Massachusetts Healthcare Reform, instated in 2006, was the model for the Patient Protection and Affordable Care Act, signed into law in 2010. While there are clear differences between the two, the primary goal of providing insurance for an entire population, improving quality and reducing healthcare costs are consistent.
Since Massachusetts Healthcare Reform, the state reports 98.1 percent of residents have health insurance coverage. A study published in the Journal of Bone and Joint Surgery examines how this high percentage of coverage impacts uninsured individuals needing orthopedic trauma care. The researchers examined patients in the state's largest metropolitan area to follow and examined uncompensated care changed after reform implementation.
The retrospective review included orthopedic trauma at three level-1 trauma centers in Boston with data from 2003 to 2010, but patients from 2006 and 2007 were excluded due to the enrollment period for subsidized healthcare insurance. There were 16,338 patients with extremity and pelvic fractures during the study period. Key study findings about the orthopedic trauma population include:
• Before Massachusetts Healthcare Reform, the uninsured population undergoing treatment for orthopedic trauma was 23.8 percent; after reform the rate dropped to 14.4 percent.
• After reform, the risk of being uninsured was around 0.6 times the pre-reform risk.
• Uncompensated care went from 16.7 percent before reform to 11.5 percent after reform.
• Estimated risk of uninsured individuals in the orthopedic trauma population experienced a 40 percent reduction after reform.
"Despite a significant improvement, these results reveal a rate of uninsured individuals fivefold greater than currently reported by the state of Massachusetts and the U.S. government," concluded the study authors.
A report from the National Bureau of Economic Research titled "The Impact of Health Care Reform on Hospital and Preventative Care: Evidence from Massachusetts" found insurance coverage through Medicaid expanded 30 percent among non-elderly residents and the expansion "appears to have crowded out private coverage." As a result, the hospitalized population decreased around 4 percentage points.
Medicare coverage did not significantly change and the total number of newly-insured patients did not demand more inpatient care. Hospital length of stay decreased 1 percent and emergency room use for routine care also declined after reform, particularly among low-income areas in the state.
Finally, hospital admissions for preventable conditions also fell 2.7 percentage points, leaving more room to treat severe cases like orthopedic trauma. Additionally, the report did not find evidence that hospital costs grew post-reform.