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. 2014 Dec;49 Suppl 2(Suppl 2):2086-103.
doi: 10.1111/1475-6773.12196. Epub 2014 Jul 16.

Effect of Massachusetts health reform on chronic disease outcomes

Tomasz P Stryjewski  1 , Fang Zhang, Dean Eliott, J Frank Wharam
Affiliations

Effect of Massachusetts health reform on chronic disease outcomes

Tomasz P Stryjewski et al. Health Serv Res. 2014 Dec.

Abstract

Objective: To determine whether Massachusetts Health Reform improved health outcomes in uninsured patients with hyperlipidemia, diabetes, or hypertension.

Data source: Partners HealthCare Research Patient Data Registry (RPDR).

Study design: We examined 1,463 patients with hyperlipidemia, diabetes, or hypertension who were uninsured in the 3 years before the 2006 Massachusetts Health Reform implementation. We assessed mean quarterly total cholesterol, glycosylated hemoglobin, and systolic blood pressure in the respective cohorts for five follow-up years compared with 3,448 propensity score-matched controls who remained insured for the full 8-year study period. We used person-level interrupted time series analysis to estimate changes in outcomes adjusting for sex, age, race, estimated household income, and comorbidity. We also analyzed the subgroups of uninsured patients with poorly controlled disease at baseline, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year.

Principal findings: In 5 years after Massachusetts Health Reform, patients who were uninsured at baseline did not experience detectable trend changes in total cholesterol (-0.39 mg/dl per quarter, 95 percent confidence interval [-1.11 to 0.33]), glycosylated hemoglobin (-0.02 percent per quarter [-0.06 to 0.03]), or systolic blood pressure (-0.06 mmHg per quarter [-0.29 to 0.18]). Analyses of uninsured patients with poorly controlled disease, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year yielded similar findings.

Conclusions: Massachusetts Health Reform was not associated with improvements in hyperlipidemia, diabetes, or hypertension control after 5 years. Interventions beyond insurance coverage might be needed to improve the health of chronically ill uninsured persons.

Keywords: Health reform; observational data; time series analysis.

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Figures

Figure 1
Figure 1
Outcomes of Patients with (a) Hyperlipidemia, (b) Diabetes, or (c) HypertensionNote:†Level changes represent the estimated absolute change in outcome units (HbA1C percent, mmHg, or mg/dl) from immediately before to immediately after the phase-in period in the uninsured group relative to the insured group. ‡Trend changes represent the estimated slope of the follow-up trend in the uninsured group relative to the insured group as measured by outcome units (HbA1C percent, mmHg, or mg/dl) per quarter. *Uninsured is defined as uninsured in the baseline and either being insured or uninsured in the follow-up period. Insured is defined as having health insurance over the entire study period.
Figure 2
Figure 2
Patients with No Established Primary Care in the Baseline Period: (a) Patients with Hyperlipidemia; (b) Patients with Diabetes; (c) Patients with Hypertension Note:†Level changes represent the estimated absolute change in outcome units (HbA1C percent, mmHg, or mg/dl) from immediately before to immediately after the phase-in period in the uninsured group relative to the insured group. ‡Trend changes represent the estimated slope of the follow-up trend in the uninsured group relative to the insured group as measured by outcome units (HbA1C percent, mmHg, or mg/dl) per quarter. *Uninsured is defined as uninsured in the baseline and being insured in the first year of the follow-up period. Insured is defined as having health insurance over the entire study period.
Figure 3
Figure 3
Patients with Disease Severity in the Highest Quintile at Study Entry: (a) Patients with Hyperlipidemia; (b) Patients with Diabetes; (c) Patients with HypertensionNote:†Level changes represent the estimated absolute change in outcome units (HbA1C percent, mmHg, or mg/dl) from immediately before to immediately after the phase-in period in the uninsured group relative to the insured group. ‡Trend changes represent the estimated slope of the follow-up trend in the uninsured group relative to the insured group as measured by outcome units (HbA1C percent, mmHg, or mg/dl) per quarter. *Uninsured is defined as uninsured in the baseline and either being insured or uninsured in the follow-up period. Insured is defined as having health insurance over the entire study period.
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