Mass. Health Reform Increases Inpatient Surgeries.

Researchers from the BU Schools of Medicine and Public Health, along with the VA Boston Healthcare System and Harvard Medical School, have found that inpatient medical procedures increased among some populations after healthcare reform took effect in Massachusetts.

The findings, which appear in the journal Medical Care, suggest that healthcare reform has improved access to outpatient care for vulnerable populations, possibly leading to more referrals for inpatient procedures. The biggest increases in procedure rates were among non-elderly, low- and medium-income populations, as well as Hispanics, compared to non-Hispanic whites and blacks.

The 2006 Massachusetts health reform initiative substantially decreased the number of uninsured in the state. Little is known about the reform’s impact on actual healthcare utilization among poor and minority populations, particularly for inpatient surgical procedures that are commonly initiated by outpatient physician referral.

Improved outpatient care may have led to a rise in inpatient procedures such as surgery. (US Army photo)Researchers used discharge data on Massachusetts hospitalizations for 21 months preceding and following health reform implementation (July 2006–December 2007). They identified all non-obstetrical major therapeutic procedures for patients 40 years and older, with more than 70 percent of the hospitalizations initiated by an outpatient physician referral.

Specifically, they compared pre- and post-reform utilization of major therapeutic inpatient procedures predominantly scheduled by outpatient referrals among non-elderly Massachusetts adults. Greater overall increases were found in lower-income groups, as well as among Hispanics.

“Prior to reform, both blacks and Hispanics had lower rates of these procedures compared to whites. As 90 percent of all surgeries came from outpatient physician referral, these findings suggest a meaningful improvement in access to outpatient care for the surgeries studied, especially those living in lower income areas,” explained senior author Nancy Kressin, professor of medicine at BUSM.

Karen Lasser, associate professor of medicine at BUSM and of community health sciences at BUSPH, was a co-author on the study.

The findings of significant expansion in procedure use for Hispanics and lower-income patients are consistent with the gains in insurance coverage among these subpopulations, the authors said. The findings suggest potentially improved access to outpatient care, and may reflect demand built up prior to reform, when individuals were uninsured.

“Whether such improved access – a crucially important first step to improving equity in access and outcomes – translates into improved clinical outcomes at a reasonable cost merits further study,” Kressin said.

Funding for the study came from the National Heart, Lung and Blood Institute Center for Health Insurance Reform and Cardiovascular Outcomes and Disparities.

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