Death Rates Fell in MA After Health-Care Reform
The study also found that more people in Massachusetts had insurance after the law was enacted. There were also fewer cost-related barriers to care, and more people saw their doctors for preventive care, according to the study. People also reported overall improvements in their health.
Glen Mays, professor of health services and systems research at the University of Kentucky in Lexington, said the study adds to a growing body of evidence showing that health reform improves people's health.
"Interventions that can make a dent in overall death rates in the space of just a few years are few and far between, and certainly worthy of attention," Mays said.
But the drop in deaths in Massachusetts may not have been solely the result of expanded health insurance coverage in the state, he said. Lower out-of-pocket costs for preventive care and enhanced public health programs may have played a role, too.
A previously published study showed large reductions in smoking prevalence and tobacco-related health problems among people on Medicaid after Massachusetts added a comprehensive tobacco cessation benefit to the public health program as part of its health reform strategy, Mays noted.
"You can't rule out the possibility that something else is going on," agreed Christopher Conover, a research scholar at the Center for Health Policy and Inequities Research at Duke University. "But I think they've done as good a job as you can do with the data they've got in nailing it down and tying it to insurance coverage as the causal explanation."
"The conclusion that coverage expansion leads to health benefits by facilitating access is eminently reasonable," Austin Frakt, a health economist at the Veterans Affairs Boston Healthcare System, writes in an accompanying editorial in the same issue of the journal.
But at what cost to society? The study does not examine whether health reforms that save one life per 830 people are cost effective.
Based on the study, Conover offered his own rough calculation, suggesting that saving one life costs upwards of $272,000 per "quality-adjusted year of life," a measure that refers to the quality and quantity gained as a result of the health reforms.
"Is that a good way of spending valuable taxpayer dollars? I think that's a legitimate question to be asking," Conover said.