The impact of Massachusetts health care reform on an orthopedic hand service

Purpose: The impact of Massachusetts health care reform on the burden of uninsured orthopedic care is unclear. We examined the patient population at an academic orthopedic hand surgery practice based in an inner city, level 1 trauma center as a model. We hypothesized that the percentage of overall encounters with uninsured patients would decrease and that the percentages of overall encounters with privately insured and MassHealth (Medicaid) patients would increase.

Methods: We retrospectively tallied the insurance type of all patient encounters from 2004 to 2011 for an academic orthopedic hand surgery practice. Charity care and self pay constituted the uninsured group. Insurance types that do not offer patients a choice in enrollment, such as Medicare and motor vehicle insurance, were excluded. Non-Massachusetts residents were excluded. July 1, 2007, was used as the reference date for the implementation of reform policies. Paired t-tests and change-point linear regressions were performed.

Results: The overall percentage of encounters with uninsured patients declined by approximately 2%, and the overall percentage of encounters with privately insured patients increased by approximately 3.5%, both significant changes. No significant change in MassHealth (Medicaid) was observed. Change-point linear regression revealed that privately insured encounters increased rapidly after reform but that levels have remained roughly the same since. The uninsured population was already decreasing slightly between 2004 and 2007, at a rate of approximately 0.08% per month, but it also leveled off after 2007.

Conclusions: We found that the burden of uninsured encounters on our service was reduced by a statistically significant decrease of approximately one-half. This was accompanied by a significant increase in encounters with privately insured patients. No significant change in the number of MassHealth encounters occurred.

Type of study/level of evidence: Economic/Decision Analysis IV.