Department of Medicine, Division of Preventive and Behavioral Medicine
Medical Subject Headings
Adult; Female; *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
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.
Rights and Permissions
Citation: JAMA Surg. 2015 Jul;150(7):609-15. doi: 10.1001/jamasurg.2014.2464. Link to article on publisher's site. Publisher PDF posted after 12 months as allowed by the publisher's author rights policy at http://archsurg.jamanetwork.com/public/instructionsForAuthors.aspx#SecEditorialPoliciesforAuthors.
Osler, Turner; Glance, Laurent G.; Li, Wenjun; Buzas, Jeffery S.; and Hosmer, David W., "Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts" (2015). University of Massachusetts Medical School Faculty Publications. 971.
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