Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2010 Dec;25(12):1356-62. doi: 10.1007/s11606-010-1482-y. Epub 2010 Aug 21.
Massachusetts health reform has achieved near-universal insurance coverage, yet little is known about the effects of this legislation on disparities.
Since racial/ethnic minorities and low-income individuals are over-represented among the uninsured, we assessed the effects of health reform on disparities.
Cross-sectional survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS), 2006-2008.
Adults from Massachusetts (n = 36,505) and other New England states (n = 63,263).
Self-reported health coverage, inability to obtain care due to cost, access to a personal doctor, and health status. To control for trends unrelated to reform, we compared adults in Massachusetts to those in all other New England states using multivariate logistic regression models to calculate adjusted predicted probabilities.
Overall, the adjusted predicted probability of health coverage in Massachusetts rose from 94.7% in 2006 to 97.7% in 2008, whereas coverage in New England remained around 92% (p < 0.001 for difference-in-difference). While cost-related barriers were reduced in Massachusetts, there were no improvements in access to a personal doctor or health status. Although there were improvements in coverage and cost-related barriers for some disadvantaged groups relative to trends in New England, there was no narrowing of disparities in large part because of comparable or larger improvements among whites and the non-poor.
Achieving equity in health and health care may require additional focused intervention beyond health reform.
马萨诸塞州的医疗改革已经实现了近乎普及的保险覆盖，但对于这项立法对差异的影响知之甚少。
由于少数族裔和低收入人群在未参保人群中所占比例过高，我们评估了医疗改革对差异的影响。
来自行为风险因素监测调查（BRFSS）的横断面调查数据，2006-2008 年。
来自马萨诸塞州（n=36505）和其他新英格兰州（n=63263）的成年人。
自我报告的健康保险覆盖情况、因费用而无法获得护理的能力、获得私人医生的机会以及健康状况。为了控制与改革无关的趋势，我们使用多变量逻辑回归模型将马萨诸塞州的成年人与所有其他新英格兰州的成年人进行比较，计算调整后的预测概率。
总体而言，马萨诸塞州的健康保险覆盖调整后预测概率从 2006 年的 94.7%上升到 2008 年的 97.7%，而新英格兰的覆盖率则保持在 92%左右（差异的差异 p<0.001）。虽然马萨诸塞州的成本相关障碍有所减少，但在获得私人医生或健康状况方面没有改善。尽管与新英格兰的趋势相比，一些弱势群体在覆盖范围和成本相关障碍方面有所改善，但由于白人及非贫困人口的类似或更大改善，差异并未缩小。
要实现健康和医疗保健的公平，可能需要除医疗改革之外的其他重点干预措施。
