Rates of insurance for injured patients before and after health care reform in Massachusetts: a possible case of double jeopardy.
OBJECTIVE
We determined how preinjury insurance status and injury-related outcomes among able-bodied, community-dwelling adults treated at a Level I Trauma Center in central Massachusetts changed after health care reform.


METHODS
We compared insurance status at time of injury among non-Medicare-eligible adult Massachusetts residents before (2004-2005) and after (2009-2010) health care reform, adjusted for demographic and injury covariates, and modeled associations between insurance status and trauma outcomes.


RESULTS
Among 2148 patients before health care reform and 2477 patients after health care reform, insurance rates increased from 77% to 84% (P < .001). Younger patients, men, minorities, and penetrating trauma victims were less likely to be insured irrespective of time period. Uninsured patients were more likely to be discharged home without services (adjusted odds ratio = 3.46; 95% confidence interval = 2.65, 4.52) compared with insured patients.


CONCLUSIONS
Preinjury insurance rates increased for trauma patients after health care reform but remained lower than in the general population. Certain Americans may be in "double jeopardy" of both higher injury incidence and worse outcomes because socioeconomic factors placing them at risk for injury also present barriers to compliance with an individual insurance mandate.
Heena P. Santry is with the Departments of Surgery and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Courtney E. Collins, Jason T. Wiseman, and Charles M. Psoinos are with the Department of Surgery, University of Massachusetts Medical School. Julie M. Flahive is with the Center for Outcomes Research, University of Massachusetts Medical School. Catarina I. Kiefe is with the Department of Quantitative Health Sciences, University of Massachusetts Medical School.
Heena P
HP
Santry
Courtney E
CE
Collins
Jason T
JT
Wiseman
Charles M
CM
Psoinos
Julie M
JM
Flahive
Catarina I
CI
Kiefe
D000293:Adolescent; D000328:Adult; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D014947:Wounds and Injuries / Q000453:epidemiology*; D014950:Wounds, Penetrating / Q000453:epidemiology; D055815:Young Adult