Massachusetts health reform linked with fewer all-cause, treatable deaths

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1. Health reform in Massachusetts was associated with significant reductions in all-cause mortality as well as deaths from treatable diseases. 

2. These reductions were larger in Massachusetts counties with lower household incomes and higher prereform uninsured rates. 

Evidence Rating Level: 3 (Average) 

Study Rundown: In 2006, Massachusetts passed a comprehensive health care reform act, the goals and tenets of which serve as a model for the Affordable Care Act. While research has clearly shown that the Massachusetts reform expanded health insurance among young adults and improved overall access to care, the effects of the law on mortality are less clear. The current study examined all-cause mortality and mortality from healthcare amenable causes (defined as those from potentially treatable diseases with timely care such as cardiovascular disease, infections, and cancer) in Massachusetts before (from 2001 to 2005) and after (2007 to 2010) reform. They compared these mortality changes to changes over the same period among similar populations in states without reforms (their control group). The authors found that health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care when compared to the control group. Additionally, these reductions were larger in counties with lower household incomes and higher pre-reform uninsured rates. The most important limitation of this study is that the authors used a “quasi-experimental” pre-post design, which was likely subject to confounding factors and cannot demonstrate causality. Nonetheless, the current study provides evidence that the Massachusetts reform laws may have resulted in lower mortality, carrying great implications for the Affordable Care Act.

Click to read the study, published today in the Annals of Internal Medicine

Click to read an editorial published in the Annals of Internal Medicine

Relevant Reading: Massachusetts Health Reform and Disparities in Coverage, Access and Health Status

In-Depth [pre-post, quasiexperimental study]: Data was obtained from the Centers for Disease Control and Prevention’s Compressed Mortality File. Adults aged 20 to 64 in Massachusetts were compared with a control group created from counties in non-reform states that matched the characteristics in the Massachusetts cohort. Two periods of time were compared: pre-reform (2001 to 2005) and post-reform (2007 to 2010). The primary outcome was all-cause mortality. The secondary outcome was mortality amenable to health care, defined in previous research as deaths related to conditions more likely to be preventable or treatable with timely care, such as heart disease, stroke, cancer, infections, and other conditions.

There were no significant baseline (pre-reform) differences between Massachusetts and the control group in the percentage of minorities or women, poverty and uninsured rates, and baseline mortality. However, reform in Massachusetts was associated with a significant decrease in all-cause mortality (-2.9%, p=0.003) and deaths from causes amenable to health care (-4.5%, p<0.001) compared with the control group. These changes were larger in counties with lower household incomes and higher prereform uninsured rates.

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