Lessons Learned from Health Coverage Expansion in Massachusetts: Primary Care for Individuals with Serious Psychiatric Illness: Pre- and Post- 2006 Coverage Mandates

Abstract

Purpose: Improved access to care, particularly primary care, is a key goal of healthcare reform proposals. Individuals with severe psychiatric illness have high rates of emergency room use rather than primary/preventive care. Massachusetts implemented health care reform in 2006 intended to provide more individuals with health care insurance and, thereby, access to primary care. To our knowledge no study has assessed whether this legislation impacted barriers to primary care access among individuals with serious mental illness. Methods: This study looked at effects of the 2006 Massachusetts legislation among individuals being hospitalized at a large psychiatric hospital drawing patients from throughout Eastern Massachusetts. A retrospective review of records noted whether a primary care physician was identified, along with demographic and clinical characteristics for each patient. Results: Primary care affiliation was significantly lower in 2008 than 2005. Affiliation increased 9 years after legislation, though not to the levels of the year prior to the legislation. Risk ratios for PCP non-affiliation were similar whether the model controlled for demographic characteristics only; primary and drug and alcohol related diagnoses in addition to demographic characteristics; or insurance type in addition to demographic characteristics and diagnoses. Conclusions: The risk of being unaffiliated with a PCP 2 years after legislative reform was nearly 20% higher than 1 year before. Our findings are concerning in that patients at this large regional psychiatry hospital may have been receiving less primary/preventive care in 2008 than in 2005, despite legislation aimed at improving primary care access for the general population.