title: Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: a quasi-natural experiment.
abstract: OBJECTIVE
  We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of same-sex marriage laws in Massachusetts in 2003.
  
  
  METHODS
  We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts.
  
  
  RESULTS
  In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean = 5.00 vs mean = 4.67; P = .05; Cohen's d = 0.17), mental health care visits (mean = 24.72 vs mean = 22.20; P = .03; Cohen's d = 0.35), and mental health care costs (mean = $2442.28 vs mean = $2137.38; P = .01; Cohen's d = 0.41), compared with the 12 months before the law change. These effects were not modified by partnership status, indicating that the health effect of same-sex marriage laws was similar for partnered and nonpartnered men.
  
  
  CONCLUSIONS
  Policies that confer protections to same-sex couples may be effective in reducing health care use and costs among sexual minority men.
authors.affiliation: Center for the Study of Social Inequalities in Health, Mailman School of Public Health, Columbia University, 722 W 168 St, New York, NY 10032, USA. mlh2101@columbia.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hatzenbuehler
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: Chris
authors.initials: C
authors.lastname: Grasso
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.forename: Steven
authors.initials: S
authors.lastname: Safren
authors.forename: Judith
authors.initials: J
authors.lastname: Bradford
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001727:Bisexuality / Q000706:statistics & numerical data; D003151:Community Health Centers / Q000191:economics* / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008393:Marriage / Q000208:ethnology / Q000331:legislation & jurisprudence*; D008404:Massachusetts; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D057766:Policy; D011446:Prospective Studies; D012959:Socioeconomic Factors