Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts
UMass Chan Affiliations
Prevention Research CenterDepartment of Medicine, Division of Preventive and Behavioral Medicine
Document Type
Journal ArticlePublication Date
2015-07-01Keywords
AdultFemale
*Health Care Reform
Humans
Insurance, Health
Male
Massachusetts
Medically Uninsured
New York
Retrospective Studies
Socioeconomic Factors
Survival Rate
Wounds and Injuries
Clinical Epidemiology
Epidemiology
Health Economics
Health Policy
Health Services Administration
Health Services Research
Surgery
Trauma
Metadata
Show full item recordAbstract
IMPORTANCE: Massachusetts introduced health care reform (HCR) in 2006, expecting to expand health insurance coverage and improve outcomes. Because traumatic injury is a common acute condition with important health, disability, and economic consequences, examination of the effect of HCR on patients hospitalized following injury may help inform the national HCR debate. OBJECTIVE: To examine the effect of Massachusetts HCR on survival rates of injured patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 1,520,599 patients hospitalized following traumatic injury in Massachusetts or New York during the 10 years (2002-2011) surrounding Massachusetts HCR using data from the State Inpatient Databases. We assessed the effect of HCR on mortality rates using a difference-in-differences approach to control for temporal trends in mortality. INTERVENTION: Health care reform in Massachusetts in 2006. MAIN OUTCOME AND MEASURE: Survival until hospital discharge. RESULTS: During the 10-year study period, the rates of uninsured trauma patients in Massachusetts decreased steadily from 14.9% in 2002 to 5.0.% in 2011. In New York, the rates of uninsured trauma patients fell from 14.9% in 2002 to 10.5% in 2011. The risk-adjusted difference-in-difference assessment revealed a transient increase of 604 excess deaths (95% CI, 419-790) in Massachusetts in the 3 years following implementation of HCR. CONCLUSIONS AND RELEVANCE: Health care reform did not affect health insurance coverage for patients hospitalized following injury but was associated with a transient increase in adjusted mortality rates. Reducing mortality rates for acutely injured patients may require more comprehensive interventions than simply promoting health insurance coverage through legislation.Source
JAMA Surg. 2015 Jul;150(7):609-15. doi: 10.1001/jamasurg.2014.2464. Link to article on publisher's site.DOI
10.1001/jamasurg.2014.2464Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30693PubMed ID
25946316Related Resources
Link to Article in PubMedRights
Publisher PDF posted after 12 months as allowed by the publisher's author rights policy at http://archsurg.jamanetwork.com/public/instructionsForAuthors.aspx#SecEditorialPoliciesforAuthors.ae974a485f413a2113503eed53cd6c53
10.1001/jamasurg.2014.2464
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