Journal of General Internal Medicine

, Volume 27, Issue 11, pp 1548–1554

Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey


    • Department of MedicineCambridge Health Alliance
    • Harvard Medical School
  • Assaad Sayah
    • Department of Emergency MedicineCambridge Health Alliance
    • Harvard Medical School
  • Hermione Lokko
    • Harvard Medical School
  • Steffie Woolhandler
    • City University of New York School of Public Health
  • Rachel Nardin
    • Department of MedicineCambridge Health Alliance
    • Harvard Medical School
Original Research

DOI: 10.1007/s11606-012-2173-7

Cite this article as:
McCormick, D., Sayah, A., Lokko, H. et al. J GEN INTERN MED (2012) 27: 1548. doi:10.1007/s11606-012-2173-7



Massachusetts’ health care reform substantially decreased the percentage of uninsured residents. However, less is known about how reform affected access to care, especially according to insurance type.


To assess access to care in Massachusetts after implementation of health care reform, based on insurance status and type.


We surveyed a convenience sample of 431 patients presenting to the Emergency Department of Massachusetts’ second largest safety net hospital between July 25, 2009 and March 20, 2010.


Demographic and clinical characteristics, insurance coverage, measures of access to care and cost-related barriers to care.


Patients with Commonwealth Care and Medicaid, the two forms of insurance most often newly-acquired under the reform, reported similar or higher utilization of and access to outpatient visits and rates of having a usual source of care, compared with the privately insured. Compared with the privately insured, a significantly higher proportion of patients with Medicaid or Commonwealth Care Type 1 (minimal cost sharing) reported delaying or not getting dental care (42.2 % vs. 27.1 %) or medication (30.0 % vs. 7.0 %) due to cost; those with Medicaid also experienced cost-related barriers to seeing a specialist (14.6 % vs. 3.5 %) or getting recommended tests (15.6 % vs. 5.9 %). Those with Commonwealth Care Types 2 and 3 (greater cost sharing) reported significantly more cost-related barriers to obtaining care than the privately insured (45.0 % vs. 16.0 %), to seeing a primary care doctor (25.0 % vs. 6.0 %) or dental provider (58.3 % vs. 27.1 %), and to obtaining medication (20.8 % vs. 7.0 %). No differences in cost-related barriers to preventive care were found between the privately and publicly insured.


Access to care improved less than access to insurance following Massachusetts’ health care reform. Many newly insured residents obtained Medicaid or state subsidized private insurance; cost-related barriers to access were worse for these patients than for the privately insured.


access to carehealth insurancehealth disparitieshealth care reformhealth care policy

Supplementary material

11606_2012_2173_MOESM1_ESM.docx (16 kb)
Supplementary Table 1.Cost Sharing and Health Benefits in Massachusetts Public Health Insurance Plans in 2009–2010 (DOCX 16 kb)

Copyright information

© Society of General Internal Medicine 2012