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Impact of Massachusetts Health Reform and Disparities in the Use of Endocrine Surgery
Jennifer E. Rosen, David B. McAneny, *Amresh Hanchate
Boston University, Boston, MA
Objective: The 2006 Massachusetts (MA) health care reform bill was intended to increase access to care and is often held as a national model. Our goal was to examine its’ impact on the use of inpatient endocrine surgical procedures among minorities and low-income zip code residents.
Patients: Using discharge data on MA hospitalizations for the 21 months preceding and following implementation of the 2006 health reform we identified a cohort of patients undergoing endocrine surgical procedures. Design: Stratifying census state-level population by median zip code income and race/ethnicity to differentiate potential beneficiaries of reform, we estimated pre- and post-reform procedure rates for those aged 18-64 (non-elderly).
Main Outcome Measure: To identify the impact of health reform on the change in procedure rate, we adjusted for secular changes by treating those aged 65 and older as the non-target population.
Results: Statewide total volume of inpatient endocrine procedures performed increased 22%; the top three procedures were total thyroidectomy (38%), thyroid lobectomy (20%) and parathyroidectomy (12%); 91% of all procedures were non-emergent and based on outpatient-referred hospitalizations. Adjusting for secular changes, non-elderly lower income residents experienced 37% post-reform increase (p=0.001) in procedure use while higher income counterparts experienced a 3% decrease. Comparisons by race/ethnicity indicated higher unadjusted post-reform rates among non-elderly Blacks (38%) and Hispanics (27%) compared to Whites (14%); the adjusted increase for Hispanics was marginally significant (52% increase, p=0.096).
Conclusions: Following health reform, use of endocrine procedures that are primarily initiated by outpatient referral increased among the lower-income non-elderly. These findings suggest improved access to both outpatient and endocrine surgical care for subpopulations known to underutilize health care due to lack of adequate insurance.
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