07 May Mortality Dropped After Massachusetts Health Care Reform
MedicalResearch.com Interview with:
Benjamin D. Sommers, MD, PhD
Assistant Professor of Health Policy & Economics
Harvard School of Public Health / Brigham & Women’s Hospital
Boston, MA 02115
MedicalResearch.com: What are the main findings of the study?
Dr. Sommers: We find that over the first four years since Massachusetts’ 2006 comprehensive health reform law, all-cause mortality in the state fell by 2.9%, compared to a similar population of adults living in counties outside Massachusetts that did not expand insurance during this period. We also found that the law reduced the number of adults in Massachusetts without insurance, reduced cost-related barriers to care, increased use of outpatient visits, and led to improvement in self-reported health. Overall, we estimate that the health reform law prevented over 320 deaths per year in the state – or one life saved per 830 adults gaining health insurance. Mortality rates declined primarily due to fewer deaths from causes amenable to health care, such as cancer, infections, and heart disease. We also found that the health benefits were largest for people living in poor counties in the state, areas with higher percentage of uninsured adults before the law was passed, and for minorities.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Sommers: Previous research on the health impacts of gaining insurance have been mixed. In general, health insurance has been shown to improve financial risk protection, help people pay medical bills, and promote better access to care. But studies – most recently the Oregon Health Insurance Experiment – have offered inconsistent evidence about whether expanding insurance produces better health outcomes, particularly for objective clinical measures. So our results are noteworthy in that respect, but perhaps not surprising: here we take advantage of a large natural experiment with several hundred thousand people gaining health insurance, and we have four years of data after the law. That gave us much more statistical power to find the sort of population-level impact that other well-designed but smaller studies may not have been able to detect.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Sommers: The main implications are that expanding health insurance can produce not only benefits in terms of improved access to care and perceived health, but reduced population-level mortality. Moreover, our study suggests that near-universal health insurance disproportionately benefits some of the groups that have traditionally had worse health outcomes in the U.S. – racial and ethnic minorities and adults with low incomes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Sommers: Though it is difficult to generalize directly from one state to the country as a whole, the study offers suggestive insights into what kinds of population-level health effects could possibly occur under the ACA. The natural next step for research in this area is to evaluate the impact of national health reform, in terms of its effects on coverage, access to care, and health.
Changes in Mortality After Massachusetts Health Care Reform A Quasi-experimental Study
Ann Intern Med. 2014;160(9):585-593. doi:10.7326/M13-2275