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Author: Jonathan T. Kolstad
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Languages : en
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In April 2006, the state of Massachusetts passed legislation aimed at achieving near universal health insurance coverage. A key provision of this legislation, and of the national legislation passed in March 2010, is an individual mandate to obtain health insurance. Although previous researchers have studied the impact of expansions in health insurance coverage among the indigent, children, and the elderly, the Massachusetts reform gives us a novel opportunity to examine the impact of expansion to near universal health insurance coverage among the entire state population. In this paper, we are the first to use hospital data to examine the impact of this legislation on insurance coverage, utilization patterns, and patient outcomes in Massachusetts. We use a difference-in-difference strategy that compares outcomes in Massachusetts after the reform to outcomes in Massachusetts before the reform and to outcomes in other states. We embed this strategy in an instrumental variable framework to examine the effect of insurance coverage on utilization patterns. Using the Current Population Survey, we find that the reform increased insurance coverage among the general Massachusetts population. Our main source of data is a nationally-representative sample of approximately 20% of hospitals in the United States. Among the population of hospital discharges in Massachusetts, the reform decreased uninsurance by 28% relative to its initial level. We also find that the reform affected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room. Using new measures of preventive care, we find evidence that outpatient care reduced hospitalizations for preventable conditions. The reform affected nearly all age, gender, income, and race categories. We identify some populations for which insurance had the greatest direct impact on outcomes and others for which the impact on outcomes appears to have occurred through spillovers.
Author: Jonathan T. Kolstad
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
In April 2006, the state of Massachusetts passed legislation aimed at achieving near universal health insurance coverage. A key provision of this legislation, and of the national legislation passed in March 2010, is an individual mandate to obtain health insurance. Although previous researchers have studied the impact of expansions in health insurance coverage among the indigent, children, and the elderly, the Massachusetts reform gives us a novel opportunity to examine the impact of expansion to near universal health insurance coverage among the entire state population. In this paper, we are the first to use hospital data to examine the impact of this legislation on insurance coverage, utilization patterns, and patient outcomes in Massachusetts. We use a difference-in-difference strategy that compares outcomes in Massachusetts after the reform to outcomes in Massachusetts before the reform and to outcomes in other states. We embed this strategy in an instrumental variable framework to examine the effect of insurance coverage on utilization patterns. Using the Current Population Survey, we find that the reform increased insurance coverage among the general Massachusetts population. Our main source of data is a nationally-representative sample of approximately 20% of hospitals in the United States. Among the population of hospital discharges in Massachusetts, the reform decreased uninsurance by 28% relative to its initial level. We also find that the reform affected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room. Using new measures of preventive care, we find evidence that outpatient care reduced hospitalizations for preventable conditions. The reform affected nearly all age, gender, income, and race categories. We identify some populations for which insurance had the greatest direct impact on outcomes and others for which the impact on outcomes appears to have occurred through spillovers.
Author: Jonathan T. Kolstad
Publisher:
ISBN:
Category : Economics
Languages : en
Pages : 42
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Book Description
In April 2006, the state of Massachusetts passed legislation aimed at achieving near universal health insurance coverage. A key provision of this legislation, and of the national legislation passed in March 2010, is an individual mandate to obtain health insurance. In this paper, we use hospital data to examine the impact of this legislation on insurance coverage, utilization patterns, and patient outcomes in Massachusetts. We use a difference-in-difference strategy that compares outcomes in Massachusetts after the reform to outcomes in Massachusetts before the reform and to outcomes in other states. We embed this strategy in an instrumental variable framework to examine the effect of insurance coverage on outcomes. Among the population discharged from the hospital in Massachusetts, the reform decreased uninsurance by 28% relative to its initial level. Increased coverage affected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room. We also find evidence that outpatient care reduced hospitalizations for preventable conditions. At the same time we find no evidence that the cost of hospital care increased. The reform affected nearly all age, gender, income, and race categories. We identify some populations for which insurance had the greatest direct impact on outcomes and others for which the impact on outcomes appears to have occurred through spillovers.
