The Effect of the Massachusetts Healthcare Reform on the Uninsured Rate of the Orthopaedic Trauma Population

Abstract

There was an estimated 40% reduction in risk of uninsured individuals in the orthopaedic trauma population in the metropolitan Boston area following MHR. Despite a significant improvement, these results reveal a rate of uninsured individuals fivefold greater than currently reported by the state of Massachusetts and the U.S. government.

Does Health Reform Change Femoral Neck Fracture Care? A Natural Experiment in the State of Massachusetts

“…1,[4][5][6] Although the proximity of the ACA's passage precludes a complete examination of its effect on the orthopaedic field, earlier experiences with healthcare reform in the state of Massachusetts have previously been used as a guide. 2,3,7 The healthcare reform act in Massachusetts (the Act Providing Access to Affordable, Quality, Accountable Health Care of 2006) and the ACA maintained similar aims of enhancing access to healthcare while also reducing costs and improving quality. 3 In this analysis we performed a natural experiment, evaluating changes in the delivery of surgical care to patients with femoral neck fractures in Massachusetts, before and after the implementation of health reform.…”

“…Hip fractures are ideal means to study the impact of health reform as they are nondiscretionary surgical interventions. Unlike elective procedures, decisions to perform nondiscretionary surgery are unlikely to change in the setting of health reform, 7,8,19 allowing for more effective comparison between the prereform and postreform cohorts.…”

“…[1][2][3][4][5][6][7] Commensurate with the passage of the Affordable Care Act (ACA), Medicaid, and health insurance expansion have increased the number of individuals with the capacity to obtain health services. 2,3,8,9 At the same time, a number of cost containment and quality improvement measures have also been introduced, including bundled payment programs, at-risk insurance products, value-based purchasing, and reference pricing.…”

“…The state of Massachusetts can serve as a more effective model for this purpose, however, given that health reform initiatives comparable with the ACA were enacted in 2006, with the passage of the Massachusetts Act Providing Access to Affordable, Quality, Accountable Health Care. 2,3,7 In this context, we endeavored to use the Massachusetts Statewide Inpatient Dataset (SID) to explore the impact of healthcare reform on hospital processes and quality measures associated with femoral neck fracture care. As a nondiscretionary surgical condition with a sizable impact on physical and mental health, [12][13][14][15][16][17] hip fractures are an ideal tool to examine changes in the delivery of necessary orthopaedic care that may occur secondary to health reform.…”

Massachusetts Health Care Reform and Orthopaedic Trauma

“…5 This initiative was designed to specifically evaluate the accuracy of the publicized rate of uninsured in Massachusetts and to assess the effects of MHR on our unique orthopaedic trauma population. 5 This initiative was designed to specifically evaluate the accuracy of the publicized rate of uninsured in Massachusetts and to assess the effects of MHR on our unique orthopaedic trauma population.…”