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Changes in mortality after Massachusetts health care reform: a quasi-experimental study.
Annals of Internal Medicine 2014 May 7
BACKGROUND: The Massachusetts 2006 health care reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care. Its effect on population health is less clear.
OBJECTIVE: To determine whether the Massachusetts reform was associated with changes in all-cause mortality and mortality from causes amenable to health care.
DESIGN: Comparison of mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions.
SETTING: Changes in mortality rates for adults in Massachusetts counties from 2001 to 2005 (prereform) and 2007 to 2010 (postreform) were compared with changes in a propensity score-defined control group of counties in other states.
PARTICIPANTS: Adults aged 20 to 64 years in Massachusetts and control group counties.
MEASUREMENTS: Annual county-level all-cause mortality in age-, sex-, and race-specific cells (n = 146,825) from the Centers for Disease Control and Prevention's Compressed Mortality File. Secondary outcomes were deaths from causes amenable to health care, insurance coverage, access to care, and self-reported health.
RESULTS: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (-2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100,000 adults). Deaths from causes amenable to health care also significantly decreased (-4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year.
LIMITATIONS: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.
CONCLUSION: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.
PRIMARY FUNDING SOURCE: None.
OBJECTIVE: To determine whether the Massachusetts reform was associated with changes in all-cause mortality and mortality from causes amenable to health care.
DESIGN: Comparison of mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions.
SETTING: Changes in mortality rates for adults in Massachusetts counties from 2001 to 2005 (prereform) and 2007 to 2010 (postreform) were compared with changes in a propensity score-defined control group of counties in other states.
PARTICIPANTS: Adults aged 20 to 64 years in Massachusetts and control group counties.
MEASUREMENTS: Annual county-level all-cause mortality in age-, sex-, and race-specific cells (n = 146,825) from the Centers for Disease Control and Prevention's Compressed Mortality File. Secondary outcomes were deaths from causes amenable to health care, insurance coverage, access to care, and self-reported health.
RESULTS: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (-2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100,000 adults). Deaths from causes amenable to health care also significantly decreased (-4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year.
LIMITATIONS: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.
CONCLUSION: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.
PRIMARY FUNDING SOURCE: None.
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