J Policy Anal Manage. 2014 Winter;33(1):36-69. doi: 10.1002/pam.21737.
In 2006, Massachusetts passed health care reform legislation designed to achieve nearly universal coverage through a combination of insurance market reforms, mandates, and subsidies that later served as the model for national reform. Using data from the Behavioral Risk Factor Surveillance System, we provide evidence that health care reform in Massachusetts led to better overall self-assessed health. Various robustness checks and placebo tests support a causal interpretation of the results. We also document improvements in several determinants of overall health: physical health, mental health, functional limitations, joint disorders, and body mass index. Next, we show that the effects on overall health were strongest among those with low incomes, nonwhites, near-elderly adults, and women. Finally, we use the reform to instrument for health insurance and estimate a sizeable impact of coverage on health.
2006 年，马萨诸塞州通过了医疗改革立法，旨在通过保险市场改革、强制规定和补贴的结合，实现近乎普及的医疗保险，这些措施后来成为国家改革的典范。我们利用行为风险因素监测系统的数据，提供了证据表明，马萨诸塞州的医疗保健改革导致了整体自我评估健康状况的改善。各种稳健性检查和安慰剂测试支持对结果的因果解释。我们还记录了整体健康状况的几个决定因素的改善：身体健康、心理健康、功能障碍、关节疾病和体重指数。接下来，我们表明，改革对低收入者、非白人、接近老年的成年人和女性的整体健康影响最大。最后，我们利用改革来为健康保险提供工具，并估计覆盖范围对健康的巨大影响。
