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    Pres mnhsr2011 mar1_long Pres mnhsr2011 mar1_long Presentation Transcript

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