title: Access to care after Massachusetts' health care reform: a safety net hospital patient survey.
abstract: BACKGROUND
  Massachusetts' health care reform substantially decreased the percentage of uninsured residents. However, less is known about how reform affected access to care, especially according to insurance type.
  
  
  OBJECTIVE
  To assess access to care in Massachusetts after implementation of health care reform, based on insurance status and type.
  
  
  METHODS
  We surveyed a convenience sample of 431 patients presenting to the Emergency Department of Massachusetts' second largest safety net hospital between July 25, 2009 and March 20, 2010.
  
  
  METHODS
  Demographic and clinical characteristics, insurance coverage, measures of access to care and cost-related barriers to care.
  
  
  RESULTS
  Patients with Commonwealth Care and Medicaid, the two forms of insurance most often newly-acquired under the reform, reported similar or higher utilization of and access to outpatient visits and rates of having a usual source of care, compared with the privately insured. Compared with the privately insured, a significantly higher proportion of patients with Medicaid or Commonwealth Care Type 1 (minimal cost sharing) reported delaying or not getting dental care (42.2 % vs. 27.1 %) or medication (30.0 % vs. 7.0 %) due to cost; those with Medicaid also experienced cost-related barriers to seeing a specialist (14.6 % vs. 3.5 %) or getting recommended tests (15.6 % vs. 5.9 %). Those with Commonwealth Care Types 2 and 3 (greater cost sharing) reported significantly more cost-related barriers to obtaining care than the privately insured (45.0 % vs. 16.0 %), to seeing a primary care doctor (25.0 % vs. 6.0 %) or dental provider (58.3 % vs. 27.1 %), and to obtaining medication (20.8 % vs. 7.0 %). No differences in cost-related barriers to preventive care were found between the privately and publicly insured.
  
  
  CONCLUSIONS
  Access to care improved less than access to insurance following Massachusetts' health care reform. Many newly insured residents obtained Medicaid or state subsidized private insurance; cost-related barriers to access were worse for these patients than for the privately insured.
authors: Department of Medicine, Cambridge Health Alliance, 1493 Cambridge St;, Cambridge, MA, 02139, USA. dmccormick@challiance.org
authors: Danny
authors: D
authors: McCormick
authors: Assaad
authors: A
authors: Sayah
authors: Hermione
authors: H
authors: Lokko
authors: Steffie
authors: S
authors: Woolhandler
authors: Rachel
authors: R
authors: Nardin
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D018166:Health Care Reform / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D061214:Patient Safety; D014481:United States; D055815:Young Adult