IDEAS home Printed from https://ideas.repec.org/a/eee/pubeco/v96y2012i11p909-929.html
   My bibliography  Save this article

The impact of health care reform on hospital and preventive care: Evidence from Massachusetts

Author

Listed:
  • Kolstad, Jonathan T.
  • Kowalski, Amanda E.

Abstract

In April 2006, Massachusetts passed legislation aimed at achieving near-universal health insurance coverage. The key features of this legislation were a model for national health reform, passed in March 2010. The reform gives us a novel opportunity to examine the impact of expansion to near-universal coverage state-wide. Among hospital discharges in Massachusetts, we find that the reform decreased uninsurance by 36% relative to its initial level and to other states. Reform affected utilization by decreasing length of stay, and the number of inpatient admissions originating from the emergency room. When we control for patient severity, we find evidence that preventable admissions decreased. At the same time, hospital cost growth did not increase.

Suggested Citation

  • Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
  • Handle: RePEc:eee:pubeco:v:96:y:2012:i:11:p:909-929
    DOI: 10.1016/j.jpubeco.2012.07.003
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0047272712000849
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.jpubeco.2012.07.003?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Amanda Kowalski, 2016. "Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 34(1), pages 107-117, January.
    2. Jonathan Gruber & Samuel A. Kleiner, 2012. "Do Strikes Kill? Evidence from New York State," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 127-157, February.
    3. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    4. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 431-466.
    5. Douglas Almond & Joseph J. Doyle & Amanda E. Kowalski & Heidi Williams, 2010. "Estimating Marginal Returns to Medical Care: Evidence from At-risk Newborns," The Quarterly Journal of Economics, Oxford University Press, vol. 125(2), pages 591-634.
    6. Paul L. Joskow, 1980. "The Effects of Competition and Regulation on Hospital Bed Supply and the Reservation Quality of the Hospital," Bell Journal of Economics, The RAND Corporation, vol. 11(2), pages 421-447, Autumn.
    7. Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
    8. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, Oxford University Press, vol. 127(3), pages 1057-1106.
    9. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    10. David Dranove & Mark A. Satterthwaite, 1992. "Monopolistic Competition When Price and Quality are Imperfectly Observable," RAND Journal of Economics, The RAND Corporation, vol. 23(4), pages 518-534, Winter.
    11. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    12. Glied, Sherry & Zivin, Joshua Graff, 2002. "How do doctors behave when some (but not all) of their patients are in managed care?," Journal of Health Economics, Elsevier, vol. 21(2), pages 337-353, March.
    13. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, Oxford University Press, vol. 119(1), pages 249-275.
    14. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 1-37.
    15. Congressional Budget Office, 2012. "Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act," Reports 43076, Congressional Budget Office.
    16. Mark G. Duggan, 2000. "Hospital Ownership and Public Medical Spending," The Quarterly Journal of Economics, Oxford University Press, vol. 115(4), pages 1343-1373.
    17. Sharon K. Long & Karen Stockley & Alshadye Yemane, 2009. "Another Look at the Impacts of Health Reform in Massachusetts: Evidence Using New Data and a Stronger Model," American Economic Review, American Economic Association, vol. 99(2), pages 508-511, May.
    18. Kowalski, A. & Kolstad, J., 2010. "The Impact of an Individual Health Insurance Mandate on Hospital and Preventive Care: Evidence from Massachusetts," Health, Econometrics and Data Group (HEDG) Working Papers 10/18, HEDG, c/o Department of Economics, University of York.
    19. David M. Cutler & Jonathan Gruber, 1996. "Does Public Insurance Crowd out Private Insurance?," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 391-430.
    20. Congressional Budget Office, 2012. "Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act," Reports 43076, Congressional Budget Office.
