title: The impact of Massachusetts health care reform on access, quality, and costs of care for the already-insured.
abstract: OBJECTIVE
  To assess the impact of Massachusetts Health Reform (MHR) on access, quality, and costs of outpatient care for the already-insured.
  
  
  METHODS
  Medicare data from before (2006) and after (2009) MHR implementation.
  
  
  METHODS
  We performed a retrospective difference-in-differences analysis of quantity of outpatient visits, proportion of outpatient quality metrics met, and costs of care for Medicare patients with ≥ 1 chronic disease in 2006 versus 2009. We used the remaining states in New England as controls.
  
  
  METHODS
  We used existing Medicare claims data provided by the Centers for Medicare and Medicaid Services.
  
  
  RESULTS
  MHR was not associated with a decrease in outpatient visits per year compared to controls (9.4 prereform to 9.6 postreform in MA vs. 9.4-9.5 in controls, p = .32). Quality of care in MA improved more than controls for hemoglobin A1c monitoring, mammography, and influenza vaccination, and similarly to controls for diabetic eye examination, colon cancer screening, and pneumococcal vaccination. Average costs for patients in Massachusetts increased from $9,389 to $10,668, versus $8,375 to $9,114 in control states (p < .001).
  
  
  CONCLUSIONS
  MHR was not associated with worsening in access or quality of outpatient care for the already-insured, and it had modest effects on costs. This has implications for other states expanding insurance coverage under the Affordable Care Act.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA; VA Boston Healthcare System, Boston, MA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.forename: David C
authors.initials: DC
authors.lastname: Chan
authors.forename: Jie
authors.initials: J
authors.lastname: Zheng
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D018166:Health Care Reform / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D006278:Medicare / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups; D012189:Retrospective Studies; D014481:United States
keywords: Insurance expansion; costs; outpatient care; quality