BUSM Study Finds Increasing Health Coverage Does Not Improve Readmission Rates

In a first of its kind retrospective study, BUSM researchers have found that providing health insurance coverage to previously uninsured people does not result in reducing 30-day readmission rates. The study, which appears in the British Medical Journal, used data on actual versus self-reported use of care and found no change in racial/ethnic disparities in this outcome, despite a markedly higher baseline of un-insurance among African-American and Hispanics in Massachusetts.

Hospital readmissions have been the focus of health policy interventions to reduce costs with particular focus given to uninsured and minority populations who are at increased risk for frequent readmissions. In March 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act, into law. The law established a Hospital Readmissions Reduction Program, which requires the United States Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions, effective for discharges beginning on October 1, 2012.

Prior studies suggest that when individuals have insurance, they are more likely to have a usual source of care and to utilize medical care, which can prevent unnecessary and costly hospitalizations. However, it is unknown whether expanding health insurance coverage can reduce the risk of readmissions in the overall population, specifically among minority populations.

“Among African-Americans and Hispanics, we found the odds of readmission did not decrease in Massachusetts relative to control states, and there was no change in the magnitude of the white-black and white-Hispanic difference in readmission rates,” explained lead author Karen Lasser, MD, MPH, an associate professor of medicine at BUSM.

The researchers believe that in order to reduce readmissions and disparities in readmissions, states in the US like Massachusetts need to go beyond simply expanding insurance coverage.

Funding for this study was provided by the U.S. National Institutes of Health grants (1R21NS062677, A. Hanchate, PI & 1U01HL105342-01, N. Kressin, PI) and a grant from the Rx foundation. Dr. Kressin is supported in part by a Senior Research Career Scientist award from the Department of Veterans Affairs, Health Services Research & Development Service (RCS 02-066-1).