EMBARGOED NEWS FROM HARVARDMEDICALSCHOOL /CAMBRIDGE HEALTH ALLIANCE

EMBARGOED UNTIL:

12:01pm EST, Friday, July 27, 2012

Contacts:

Danny McCormick, M.D., M.P.H., cell: (617) 548-7213,

Rachel Nardin, M.D., cell: (617) 820-4275,

Gaps in Access to Care Found for Newly Insured Under Massachusetts Health Reform

Patients who obtained public insurance as a result of Massachusetts’ health care reform face cost-related barriers that may affect their access to care, HarvardMedicalSchool researchers say.

Massachusetts’ health care reform may have cut the state’s uninsurance rate, but according to a new study by researchers at HarvardMedicalSchool published online in the Journal of General Internal Medicine, access to care may still be suboptimal for those who gained coverage as a result of the health reform law.

The study authors surveyed 431 adult patients visiting the emergency room of Massachusetts’ second largest safety-net hospital. They found that patients with Commonwealth Care and Medicaid – the two programs through which most of the uninsured in Massachusetts gained coverage – reported similar or higher levels of access to and utilization of outpatient visits compared with the privately insured, as well as similar access to preventive care.

However, compared with the privately insured (7.0%), a significantly higher proportion of patients with Medicaid (30.0%) or Commonwealth Care Type 1 (26.8%) reported delaying or not getting a medication. Similarly, patients with Commonwealth Care (51.2%) and Medicaid (42.2%) were substantially more likely to report delaying or not getting dental care due to cost compared with the privately insured (27.1%). Those with Medicaid also experienced more cost-related barriers than privately insured patients when it came to seeing a specialist (14.6% vs 3.5%) or getting recommended tests (15.6% vs. 5.9%). This is despite relatively low patient cost-sharing requirements in these insurance types.

Patients with Commonwealth Care Types 2 and 3, which have greater cost sharing requirements, reported significantly more cost-related barriers to obtaining care, generally, than the privately insured (45.0% vs. 16.0%), as well as greater barriers to seeing a primary care doctor (25.0% vs. 6.0%), dental provider (58.3% vs. 27.1%), and to obtaining medication (20.8% vs. 7.0%).

The uninsured in the study fared substantially worse on every measure of access to care when compared with the privately insured.

“These findings illustrate that the insurance plans that most previously uninsured patients received in Massachusetts as part of health care reform had a mixed effect in terms of access to care” said the study’s lead author, Dr. Danny McCormick, an Assistant Professor at HarvardMedicalSchool. “While patients with Medicaid and Commonwealth Care had difficulty finding physicians who would accept their insurance type, they were ultimately able to see primary care doctors at the same rates as privately insured patients”. However, he said, “our findings also suggest that these forms of insurance may leave low-income patients with substantial cost-related barriers to care not faced by the privately insured”.

Senior author Dr. Rachel Nardin, an Assistant Professor at HarvardMedicalSchool, said: “health policy experts often assume that because Massachusetts health care reform decreased the percentage of uninsured in our state, that access to care would follow suit. However, our study illustrates that all forms of insurance are not equal. While Medicaid and publicly subsidized private insurance play a critical role in improving access to care for low-income people, our study shows that there is still work to be done to ensure equality of access”.

McCormick added, “Since the Massachusetts health care reform law served as the model for the national health reform law our results should prompt policy makers to carefully examine the adequacy of health insurance available to those who will gain coverage as part of national health care reform”.

“Access to Care after Massachusetts Health Care Reform: A Safety-Net Hospital Survey”., Danny McCormick, MD, MPH, Assaad Sayah, M.D., Hermione Lokko, B.Sc., Steffie Woolhandler, M.D., MPH., and Rachel Nardin, M.D Journal of General Internal Medicine, Sept. 19, 2011.

A copy of the article is available to media professionals by contacting study authors.

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