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Massachusetts Health Reform and Disparities in Coverage, Access and Health Status

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ABSTRACT

Background

Massachusetts health reform has achieved near-universal insurance coverage, yet little is known about the effects of this legislation on disparities.

Objective

Since racial/ethnic minorities and low-income individuals are over-represented among the uninsured, we assessed the effects of health reform on disparities.

Design

Cross-sectional survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS), 2006–2008.

Participants

Adults from Massachusetts (n = 36,505) and other New England states (n = 63,263).

Main Measures

Self-reported health coverage, inability to obtain care due to cost, access to a personal doctor, and health status. To control for trends unrelated to reform, we compared adults in Massachusetts to those in all other New England states using multivariate logistic regression models to calculate adjusted predicted probabilities.

Key Results

Overall, the adjusted predicted probability of health coverage in Massachusetts rose from 94.7% in 2006 to 97.7% in 2008, whereas coverage in New England remained around 92% (p < 0.001 for difference-in-difference). While cost-related barriers were reduced in Massachusetts, there were no improvements in access to a personal doctor or health status. Although there were improvements in coverage and cost-related barriers for some disadvantaged groups relative to trends in New England, there was no narrowing of disparities in large part because of comparable or larger improvements among whites and the non-poor.

Conclusions

Achieving equity in health and health care may require additional focused intervention beyond health reform.

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Acknowledgements

This research was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (NIH Grant #1 UL1 RR 025758-01 and financial contributions from participating institutions). The funding organizations were not involved in the design or conduct of the study, interpretation of the data, or preparation of the manuscript.

Conflict of Interest

Dr. Haas has received research grants from the Aetna Foundation and Pfizer during the past 3 years. None of the other authors report a conflict of interest.

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Correspondence to Jennifer S. Haas MD, MSPH.

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Zhu, J., Brawarsky, P., Lipsitz, S. et al. Massachusetts Health Reform and Disparities in Coverage, Access and Health Status. J GEN INTERN MED 25, 1356–1362 (2010). https://doi.org/10.1007/s11606-010-1482-y

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  • DOI: https://doi.org/10.1007/s11606-010-1482-y

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