Advancing equity in healthcare

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1617 (Published 01 April 2015) Cite this as: BMJ 2015;350:h1617
  1. Marshall H Chin, Richard Parrillo family professor of healthcare ethics
  1. 1 Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007 Chicago, IL 60637, USA
  1. mchin{at}medicine.bsd.uchicago.edu

Lessons from Massachusetts and beyond

Healthcare reforms in Massachusetts that began in 2006 might foreshadow the effects of President Obama’s national Affordable Care Act and have been subject to intense scrutiny as a result. Two linked studies of the reforms in Massachusetts indicate that expanding of health insurance is helpful but not enough to eliminate important social and ethnic disparities in care and outcomes.1 2 Hanchate and colleagues (doi:10.1136/bmj.h440) studied joint replacement surgery, an effective treatment for end stage joint disease that reduces pain and improves function and quality of life3 but is underused among patients on low incomes and those from racial and ethnic minority backgrounds.4 In their study, greater access to health insurance in Massachusetts was associated with increased rates of knee and hip replacement surgery among Hispanic and black people compared with white people but was not associated with increased rates among people on low incomes relative to richer people.1 In a second study, McCormick and colleagues (doi:10.1136/bmj.h1480) found no association between Massachusetts healthcare reforms and reduced racial and ethnic disparities in admissions to hospital for diseases such as asthma, diabetes, and heart failure. Many admissions for these “ambulatory care sensitive conditions” are preventable if patients have access to high quality outpatient …

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