Pres mnhsr2011 mar1_long

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Pres mnhsr2011 mar1_long

  1. 1. Tracking the Impacts of Health Reform: Lessons from Massachusetts<br />Sharon K. Long<br />University of Minnesota<br />Measuring the State-Level Impact of Health Reform<br />2011 Minnesota Health Services Research Conference<br />March 1, 2011<br />
  2. 2. 2<br />Health reform in Massachusetts<br />Legislation passed in April 2006, with implementation beginning in July 2006<br />Major goals:<br />Extend comprehensive insurance coverage to all Massachusetts residents<br />Improve access, affordability, and quality of health care<br />Became the foundation for the 2010 national health reform legislation<br />
  3. 3. 3<br />Elements of Massachusetts health reform<br />Expanded eligibility for public programs<br />Created health insurance exchanges<br />Provided subsidies for low- and moderate- income individuals<br />Expanded dependent coverage <br />Individual mandate<br />Requirements for employers<br />Standards for covered benefits<br />
  4. 4. Key changes in coverage options under health reform in Massachusetts<br />4<br />Note: FPL is federal poverty level<br />
  5. 5. 5<br />Stakeholders began planning for an impact evaluation in May 2006<br />Reviewed available data sources<br />National surveys<br />MA sample size too small<br />Survey content too narrow<br />Data available too late for policy/program purposes<br />Existing state data (survey and administrative data)<br />Available outcomes relatively narrow<br />Stakeholder concerns about access to state data<br />Decided to invest in a new state survey<br />Funded by BCBSMA Foundation, with support from Commonwealth Fund and RWJF<br />
  6. 6. 6<br />Data<br />Massachusetts Health Reform Survey<br />Sample of non-elderly adults 18-64 years old<br />Baseline survey in 2006, follow-ups 2007 to 2010 (underway)<br />Oversamples of the lower-income and uninsured adults who were targeted by reform<br />Telephone interviews, with cell-phones added in 2010<br />Sample size ~3000 each year<br />
  7. 7. 7<br />Outcome measures<br />Health insurance status—current, prior year<br />Availability of/adequacy of employer sponsored insurance<br />Access to care/barriers to obtaining care<br />Use of health care services<br />Affordability of health care services and medical debt<br />Attitudes toward health reform and, particularly, the individual mandate<br />
  8. 8. 8<br />Methods<br />Estimate impact of health reform as change over time from fall 2006<br />Pre-post estimates will also capture recession & health care cost trends<br />Consistent findings from studies using national data to estimate difference-in-differences models that compare changes in MA to other states<br />Multivariate regression models control for demographic characteristics, health and disability status, socioeconomic status and region of state<br />
  9. 9. 9<br />Health insurance coverage, 2006-2009<br />Adults more likely to have health insurance under health reform.<br />Source: 2006-2009 Massachusetts Health Reform Survey<br />Note: Regression-adjusted estimates<br />* (**) (***) Significantly different from fall 2006 at the .10 (.05) (.01) level, two-tailed test.<br />
  10. 10. 10<br />Type of health insurance coverage, 2006-2009<br />Employer-sponsored insurance coverage increased under health reform.<br />Source: 2006-2009 Massachusetts Health Reform Survey<br />Note: Regression-adjusted estimates<br />* (**) (***) Significantly different from fall 2006 at the .10 (.05) (.01) level, two-tailed test.<br />
  11. 11. 11<br />Employers’ insurance offer and employees’ take-up, 2005-2009<br />Employers more likely to offer health insurance coverage to workers and workers more likely to take-up coverage under health reform.<br />Source: 2006-2009 Massachusetts Division of Health Care Finance and Policy Employer Survey<br />
  12. 12. 12<br />Health care access and use, 2006-2009<br />Adults more likely to have a regular health care provider and to have had health care visits over the prior year under health reform<br />Source: 2006-2009 Massachusetts Health Reform Survey<br />Note: Regression-adjusted estimates<br />*(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two tailed test<br />
  13. 13. 13<br />Unmet need for care, 2006-2009<br />Adults less likely to have unmet need for any reason under health reform<br />Source: 2006-2009 Massachusetts Health Reform Survey<br />Note: Regression-adjusted estimates<br />*(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two-tailed test<br />
  14. 14. 14<br />Health care costs and affordability for individuals, 2006-2009<br />Improvements in affordability of care under health reform despite increasing health care costs and economic recession <br />Source: 2006-2009 Massachusetts Health Reform Survey<br />Note: Regression-adjusted estimates<br />*(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two-tailed test<br />
  15. 15. Additions to the state survey in anticipation of national health reform<br />Provider capacity/barriers to care<br />After hours care/emergency care use<br />Health care costs/medical debt<br />Medical home/care coordination<br />Experiences navigating health programs and the health care system<br />Employers’ response to reform/quality of employer-sponsored insurance coverage<br />15<br />
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