Access to and Affordability of Care in Massachusetts as of Fall 2008: Geographic and Racial/Ethnic Differences

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Abstract

Massachusetts continues to move forward on comprehensive health reform, with improvements in coverage, access to care and the affordability of care in the state. This policy brief provides a supplement to a recent Health Affairs article on health reform in Massachusetts, examining geographic and racial/ethnic differences in access to care and affordability of care across the commonwealth in Fall 2008.

Summary

Massachusetts continues to move forward on comprehensive health reform, with uninsurance at historically low levels. Building on that coverage expansion, there have been improvements in access to care and the affordability of care in the state, as reported in a recent Health Affairs article. Notwithstanding these successes, some of the early gains under health reform in reducing barriers to care and improving the affordability of care had eroded by Fall 2008, reflecting trends that pre-date health reform—constraints on provider capacity and increasing health care costs. This policy brief provides a supplement to the recent Health Affairs article, examining geographic and racial/ethnic differences in access to care and affordability of care across Massachusetts in Fall 2008.

Data and Methods

This brief uses data from a survey of adults aged 18 to 64 years old in Massachusetts that was conducted in Fall 2008 (N=4,041). The survey, which is part of an on-going effort to track the effects of health reform in the state, is described elsewhere. Of relevance here, the Fall 2008 survey included oversamples across six regions of the state and among non-Hispanic black and Hispanic adults in the state. As shown in Exhibit 1, the six regions of the state are:

(1) Boston—Suffolk county (N=613)
(2) MetroWest—Middlesex and Norfolk counties (N=800)
(3) Northeast—Essex county (N=414)
(4) Central—Worcester county (N=640)
(5) Western—Berkshire, Franklin, Hampden, and Hampshire counties (N=820)
(6) Southeast—Barnstable, Bristol, Dukes, Nantucket and Plymouth counties (N=754)

In testing for differences across the regions, we use the MetroWest region as the comparison since we find that adults in that region tend to have better access to care and fewer issues with the affordability of health care than adults in other regions of the state. We also rank the regions from 1 (better access or affordability) to 6 (worse access or affordability) on each of the measures to facilitate the comparison of the regions across the full set of access to care and affordability of care measures.

In testing for differences across racial/ethnic groups, we compare non-Hispanic black adults (N=392) and Hispanic adults (N=576) to white, non-Hispanic adults (N=2,668). We do not have a sufficient sample size to include other, non-Hispanic adults in this part of the analysis.

We control for differences in health care needs in making the comparisons reported here to focus on differences in access to and affordability of care for adults in Massachusetts with similar health care needs.4 Specifically, we control for age, gender, health status, disability status, presence of chronic conditions, and, for women, whether they were pregnant in the last 12 months. Thus, the differences across regions or across race/ethnicity groups reported here reflect the effects of factors beyond these measures of health care needs, including differences in socioeconomic status, in the local health care system, or other factors.

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