Survival rates in trauma patients after Massachusetts health insurance reform

Massachusetts introduced health care reform in 2006 to expand health insurance coverage and improve outcomes. Some previous research has suggested improved survival rates following injury in patients with insurance. But the relationship of insurance to survival after injury may not be well understood. Some might expect that survival after traumatic injury may be unrelated to a person's insurance status because all injured persons have access to emergency care, according to the study background.

Turner Osler, M.D., M.Sc., of the University of Vermont, Colchester, and coauthors conducted a study of more than 1.5 million patients hospitalized following traumatic injury in Massachusetts or New York, a neighboring state that did not institute health care reform like Massachusetts. The study examined the 10 years (2002-2011) surrounding reform in Massachusetts.

The rates of uninsured trauma patients in Massachusetts decreased steadily from 14.9 percent in 2002 to 5 percent in 2011. The authors also found health care reform was associated with a passing increase in the adjusted mortality rate that accounted for as many as 604 excess deaths during four years.

"Fortunately, the increase in mortality among trauma patients following Massachusetts HCR [health care reform] resolved within a few years. It may not be possible to retrospectively reconstruct the causal pathway responsible for the increased excess deaths following HCR and its subsequent resolution. ... There are compelling arguments for providing health insurance to all citizens of the United States but our analysis suggests that simply providing health insurance incentives and subsidies does not improve survival for trauma patients. ... Ours is thus a cautionary tale for health care reformers: successful HCR for trauma patients will likely require more complex interventions than simply promoting health insurance coverage legislatively," the study concludes.