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Effect of Massachusetts Health Reform on Chronic Disease Outcomes

Authors

  • Tomasz P. Stryjewski M.D., M.P.P.,

    Corresponding author
    1. Department of Medicine, Massachusetts General Hospital, Boston, MA
    • Address correspondence to Tomasz P. Stryjewski, M.D., M.P.P., Department of Medicine, Massachusetts General Hospital, 55 Fruit St., GRB 740, Boston, MA 02114; e-mail: tstryjewski@partners.org.

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  • Fang Zhang Ph.D.,

    1. Department of Population Medicine, Harvard Medical School, Boston, MA
    2. Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
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  • Dean Eliott M.D.,

    1. Departments of Ophthalmology at Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary, Boston, MA
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  • J. Frank Wharam M.B., B.Ch., B.A.O., M.P.H.

    1. Department of Population Medicine, Harvard Medical School, Boston, MA
    2. Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
    3. Department of Medicine, Brigham and Women's Hospital, Boston, MA
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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.

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