    21. David M. Cutler & Mark McClellan & Joseph P. Newhouse, 2000. "How Does Managed Care Do It?," RAND Journal of Economics, The RAND Corporation, vol. 31(3), pages 526-548, Autumn.
    22. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Johanna Catherine Maclean & Brendan Saloner, 2018. "Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 76-101, January.
    2. repec:hrv:faseco:34330197 is not listed on IDEAS
    3. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    4. Mark Duggan & Atul Gupta & Emilie Jackson, 2019. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector," NBER Working Papers 25488, National Bureau of Economic Research, Inc.
    5. Dunn, Abe & Shapiro, Adam Hale, 2015. "Physician payments under health care reform," Journal of Health Economics, Elsevier, vol. 39(C), pages 89-105.
    6. Ponzo, Michela & Scoppa, Vincenzo, 2016. "Cost-Sharing and Use of Health Services in Italy: Evidence from a Fuzzy Regression Discontinuity Design," IZA Discussion Papers 9772, Institute of Labor Economics (IZA).
    7. Ponzo, Michela & Scoppa, Vincenzo, 2021. "Does demand for health services depend on cost-sharing? Evidence from Italy," Economic Modelling, Elsevier, vol. 103(C).
    8. Bhalotra, Sonia & Fernández, Manuel, 2021. "The Right to Health and the Health Effects of Denials," CEPR Discussion Papers 16642, C.E.P.R. Discussion Papers.
    9. Raj Chetty & Amy Finkelstein, 2012. "Social Insurance: Connecting Theory to Data," NBER Working Papers 18433, National Bureau of Economic Research, Inc.
    10. Barbaresco, Silvia & Courtemanche, Charles J. & Qi, Yanling, 2015. "Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults," Journal of Health Economics, Elsevier, vol. 40(C), pages 54-68.
    11. Zhao, Weimin, 2019. "Does health insurance promote people's consumption? New evidence from China," China Economic Review, Elsevier, vol. 53(C), pages 65-86.
    12. Kondo, Ayako & Shigeoka, Hitoshi, 2013. "Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan," Journal of Public Economics, Elsevier, vol. 99(C), pages 1-23.
    13. Johanna Catherine Maclean & Brendan Saloner, 2019. "The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(2), pages 366-393, March.
    14. Andersen, Martin S., 2018. "Effects of Medicare coverage for the chronically ill on health insurance, utilization, and mortality: Evidence from coverage expansions affecting people with end-stage renal disease," Journal of Health Economics, Elsevier, vol. 60(C), pages 75-89.
    15. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    16. Dominic Coey, 2015. "The Effect of Medicaid on Health Care Consumption of Young Adults," Health Economics, John Wiley & Sons, Ltd., vol. 24(5), pages 558-565, May.
    17. Jacqueline Fiore, 2017. "The Impact of the Affordable Care Act's Medicaid Expansion on Medicaid Spending by Health Care Service Category," Working Papers 1706, Tulane University, Department of Economics, revised Mar 2018.
    18. Miller, Sarah, 2012. "The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform," Journal of Public Economics, Elsevier, vol. 96(11), pages 893-908.
    19. Dunn, Abe & Knepper, Matthew & Dauda, Seidu, 2021. "Insurance expansions and hospital utilization: Relabeling and reabling?," Journal of Health Economics, Elsevier, vol. 78(C).
    20. Hamersma, Sarah & Maclean, Johanna Catherine, 2021. "Do expansions in adolescent access to public insurance affect the decisions of substance use disorder treatment providers?," Journal of Health Economics, Elsevier, vol. 76(C).
    21. Akosa Antwi, Yaa & Moriya, Asako S. & Simon, Kosali I., 2015. "Access to health insurance and the use of inpatient medical care: Evidence from the Affordable Care Act young adult mandate," Journal of Health Economics, Elsevier, vol. 39(C), pages 171-187.

    More about this item

    Keywords

    Health; Health care; Health reform; Insurance; Hospitals; Massachusetts; Preventive care;
    All these keywords.

    JEL classification:

    • H22 - Public Economics - - Taxation, Subsidies, and Revenue - - - Incidence
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I28 - Health, Education, and Welfare - - Education - - - Government Policy
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:pubeco:v:96:y:2012:i:11:p:909-929. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: http://www.elsevier.com/locate/inca/505578 .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505578 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.