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Elective surgeries up among low-income and Hispanic adults after state health law

More low-income and Hispanic adults in Massachusetts underwent knee or hip replacements and 15 other elective inpatient surgeries after the state expanded health insurance coverage to nearly all its residents in 2006, according to a new study by Boston University researchers.

The results suggest that the law helped these populations more readily see primary care physicians who would have referred them for such operations, said Boston University School of Medicine professor Nancy Kressin, who led the study.

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“The starting point in that whole process is to go to the primary care doctor who says ‘Hmmm, you need to go to an orthopedist,’ ” she said.

Kressin’s group compared surgery rates for middle-aged adults in the 21 months just before Massachusetts expanded Medicaid in July 2006 to cover more low-income patients, with rates between January 2008 and September 2009.

To account for medical trends unrelated to passage of the law, the researchers also looked at surgery rates among elderly Medicare patients who were unaffected by the expanded coverage. When the data were adjusted for these trends, Hispanic patients underwent 22 percent more elective surgeries, which also included hysterectomies and heart valve procedures. There was no net increase for black patients. Residents of areas with low average incomes sought 8 percent more surgeries after 2006, according to the study published in the current issue of the journal Medical Care.

“This actually shows some continuity of care, and following a treatment plan that’s been established by a primary care provider,” said Amy Whitcomb Slemmer, executive director of the Boston-based consumer group Health Care for All. “It’s fulfilling part of the promise of health reform.”

Kressin’s findings are consistent with a 2010 Urban Institute survey funded by the Blue Cross Blue Shield of Massachusetts Foundation , which found that within three years of the law passing, non-white patients were about as likely as white patients to have seen a doctor in the past year, closing a gap from 2006.

A Harvard School of Public Health study released this week found that many people who reported being sick in the past year felt that high out-of-pocket costs were an increasing barrier to health care in Massachusetts.

“Maybe there were a number of people who didn’t get the procedure who would have otherwise but for the out-of-pocket costs,” said Kressin, “but these results [of her study] suggest an increasing number of people did get procedures.”

Helen Shen can be reached at helen.shen@globe.com. Follow her on Twitter @HelenShenWrites.
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