Author: Jonathan T. Kolstad
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Abstract: In April 2006, the state of Massachusetts passed legislation aimed at achieving near universal health insurance coverage. A key provision of this legislation, and of the national legislation passed in March 2010, is an individual mandate to obtain health insurance. Although previous researchers have studied the impact of expansions in health insurance coverage among the indigent, children, and the elderly, the Massachusetts reform gives us a novel opportunity to examine the impact of expansion to near-universal health insurance coverage among the entire state population. In this paper, we are the first to use hospital data to examine the impact of this legislation on insurance coverage, utilization patterns, and patient outcomes in Massachusetts. We use a difference-in-difference strategy that compares outcomes in Massachusetts after the reform to outcomes in Massachusetts before the reform and to outcomes in other states. We embed this strategy in an instrumental variable framework to examine the effect of insurance coverage on utilization patterns. Using the Current Population Survey, we find that the reform increased insurance coverage among the general Massachusetts population. Our main source of data is a nationally-representative sample of approximately 20% of hospitals in the United States. Among the population of hospital discharges in Massachusetts, the reform decreased uninsurance by 36% relative to its initial level. We also find that the reform affected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room. Using new measures of preventive care, we find some evidence that hospitalizations for preventable conditions were reduced. The reform affected nearly all age, gender, income, and race categories. We also examine costs on the hospital level and find that hospital cost growth did not increase after the reform in Massachusetts relative to other states
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309083435
Category : Medical
Languages : en
Pages : 213
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Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
ISBN: 030946921X
Category : Medical
Languages : en
Pages : 161
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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Author: Norma Coe
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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This paper examines the impact of the Massachusetts Health Insurance reform of 2016 on job mobility and employment exit using administrative data from the Social Security Administration. The Massachusetts reform mandated that every resident have insurance coverage and facilitated this initiative by requiring employers to offer coverage, as well as expanding Medicaid and creating health insurance exchanges with subsidized premiums. These elements provided the basis for the Patient Protection and Affordable Care Act (ACA) passed nationwide in 2010, so the experience of workers in Massachusetts provides evidence for how the ACA may affect labor market efficiency. Of particular interest is the extent to which Massachusetts' reform reduced “job lock” - the phenomenon in which workers stay with employers to maintain their health insurance coverage, rather than move to a more productive match at another employer (especially a small firm unlikely to offer coverage) or exit employment entirely. The project measures differential effects by age, gender, and firm size, and tries to disentangle the effects of the employer mandate and the individual mandate by identifying individuals who cross state lines between home and work. This paper found that: • Trend analysis and regression estimates indicate that Massachusetts residents were actually less likely to move to new employers after the reform, relative to workers in neighboring states that did not make structural changes to their health insurance markets. • Estimates of whether Massachusetts workers moved from large firms, which likely offered insurance, to small firms is statistically insignificant. • Employment transitions were largely unaffected by the Massachusetts reform, though some select groups saw increases in employment exits that may be consistent with the easing of job lock. The policy implications of this paper are: • On the whole, the evidence that the Massachusetts reform increased mobility across employers or out of employment is weak. • These findings suggest that either job lock does not tie workers to their jobs as much as labor economic theory had suggested, or that the Massachusetts reform, and by extension the ACA, may not ease job lock as much as some previous research had suggested.
Author: Michael Scott Jackson
Publisher:
ISBN:
Category : Health care reform
Languages : en
Pages : 0
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The author examines the impact of the Massachusetts' health reform law of 2006, Chapter 58 of the Acts of 2006: An Act Providing Access to Affordable, Quality, Accountable Health Care, which uses both individual and employer insurance-mandates on Entrepreneurship in the formation of new organizations. Previous studies have employed policy analysis and simulation modeling to the impact of theoretical mandatory health insurance regimes on small business, but the contributions of this study are that it is the first to explore the impact of a real world health insurance system or policy change on the entrepreneur and to do so empirically, in real time and within the most natural economic geography, a single MSA or Labor Market Area. It therefore tests whether a given social policy facilitates or impedes the formation of new organizations, and therefore, encourages or discourages employment growth via new organization formation. The author finds significant and persistent suppression of new organization formation when controlling for organization size, sector and owner gender, and limited evidence of geographic displacement of firms across the New Hampshire border. While theory suggests mandatory insurance should reduce insurance costs and improve worker productivity, the author finds that the regulation has no significant impact on worker productivity and limited evidence of increases in insurance costs, and estimates the expected cost in terms of lost employment, sales to the local economy and tax revenue to in the majority of cases exceed the benefit.
Author: Elizabeth Weeks
Publisher:
ISBN:
Category :
Languages : en
Pages : 30
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This Article briefly describes the key features of the Massachusetts Health Care Reform Act, focusing particularly on the Connector. It then offers preliminary thoughts on the expected effect of that mechanism for creating quality, affordable health insurance products for individuals. Observers anticipate that commercial insurers will offer scant coverage and high-premium, high-deductible plans through the Connector, which coverage ultimately may be neither more affordable than products currently or more helpful to covering the cost of health care than no coverage at all. If the Connector fails to facilitate the individual insurance mandate, Massachusetts's promise of universal coverage may begin to unravel. Moreover, its usefulness as a model for other states proposing or considering similar risk-pooling mechanisms will be greatly diminished.
Author: Jonathan T. Kolstad
Publisher:
ISBN:
Category : Economics
Languages : en
Pages : 58
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We model the labor market impact of the three key provisions of the recent Massachusetts and national "mandate-based" health reforms: individual and employer mandates and expansions in publicly-subsidized coverage. Using our model, we characterize the compensating differential for employer-sponsored health insurance (ESHI) -- the causal change in wages associated with gaining ESHI. We also characterize the welfare impact of the labor market distortion induced by health reform. We show that the welfare impact depends on a small number of "sufficient statistics" that can be recovered from labor market outcomes. Relying on the reform implemented in Massachusetts in 2006, we estimate the empirical analog of our model. We find that jobs with ESHI pay wages that are lower by an average of $6,058 annually, indicating that the compensating differential for ESHI is only slightly smaller in magnitude than the average cost of ESHI to employers. Because the newly-insured in Massachusetts valued ESHI, they were willing to accept lower wages, and the deadweight loss of mandate-based health reform was less than 5% of what it would have been if the government had instead provided health insurance by levying a tax on wages.
Author: Wen Chen
Publisher:
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Category :
Languages : en
Pages :
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