Massachusetts Health Reform's Effect on Hospitalizations with Substance Use Disorder-Related Diagnoses.

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Abstract

OBJECTIVE

To examine whether Massachusetts (MA) health reform affected substance (alcohol or drug) use disorder (SUD)-related hospitalizations in acute care hospitals.

DATA/STUDY SETTING

2004-2010 MA inpatient discharge data.

DESIGN

Difference-in-differences analysis to identify pre- to postreform changes in age- and sex-standardized population-based rates of SUD-related medical and surgical hospitalizations, adjusting for secular trends.

DATA EXTRACTION METHODS

We identified 373,751 discharges where a SUD-related diagnosis was a primary or secondary discharge diagnosis.

FINDINGS

Adjusted for age and sex, the rates of drug use-related and alcohol use-related hospitalizations prereform were 7.21 and 8.87 (per 1,000 population), respectively, in high-uninsurance counties, and 8.58 and 9.63, respectively, in low-uninsurance counties. Both SUD-related rates increased after health reform in high- and low-uninsurance counties. Adjusting for secular trends in the high- and low-uninsurance counties, health reform was associated with no change in drug- or alcohol-related hospitalizations.

CONCLUSIONS

Massachusetts health reform was not associated with any changes in substance use disorder-related hospitalizations. Further research is needed to determine how to reduce substance use disorder-related hospitalizations, beyond expanding insurance coverage.

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