After implementation of health insurance reforms occurred in Massachusetts that also expanded access to care to non-safety-net hospitals, the proportion of discharges among minority patients receiving inpatient care at minority-serving hospitals increased had an increased proportion of discharges.1 The insurance reforms expanded access to care in non-safety net hospitals. However, these findings suggest , suggesting that minority-serving hospitals remain are an important and vital to providing care for these patient populations. These facilities may benefit from component of the health care system and may benefit greatly from iinterventions such as raising Medicaid reimbursement rates.1

The health reform in Massachusetts, which occurred in , implemented in 2006-2008, expanded access to public medical insurance, created a health insurance exchange for more affordable private insurance, and served as a model for the Affordable Care Act (ACA). As a result, thousands of previously uninsured patients entered the marketplace.

The researchers compared Inpatient inpatient discharge data from 2004 to 2009 for Massachusetts, New York, and New Jersey were compared between 2004 and 2009 by the research team. They also identified minority-serving hospitals and safety-net hospitals in each state, and then examined the change in concentrations of minority discharges at minority-serving hospitals and tracked the movement of “safety-net hospital users,” (or patients with at least four 4 hospitalizations within the study period).

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The minority-serving hospitals in Massachusetts had a significant increase of 5.8% in minority discharges compared to New Jersey, and a nonsignificant increase of 2.1% compared to New York. Among patients who were “the safety-net hospital users,” in all 3 states, 62% continued to receive care at safety-net hospitals in the post-reform period. Patient Only slightly greater movement of patients from safety-net to non-safety-net hospitals was only slightly greater occurred in Massachusetts versus vs New York and New Jersey.

“We went into this study assuming that we’d see a migration of minority patients away from minority-serving hospitals post-reform, but we saw an increase in the proportion of minority patients at minority-serving hospitals,” said lead author explained Karen Lasser, MD, MPH, primary care internist at Boston Medical Center and associate professor of medicine at Boston University School of Medicine, and lead author of the study. 

“While Massachusetts safety-net hospitals (many of which are minority-serving) received large cuts in payments with the idea that other hospitals would assume the care of previously uninsured patients, this study demonstrates the importance of securing the future of safety-net and minority-serving hospitals through policy-based interventions to assure the continued care of vulnerable and underserved patient populations.”

Possible explanations for the increased proportion of minorities cared for at minority-serving hospitals in Massachusetts over the study period were offered. These explanations include “loyalty” of minority patients; services that are often unavailable at other facilities due to poor reimbursement rates such as insurance assistance, interpretation, and intensive case management which are often unavailable at other facilities due to poor reimbursement rates; and a primary care physician shortage in Massachusetts.


1. Lasser KE, Hanchate AD, McCormick D, et al. Massachusetts Health health Reform’s reform’s Effect effect on Hospitals’ hospitals’ Racial racial Mix mix of Patients patients and on Patients’ patients’ Use use of Safetysafety-net Hospitals hospitals[published online June 3, 2016]. Medical Care. 2016 Jun 3. doi:10.1097/MLR.0000000000000575. [Epub ahead of print]