Massachusetts Coverage Expansion Associated with Reduction in Primary Care Utilization among Medicare Beneficiaries

Abstract

Objective. To examine whether expanding coverage for the nonelderly affects primary care utilization among Medicare beneficiaries. Data Source. Study Design. We use two zip code-level outcomes: arc percent change in primary care visits per Medicare beneficiary per year, and percentage point change in the share of beneficiaries with one or more primary care visits. We use a regression-based difference-in-difference analysis that compares Massachusetts with surrounding states, and zip codes with high, medium, and low uninsurance rates in 2005. The 2005 uninsurance rates correspond to the size of Massachusetts' coverage expansion. We use propensity scores for identification of comparable zip codes and for weighting. Principal Findings. In areas of Massachusetts with the highest uninsurance rateswhere insurance expansion had the largest impact-visits per beneficiary fell 6.9 percent (p < .001) relative to areas of Massachusetts with the smallest uninsurance rates. Conclusions. The expansion of coverage for the nonelderly reduced primary care visits, but it did not reduce the percent of beneficiaries with at least one visit. These results could imply restricted access, increased efficiency, or some blend.

Integrative literature review: access to primary healthcare services

“…One study (15) analyzed Medicaid in the population of Massachusetts and its trends in the useof primary care services. In 2006, there was a policy change at the state level, and health reform significa ntly increased insurance coverage among non-elderly people, unlike other nearby states.…”

“…After reviewing the literature, the access to health care in international scenarios was analyzed, in terms of ensuring or not the access to PHC by specific populations (10)(11)(12)(13)(14) ; some studies show the access through health plans (15)(16)(17)(18)(19) ; or address possibilities or proposals to improve the access to services either through restructuring (23)(24)(25)(26)(27)29) or strategies implemented for this purpose (7,(20)(21)(22)28,30) .…”

The Effects of State Medicaid Expansions for Working-Age Adults on Senior Medicare Beneficiaries

“…Elsewhere in the literature, theories about the spillover effects of restrictive insurance coverage (Glied and Zivin 2002) suggest a scenario where Medicaid expansions could decrease the healthcare supplied to Medicare beneficiaries. In addition to these competing theoretical predictions, the few existing empirical studies on this topic produce mixed results (Sommers, Baicker, and Epstein 2012;Bond and White 2013;Joynt et al 2013;Glied 2014;Joynt et al 2015).…”

Impact of Medicare Part D on out‐of‐pocket drug costs and medical use for patients with cancer

“…This methodology has been used previously in studies evaluating intervention programs or policies. [23][24][25][26] A multivariate differences-in-differences model is written as:…”

“…A differences‐in‐differences model assumes that, in the absence of the treatment or in our case Medicare Part D, the average outcomes for the exposed and control groups would have followed parallel paths over time. This methodology has been used previously in studies evaluating intervention programs or policies . A multivariate differences‐in‐differences model is written as: in which “group” is the variable for the treatment and control groups and B1 is the coefficient that reflects the differences between the control and treatment groups.…”