title: The effect of the Massachusetts healthcare reform on the uninsured rate of the orthopaedic trauma population.
abstract: BACKGROUND
  The 2006 Massachusetts Healthcare Reform (MHR) has resulted in health coverage for 98.1% of residents in Massachusetts. The purpose of this study was to evaluate the effect of MHR on the actual rate of uninsured individuals in the orthopaedic trauma population in the largest metropolitan area of Massachusetts. We also sought to measure the change in uncompensated care following the implementation of MHR.
  
  
  METHODS
  We performed a retrospective review of all patients treated by the orthopaedic trauma services at three of the four level-I trauma centers in Boston from 2003 to 2010. The primary study cohort consisted of all uninsured patients, while the remaining patients were considered to have insurance. The study population was divided into two groups to compare the uninsured rate before and after MHR. Patients from 2006 to 2007 were excluded from the analysis to allow for an enrollment period in subsidized health insurance.
  
  
  RESULTS
  A total of 16,338 patients with extremity and pelvic fractures and dislocations were treated from 2003 to 2010. There was a significant decrease in the uninsured rate from 23.8% to 14.4% following MHR (p < 0.001). The post-MHR risk of being uninsured is approximately 0.6 times the pre-MHR risk, with a 95% confidence interval of 0.56 to 0.65. There was also a reduction in the proportion of uncompensated care from 16.7% to 11.5% after MHR.
  
  
  CONCLUSIONS
  There was an estimated 40% reduction in risk of uninsured individuals in the orthopaedic trauma population in the metropolitan Boston area following MHR. Despite a significant improvement, these results reveal a rate of uninsured individuals fivefold greater than currently reported by the state of Massachusetts and the U.S. government.
authors.affiliation: Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, 55 Fruit Street, White 535, Boston, MA 02115.
authors.forename: Rull James
authors.initials: RJ
authors.lastname: Toussaint
authors.affiliation: Department of Orthopaedic Surgery, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Pav. E Room E-003, Montreal, QC H3T 1E2, Canada.
authors.forename: Stephane G
authors.initials: SG
authors.lastname: Bergeron
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street Boston, MA 02115.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Weaver
authors.affiliation: Department of Orthopaedic Surgery, Boston Medical Center, 725 Albany Street, Shapiro 4th Floor, Suite 4B, Boston, MA 02118.
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 3C, Boston, MA 02114.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Vrahas
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street Boston, MA 02115.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D001900:Boston; D005121:Extremities / Q000293:injuries*; D050723:Fractures, Bone / Q000601:surgery*; D018166:Health Care Reform / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D017664:Uncompensated Care / Q000706:statistics & numerical data; D055815:Young Adult