Racial Differences in Insurance Stability After Health Insurance Reform.
Adult
Ethnicity
/ statistics & numerical data
Female
Health Care Reform
Healthcare Disparities
/ ethnology
Humans
Hypertension
/ therapy
Insurance Coverage
/ statistics & numerical data
Insurance, Health
/ statistics & numerical data
Male
Massachusetts
Medically Uninsured
/ ethnology
Middle Aged
Racial Groups
/ statistics & numerical data
Safety-net Providers
Time Factors
Young Adult
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
pubmed:
27
2
2019
medline:
14
6
2019
entrez:
27
2
2019
Statut:
ppublish
Résumé
One of the potential benefits of insurance reform is greater stability of insurance and reduced coverage disparities by race and ethnicity. We examined the temporal trends in insurance coverage by racial/ethnic group before and after Massachusetts Insurance Reform by abstracting records across 2 urban safety net hospital systems. We examined adjusted odds of being uninsured and incident rate ratios of gaining and losing insurance over time by race and ethnicity. We used billing records to capture the payer for each episode of care. We included data from January 2005 through December 2013 on patients with hypertension between the ages of 21 and 64 years. We compared 4 racial and ethnic groups: non-Hispanic white, non-Hispanic Black, non-Hispanic Asian, and Hispanic. We examined individual patients' insurance coverage status in 6-month intervals. We compared odds of being uninsured in the transition and postinsurance reform period to the prereform period, adjusting for age, sex, comorbidities practice location and education, and income by Census tract. Among 48,291 patients with hypertension, reduction in rates of uninsurance with insurance reform was greater for Hispanic (29.7%), non-Hispanic Black (24.8%), and non-Hispanic Asian (26.8%) than non-Hispanic white (14.9%) patients. The odds of becoming uninsured were reduced in all racial and ethnic groups (odds ratio, 0.27-0.41). Massachusetts Insurance Reform resulted in stable insurance coverage and a reduction in disparities in insurance instability by race and ethnicity.
Sections du résumé
BACKGROUND
One of the potential benefits of insurance reform is greater stability of insurance and reduced coverage disparities by race and ethnicity.
OBJECTIVES
We examined the temporal trends in insurance coverage by racial/ethnic group before and after Massachusetts Insurance Reform by abstracting records across 2 urban safety net hospital systems.
RESEARCH DESIGN
We examined adjusted odds of being uninsured and incident rate ratios of gaining and losing insurance over time by race and ethnicity. We used billing records to capture the payer for each episode of care.
SUBJECTS
We included data from January 2005 through December 2013 on patients with hypertension between the ages of 21 and 64 years. We compared 4 racial and ethnic groups: non-Hispanic white, non-Hispanic Black, non-Hispanic Asian, and Hispanic.
MEASURES
We examined individual patients' insurance coverage status in 6-month intervals. We compared odds of being uninsured in the transition and postinsurance reform period to the prereform period, adjusting for age, sex, comorbidities practice location and education, and income by Census tract.
RESULTS
Among 48,291 patients with hypertension, reduction in rates of uninsurance with insurance reform was greater for Hispanic (29.7%), non-Hispanic Black (24.8%), and non-Hispanic Asian (26.8%) than non-Hispanic white (14.9%) patients. The odds of becoming uninsured were reduced in all racial and ethnic groups (odds ratio, 0.27-0.41).
CONCLUSIONS
Massachusetts Insurance Reform resulted in stable insurance coverage and a reduction in disparities in insurance instability by race and ethnicity.
Identifiants
pubmed: 30807452
doi: 10.1097/MLR.0000000000001078
pmc: PMC6605092
mid: NIHMS1519386
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
256-261Subventions
Organisme : NIMHD NIH HHS
ID : R01 MD007735
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001064
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002544
Pays : United States
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