Patients still need safety nets after healthcare reform


A new study finds an increase in the proportion of minority patients who use safety-net hospitals in Massachusetts since the state implemented healthcare reform, according to a new study published in the journal Medical Care.

Massachusetts implemented widespread health reform from 2006 to 2008. As a result, previously uninsured patients received public medical insurance and had opportunities to acess more affordable medical insurance.  Researchers from Boston Medical Center, led by Karen Lasser, M.D., thought that as a result more minority patients wouldn't seek care as often at safety-net hospitals. But the findings proved otherwise.

Researchers compared inpatient discharge data from Massachusetts providers to that of New York and New Jersey providers between 2004 and 2009, identifying safety-net hospitals and those serving predominantly minority populations in each state. They next analyzed shifts in discharges at minority-serving providers as well as the movement of patients with four or more hospitalizations within the study period, or “safety-net hospital users.”

They found minority discharges at the Bay State’s minority-serving hospitals increased 5.8 percent compared to New Jersey. They increased relative to New York as well, but only a statistically non-significant 2.1 percent. Sixty-two percent of the safety-net hospital users across all three states continued to receive care at safety-care hospitals in the second half of the research period, after Massachusetts implemented its healthcare reform.

Researchers have a few theories as to the increase of minorities seeking care at minority-serving hospitals in Massachusetts, including services they can’t get anywhere else such as interpretation and intensive care management, or Massachusetts’ primary care physician shortage.

“We went into this study assuming that we’d see a migration of minority patients away from minority-serving hospitals post-reform, but we saw an increase in the proportion of minority patients at minority-serving hospitals,” Lasser said in a statement. “While Massachusetts safety-net hospitals (many of which are minority-serving) received large cuts in payments with the idea that other hospitals would assume the care of previously uninsured patients, this study demonstrates the importance of securing the future of safety-net and minority-serving hospitals through policy-based interventions to assure the continued care of vulnerable and underserved patient populations.”

Support for safety-net facilities in the wake of healthcare reform is also a major issue at the national level, as many such hospitals, particularly in rural areas, face reimbursement cuts under the Affordable Care Act without increased Medicaid revenues to offset them.

- here’s the study abstract
- read the statement