients, which enabled them to potentially shift inpatient care to nonminority-serving or nonsafety-net hospitals. OBJECTIVES: Examine whether MA health reform affected hospitals' racial mix of patients, and individual patients' use of safety-net hospitals. RESEARCH DESIGN: Difference-in-differences analysis of 2004-2009 inpatient discharge data from MA, compared with New York (NY), and New Jersey (NJ), to identify postreform changes, adjusting for secular changes. SUBJECTS: (1) Hospital-level analysis (discharges): 345 MA, NY, and NJ hospitals; (2) patient-level analysis (patients): 39,921 patients with ≥2 hospitalizations at a safety-net hospital in the prereform period. MEASURES: Prereform to postreform changes in percentage of discharges that are minority (black and Hispanic) at minority-serving hospitals; adjusted odds of patient movement from safety-net hospitals (prereform) to nonsafety-net hospitals (postreform) by age group and state. RESULTS: Treating NJ as the comparison state, MA reform was associated with an increase of 5.8% (95% CI, 1.4%-10.3%) in the percentage of minority discharges at MA minority-serving hospitals; with NY as the comparison state, the change was 2.1% (95% CI, -0.04% to 4.3%). Patient movement from safety-net to nonsafety-net hospitals was greater in MA than comparison states (difference-in-differences adjusted OR=1.3; 95% CI, 1.0-1.7; P=0.04). CONCLUSIONS: Following MA health reform, the safety-net remains an important component of the health care system.
BACKGROUND: Because of residential segregation and a lack of health insurance, minorities often receive care in different facilities than whites. Massachusetts (MA) health reform provided insurance to previously uninsured patients, which enabled them to potentially shift inpatient care to nonminority-serving or nonsafety-net hospitals. OBJECTIVES: Examine whether MA health reform affected hospitals' racial mix of patients, and individual patients' use of safety-net hospitals. RESEARCH DESIGN: Difference-in-differences analysis of 2004-2009 inpatient discharge data from MA, compared with New York (NY), and New Jersey (NJ), to identify postreform changes, adjusting for secular changes. SUBJECTS: (1) Hospital-level analysis (discharges): 345 MA, NY, and NJ hospitals; (2) patient-level analysis (patients): 39,921 patients with ≥2 hospitalizations at a safety-net hospital in the prereform period. MEASURES: Prereform to postreform changes in percentage of discharges that are minority (black and Hispanic) at minority-serving hospitals; adjusted odds of patient movement from safety-net hospitals (prereform) to nonsafety-net hospitals (postreform) by age group and state. RESULTS: Treating NJ as the comparison state, MA reform was associated with an increase of 5.8% (95% CI, 1.4%-10.3%) in the percentage of minority discharges at MA minority-serving hospitals; with NY as the comparison state, the change was 2.1% (95% CI, -0.04% to 4.3%). Patient movement from safety-net to nonsafety-net hospitals was greater in MA than comparison states (difference-in-differences adjusted OR=1.3; 95% CI, 1.0-1.7; P=0.04). CONCLUSIONS: Following MA health reform, the safety-net remains an important component of the health care system.
Authors: Amresh D Hanchate; Karen E Lasser; Alok Kapoor; Jennifer Rosen; Danny McCormick; Meredith M D'Amore; Nancy R Kressin Journal: Med Care Date: 2012-07 Impact factor: 2.983
Authors: Karen M Freund; Amy LeClair; Norma Terrin; Amresh D Hanchate; Lori Lyn Price; Alejandro Moreno-Koehler; Jill Suzukida; Sucharita Kher; Elena Byhoff; Nancy R Kressin Journal: Med Care Date: 2019-04 Impact factor: 2.983
Authors: Amresh D Hanchate; Danny McCormick; Karen E Lasser; Chen Feng; Meredith G Manze; Nancy R Kressin Journal: Health Serv Res Date: 2016-08-08 Impact factor: 3.402
Authors: Vivian Y Wu; Kathryn R Fingar; H Joanna Jiang; Raynard Washington; Andrew W Mulcahy; Eli Cutler; Gary Pickens Journal: Health Serv Res Date: 2018-01-21 Impact factor: 3.402