Rates of insurance for injured patients before and after health care reform in Massachusetts: a possible case of double jeopardy

UMMS Affiliation

Department of Surgery; Department of Quantitative Health Sciences;Center for Outcomes Research

Publication Date


Document Type



Adolescent; Adult; Female; Health Care Reform; Humans; Insurance, Health; Male; Massachusetts; Medically Uninsured; Middle Aged; Wounds and Injuries; Wounds, Penetrating; Young Adult


Economics | Health and Medical Administration | Health Policy | Health Services Administration | Public Health | Translational Medical Research


OBJECTIVES: We determined how preinjury insurance status and injury-related outcomes among able-bodied, community-dwelling adults treated at a Level I Trauma Center in central Massachusetts changed after health care reform.

METHODS: We compared insurance status at time of injury among non-Medicare-eligible adult Massachusetts residents before (2004-2005) and after (2009-2010) health care reform, adjusted for demographic and injury covariates, and modeled associations between insurance status and trauma outcomes.

RESULTS: Among 2148 patients before health care reform and 2477 patients after health care reform, insurance rates increased from 77% to 84% (P < .001). Younger patients, men, minorities, and penetrating trauma victims were less likely to be insured irrespective of time period. Uninsured patients were more likely to be discharged home without services (adjusted odds ratio = 3.46; 95% confidence interval = 2.65, 4.52) compared with insured patients.

CONCLUSIONS: Preinjury insurance rates increased for trauma patients after health care reform but remained lower than in the general population. Certain Americans may be in "double jeopardy" of both higher injury incidence and worse outcomes because socioeconomic factors placing them at risk for injury also present barriers to compliance with an individual insurance mandate.


UMCCTS funding

DOI of Published Version



Am J Public Health. 2014 Jun;104(6):1066-72. doi: 10.2105/AJPH.2013.30171 Link to article on publisher's site

Journal/Book/Conference Title

American journal of public health

Related Resources

Link to Article in PubMed

PubMed ID