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Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
Aea gender final
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Aea gender final

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  • 1. Sharon K. Long University of Minnesota Karen Stockley Urban Institute Shanna Shulman Blue Cross Blue Shield of Massachusetts Foundation American Economic Association Annual Meetings Session: Gender Gaps in Families, Health Care, and Industry January 8, 2011 Have Gender Gaps in Insurance Coverage and Access to Care Narrowed Under Health Reform? Findings from Massachusetts
  • 2. Background
  • 3. Gender Differences in Health Care Women have greater health care needs than men, partially driven by: Reproductive health needs among younger women Higher incidence of chronic conditions for older women Women use care more than men Greater health care needs Higher levels of insurance coverage Women face higher medical cost burdens More likely to forgo needed care due to cost Spend greater share of income on medical care Sources: James et al. 2009; Rustgi, Doty, and Collins. 2010
  • 4. Massachusetts Health Reform Legislation passed in April 2006 Major goals: Extend comprehensive insurance coverage to all residents Improve access, affordability, quality of health care Many parts, including: Medicaid (MassHealth) expansions New income-related subsidies to purchase private coverage (CommCare) New purchasing arrangement to purchase private coverage (CommChoice) New entity to regulate and facilitate the purchase of private coverage (the Connector) Insurance market reforms Requirements for employers Individual mandate
  • 5. Research Question How did gender differences in insurance coverage, access, use, and affordability of health care change under health reform in Massachusetts? Examine changes in gender gaps in insurance coverage Examine changes in gender gaps in access, use, and affordability associated with the coverage expansions Expect these gaps to narrow as coverage levels become more equalized between the sexes
  • 6. Data Massachusetts Health Reform Survey Pre-reform survey--fall 2006 Post-reform surveys--fall 2007, 2008 and 2009 Stratified random samples Telephone interviews with samples of adults 18 to 64 Oversamples of lower-income and uninsured adults Questions on insurance coverage; access, use, and affordability of care; support for health reform Sample sizes 3000+ in each year
  • 7. Analytic Framework Compare gender differences in outcomes for cross-sectional samples of men and women before and after health reform Estimate multivariate regression models of gender differences before and after reform Controlling for demographic, health and disability, socioeconomic characteristics, region of state Models of gender differences pre and post-reform estimated within each year (2006 or 2009) Estimate difference-in-difference models comparing changes for men and women over the study period Data from 2006-2009 Testing whether significant change in gender differences under health reform
  • 8. Analytic Framework Changes in gender differences between fall 2006 and 2009 attributed to state’s reform efforts Aggregate impact of health reform on gender disparities Assumption: other factors not changing differentially for men and women over the study period Violation could bias interpretation (e.g. if recession affected men or women more severely) Will also provide insight into the benefits of insurance coverage for men and women More speculative findings
  • 9. Estimation Approach Estimate separate models by age group All non-elderly adults (ages 18-64) Younger adults (ages 18-45) Older adults (ages 46-64) Linear probability models, controlling for complex survey design
  • 10. Gender Differences Prior to Health Reform
  • 11. Changes for Men and Women Under Health Reform
  • 12. Gender Differences After Health Reform
  • 13. Conclusions Men and women both gained under health reform Coverage expansions associated with gains in access, use, and affordability for both genders Narrowing of gender gap in insurance coverage, particularly for younger adults Inconsistent financial effect of coverage gains for women and men In 2009 women had higher levels of coverage but were more likely to report unmet need and problems affording care Suggests that insurance provides better financial protection for men than women

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