University of Minnesota, SHADAC, Minneapolis, MN 55414, USA.
Health Serv Res. 2011 Feb;46(1 Pt 2):365-87. doi: 10.1111/j.1475-6773.2010.01211.x. Epub 2010 Nov 19.
To analyze the effects of health reform efforts in two large states--New York and Massachusetts.
DATA SOURCES/STUDY SETTING: National Health Interview Survey (NHIS) data from 1999 to 2008.
We take advantage of the "natural experiments" that occurred in New York and Massachusetts to compare health insurance coverage and health care access and use for adults before and after the implementation of the health policy changes. To control for underlying trends not related to the reform initiatives, we subtract changes in the outcomes over the same time period for comparison groups of adults who were not affected by the policy changes using a differences-in-differences framework. The analyses are conducted using multiple comparison groups and different time periods as a check on the robustness of the findings.
DATA COLLECTION/EXTRACTION METHODS: Nonelderly adults ages 19-64 in the NHIS.
We find evidence of the success of the initiatives in New York and Massachusetts at expanding insurance coverage, with the greatest gains reported by the initiative that was broadest in scope--the Massachusetts push toward universal coverage. There is no evidence of improvements in access to care in New York, reflecting the small gains in coverage under that state's reform effort and the narrow focus of the initiative. In contrast, there were significant gains in access to care in Massachusetts, where the impact on insurance coverage was greater and a more comprehensive set of reforms were implemented to improve access to a full array of health care services. The estimated gains in coverage and access to care reported here for Massachusetts were achieved in the early period under health reform, before the state's reform initiative was fully implemented.
Comprehensive reform initiatives are more successful at addressing gaps in coverage and access to care than are narrower efforts, highlighting the potential gains under national health reform. Tracking the implications of national health reform will be challenging, as sample sizes and content in existing national surveys are not currently sufficient for in-depth evaluations of the impacts of reform within many states.
分析两个大州——纽约州和马萨诸塞州——的医改努力所产生的效果。
数据来源/研究环境：1999 年至 2008 年的全国健康访谈调查（NHIS）数据。
我们利用纽约州和马萨诸塞州发生的“自然实验”，比较这些政策变化实施前后，成年人的医疗保险覆盖范围和获得医疗服务的机会以及使用情况。为了控制与改革举措无关的潜在趋势，我们使用差异中的差异框架，为未受政策变化影响的成年人比较组减去同一时期内结果的变化。使用多个比较组和不同时间段进行分析，以检查结果的稳健性。
数据收集/提取方法：NHIS 中的 19-64 岁非老年人。
我们发现纽约州和马萨诸塞州的这些举措在扩大保险覆盖范围方面取得了成功的证据，其中范围最广的——马萨诸塞州推动普及保险——取得的成效最大。在纽约，没有证据表明获得医疗服务的情况有所改善，这反映了该州改革努力中保险覆盖范围的微小增长，以及该举措的重点狭窄。相比之下，在马萨诸塞州，获得医疗服务的机会有了显著改善，因为该州的保险覆盖范围有了更大的影响，并且实施了更全面的改革措施，以改善获得全方位医疗服务的机会。这里报告的马萨诸塞州在保险覆盖范围和获得医疗服务方面的估计收益是在医改早期实现的，当时该州的改革举措尚未全面实施。
全面的改革举措比范围较窄的举措更成功地解决了覆盖范围和获得医疗服务机会方面的差距，突出了国家医改带来的潜在收益。追踪国家医改的影响具有挑战性，因为现有国家调查的样本量和内容目前不足以对许多州的改革影响进行深入评估。
