Karen M Freund1,2, Amy LeClair1, Norma Terrin1,3, Amresh D Hanchate4, Lori Lyn Price1,3, Alejandro Moreno-Koehler3, Jill Suzukida2, Sucharita Kher5, Elena Byhoff1,2, Nancy R Kressin4,6. 1. The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center. 2. Department of Medicine, Division of Internal Medicine and Primary Care, Tufts Medical Center. 3. Tufts Clinical and Translational Science Institute, Tufts University. 4. Boston University School of Medicine. 5. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Tufts University, Boston. 6. Veterans Affairs Boston Healthcare System, Brockton, MA.
Abstract
BACKGROUND: One of the potential benefits of insurance reform is greater stability of insurance and reduced coverage disparities by race and ethnicity. OBJECTIVES: We examined the temporal trends in insurance coverage by racial/ethnic group before and after Massachusetts Insurance Reform by abstracting records across 2 urban safety net hospital systems. RESEARCH DESIGN: We examined adjusted odds of being uninsured and incident rate ratios of gaining and losing insurance over time by race and ethnicity. We used billing records to capture the payer for each episode of care. SUBJECTS: We included data from January 2005 through December 2013 on patients with hypertension between the ages of 21 and 64 years. We compared 4 racial and ethnic groups: non-Hispanic white, non-Hispanic Black, non-Hispanic Asian, and Hispanic. MEASURES: We examined individual patients' insurance coverage status in 6-month intervals. We compared odds of being uninsured in the transition and postinsurance reform period to the prereform period, adjusting for age, sex, comorbidities practice location and education, and income by Census tract. RESULTS: Among 48,291 patients with hypertension, reduction in rates of uninsurance with insurance reform was greater for Hispanic (29.7%), non-Hispanic Black (24.8%), and non-Hispanic Asian (26.8%) than non-Hispanic white (14.9%) patients. The odds of becoming uninsured were reduced in all racial and ethnic groups (odds ratio, 0.27-0.41). CONCLUSIONS: Massachusetts Insurance Reform resulted in stable insurance coverage and a reduction in disparities in insurance instability by race and ethnicity.
BACKGROUND: One of the potential benefits of insurance reform is greater stability of insurance and reduced coverage disparities by race and ethnicity. OBJECTIVES: We examined the temporal trends in insurance coverage by racial/ethnic group before and after Massachusetts Insurance Reform by abstracting records across 2 urban safety net hospital systems. RESEARCH DESIGN: We examined adjusted odds of being uninsured and incident rate ratios of gaining and losing insurance over time by race and ethnicity. We used billing records to capture the payer for each episode of care. SUBJECTS: We included data from January 2005 through December 2013 on patients with hypertension between the ages of 21 and 64 years. We compared 4 racial and ethnic groups: non-Hispanic white, non-Hispanic Black, non-Hispanic Asian, and Hispanic. MEASURES: We examined individual patients' insurance coverage status in 6-month intervals. We compared odds of being uninsured in the transition and postinsurance reform period to the prereform period, adjusting for age, sex, comorbidities practice location and education, and income by Census tract. RESULTS: Among 48,291 patients with hypertension, reduction in rates of uninsurance with insurance reform was greater for Hispanic (29.7%), non-Hispanic Black (24.8%), and non-Hispanic Asian (26.8%) than non-Hispanic white (14.9%) patients. The odds of becoming uninsured were reduced in all racial and ethnic groups (odds ratio, 0.27-0.41). CONCLUSIONS: Massachusetts Insurance Reform resulted in stable insurance coverage and a reduction in disparities in insurance instability by race and ethnicity.
Authors: John E McDonough; Brian Rosman; Mehreen Butt; Lindsey Tucker; Lisa Kaplan Howe Journal: Health Aff (Millwood) Date: 2008-06-03 Impact factor: 6.301
Authors: Alok Kapoor; Tracy A Battaglia; Alexis P Isabelle; Amresh D Hanchate; Richard L Kalish; Sharon Bak; Rebecca G Mishuris; Swati M Shroff; Karen M Freund Journal: J Health Care Poor Underserved Date: 2014-02
Authors: Andrew P Wilper; Steffie Woolhandler; Karen E Lasser; Danny McCormick; David H Bor; David U Himmelstein Journal: Health Aff (Millwood) Date: 2009-10-20 Impact factor: 6.301