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.
To determine whether the Massachusetts reform was associated with changes in all-cause mortality and mortality from causes amenable to health care.
Comparison of mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions.
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.
Adults aged 20 to 64 years in Massachusetts and control group counties.
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.
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.
Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.
Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.
Primary Funding Source:
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Author, Article, and Disclosure Information
Benjamin D. Sommers,
From the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, and The Urban Institute, Washington, DC.
Presented in part at the 36th Annual Meeting of the Society of General Internal Medicine in Denver, Colorado, on 26 April 2013 and the Annual Research Meeting of AcademyHealth in Baltimore, Maryland, on 24 June 2013.
Disclaimer: Dr. Sommers is an advisor in the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services. However, this paper was written in Dr. Sommers’ capacity as a Harvard employee and does not represent the views of the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank James Ware at the Harvard School of Public Health for thoughtful advice on our statistical analysis; Jacob Robbins and Sarah Gordon, Research Assistants at the Harvard School of Public Health, for their work on this project; and Katherine Hempstead at the Robert Wood Johnson Foundation for helpful suggestions related to health care–amenable mortality.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2275.
Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Available from Dr. Sommers (e-mail, bsommers@hsph.
Corresponding Author: Benjamin D. Sommers, MD, PhD, Department of Health Policy and Management, Harvard School of Public Health, Kresge Building, Room 406, 677 Huntington Avenue, Boston, MA 02115; e-mail, bsommers@hsph.
Current Author Addresses: Drs. Sommers and Baicker: Department of Health Policy and Management, Harvard School of Public Health, Kresge Building, Room 406, 677 Huntington Avenue, Boston, MA 02115.
Dr. Long: Health Policy Center, Urban Institute, 2100 M Street NW, Washington, DC 20037.
Author Contributions: Conception and design: B.D. Sommers, S.K. Long, K. Baicker.
Analysis and interpretation of the data: B.D. Sommers, S.K. Long, K. Baicker.
Drafting of the article: B.D. Sommers, S.K. Long, K. Baicker.
Critical revision of the article for important intellectual content: B.D. Sommers, S.K. Long, K. Baicker.
Final approval of the article: B.D. Sommers, S.K. Long, K. Baicker.
Statistical expertise: B.D. Sommers, S.K. Long, K. Baicker.
Collection and assembly of data: B.D. Sommers.