JAMA: Mass. healthcare reform linked with greater safety-net demand
“Despite the significant reduction in un-insurance levels in Massachusetts that occurred with healthcare reform, the demand for care at safety-net facilities continues to rise,” stated researchers in an original investigation published Aug. 8 online in the Archives of Internal Medicine.
In Massachusetts, healthcare reform legislation implemented in 2006 expanded insurance coverage of nonelderly adults from 87.5 percent in 2006 to 95.2 percent in 2009, and lowered the state's un-insurance rate to 1.9 percent by 2010, wrote Leighton Ku, PhD, MPH, from the department of health policy at George Washington University in Washington, D.C., and colleagues.
Using data from Massachusetts safety net facilities and patients, researchers sought to assess changes in the demand for and use of outpatient and inpatient care since the state's implementation of healthcare reform.
Data for community health centers (CHCs) were obtained from the Uniform Data System for Massachusetts for 2005 through 2009. Data for hospitals were obtained from the Massachusetts Division of Health Care Finance and Policy for calendar years 2006 through 2009. Data regarding patients' perspectives were obtained from the 2009 Massachusetts Health Reform Survey, a state-representative telephone survey of 3,041 nonelderly adults. The researchers also conducted case study interviews from January through March 2010 with CHC and hospital administrators and medical staff in Boston, Fall River, Springfield and Pittsfield, Mass.
The total number of patients served by CHCs increased by 31 percent from 2005 to 2009 and the average number of patient visits also increased, the authors found. During the same period, the number of patients without insurance in the CHC caseload decreased from 35.5 percent to 19.9 percent. Staff members at CHCs told researchers that newly insured patients returned because they like the care received at these sites and the relationships they had developed with center healthcare professionals.
The authors defined safety-net hospitals as those that, in 2009, received 20 percent or more of their net patient service revenue from Medicaid or two Massachusetts programs for low-income patients: Commonwealth Care and the Health Safety-Net program. They identified 17 institutions as safety-net hospitals and 48 without that designation. Overall the growth levels from 2006 to 2009 were similar for both types of hospitals. However, nonemergency ambulatory care visits from outpatient departments and hospitals' community clinics increased 9.2 percent for safety-net hospitals and 4.1 percent for non-safety-net hospitals.
“The number of inpatient admissions was comparable for safety-net and non-safety-net hospitals,” the authors wrote. “Most safety-net patients reported that they used these facilities because they were convenient (79.3 percent) and affordable (73.8 percent); only 25.2 percent reported having had problems getting appointments elsewhere.”
The researchers analyzed responses from patients of safety-net facilities who were non-elderly adults with incomes below 300 percent of the poverty line. Roughly two-thirds had health coverage through a public program. Safety-net patients reported seeking care at emergency departments more than other low-income adults or all adults. According to the authors, of the lower-income safety-net patients, 33.3 percent said they had sought care for a nonemergency condition at an emergency department, compared with 14.7 percent of all adults. Most reported that they used safety-net facilities because these services were convenient and affordable, with one-quarter reporting difficulty in obtaining care elsewhere.
"Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there,” the authors concluded. “It will continue to be important to support safety-net providers, even after healthcare reform programs are established."
In Massachusetts, healthcare reform legislation implemented in 2006 expanded insurance coverage of nonelderly adults from 87.5 percent in 2006 to 95.2 percent in 2009, and lowered the state's un-insurance rate to 1.9 percent by 2010, wrote Leighton Ku, PhD, MPH, from the department of health policy at George Washington University in Washington, D.C., and colleagues.
Using data from Massachusetts safety net facilities and patients, researchers sought to assess changes in the demand for and use of outpatient and inpatient care since the state's implementation of healthcare reform.
Data for community health centers (CHCs) were obtained from the Uniform Data System for Massachusetts for 2005 through 2009. Data for hospitals were obtained from the Massachusetts Division of Health Care Finance and Policy for calendar years 2006 through 2009. Data regarding patients' perspectives were obtained from the 2009 Massachusetts Health Reform Survey, a state-representative telephone survey of 3,041 nonelderly adults. The researchers also conducted case study interviews from January through March 2010 with CHC and hospital administrators and medical staff in Boston, Fall River, Springfield and Pittsfield, Mass.
The total number of patients served by CHCs increased by 31 percent from 2005 to 2009 and the average number of patient visits also increased, the authors found. During the same period, the number of patients without insurance in the CHC caseload decreased from 35.5 percent to 19.9 percent. Staff members at CHCs told researchers that newly insured patients returned because they like the care received at these sites and the relationships they had developed with center healthcare professionals.
The authors defined safety-net hospitals as those that, in 2009, received 20 percent or more of their net patient service revenue from Medicaid or two Massachusetts programs for low-income patients: Commonwealth Care and the Health Safety-Net program. They identified 17 institutions as safety-net hospitals and 48 without that designation. Overall the growth levels from 2006 to 2009 were similar for both types of hospitals. However, nonemergency ambulatory care visits from outpatient departments and hospitals' community clinics increased 9.2 percent for safety-net hospitals and 4.1 percent for non-safety-net hospitals.
“The number of inpatient admissions was comparable for safety-net and non-safety-net hospitals,” the authors wrote. “Most safety-net patients reported that they used these facilities because they were convenient (79.3 percent) and affordable (73.8 percent); only 25.2 percent reported having had problems getting appointments elsewhere.”
The researchers analyzed responses from patients of safety-net facilities who were non-elderly adults with incomes below 300 percent of the poverty line. Roughly two-thirds had health coverage through a public program. Safety-net patients reported seeking care at emergency departments more than other low-income adults or all adults. According to the authors, of the lower-income safety-net patients, 33.3 percent said they had sought care for a nonemergency condition at an emergency department, compared with 14.7 percent of all adults. Most reported that they used safety-net facilities because these services were convenient and affordable, with one-quarter reporting difficulty in obtaining care elsewhere.
"Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there,” the authors concluded. “It will continue to be important to support safety-net providers, even after healthcare reform programs are established."