PhotoIt's been more than three years since the Patient Protection and Affordable Care Act, also known as Obamacare, was signed into law, and nearly a year since it was upheld by the Supreme Court and still the debate rages: “Will it increase costs or won't it?”

In 2006, Massachusetts reformed its healthcare system and, according to data presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2013, there was no substantial increase in hospital use or costs. The reforms increased the number of people insured by 300,000.

And, the findings were true even among safety-net hospitals, which often have an open-door policy to accept patients regardless of the ability to pay. These hospitals are most likely to care for people who need free services, use Medicaid or must pay their own hospital bills.

Little difference

"In light of the Affordable Healthcare Act, we wanted to validate concerns that insurance reform would lead to dramatic increases in healthcare use and costs," said Amresh D. Hanchate, Ph.D., the study's lead author, an economist at the V.A. Boston Healthcare System and assistant professor at Boston University School of Medicine. "We were surprised to find little impact on healthcare use. Changes we saw in Massachusetts are very similar to those we saw in New Jersey, New York and Pennsylvania — states without reform."

The study analyzed information on more than 2.6 million patients ages 18-64 discharged from 66 short-term acute care hospitals in Massachusetts in 2004-2010.

Prior to reform, in 2004-2006, the number of average quarterly admissions for each hospital was 1,502. After reform, in 2008 -2010, the average was 1,557 -- a 3.6% increase versus a 3.3% increase in the comparison states.

Further findings

The researchers also found:

  • The total days of inpatient care increased by 0.94% in Massachusetts, compared with 0.80% in the comparison states.
  • Hospital charges per quarter rose 1.1% more in Massachusetts than in the comparison states.
  • Hospital use increased among previously high uninsured groups; the number of hospitalizations increased by 2.8% among blacks and by 4.5% among Hispanics.
  • The results were similar to those of safety-net hospitals and Medicare patients.

"These results are more applicable for states similar to Massachusetts in terms of the current healthcare system and government policy," Hanchate said. "Because states vary a lot, it's hard to say how this would compare for the rest of the country."

Further study is needed to determine if the delivery of services changed, including whether inpatient services being moved to an outpatient setting, he said.

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