Intended for healthcare professionals


Does US health reform reduce hospital readmission rates?

BMJ 2014; 348 doi: (Published 15 April 2014) Cite this as: BMJ 2014;348:g2641
  1. Adam Steventon, postgraduate fellow1, senior research analyst2,
  2. Harlan Krumholz, professor of medicine3
  1. 1Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT 06510, USA
  2. 2Nuffield Trust, London W1G 7LP, UK
  3. 3Yale University School of Medicine
  1. Correspondence to: adam.steventon{at}

Not in Massachusetts—insurance expansion alone won’t be enough

In 2012, after the 2010 Affordable Care Act became law but before its full implementation, around 47 million people in the United States were without healthcare insurance. The sweeping provisions of the Affordable Care Act were primarily focused on expanding insurance coverage. An open question is whether such provisions will also affect healthcare utilization and health outcomes.

In a linked paper (doi:10.1136/bmj.g2329), Lasser and colleagues studied the effect of reforms in Massachusetts, which passed legislation before the Affordable Care Act and similarly sought to broaden insurance coverage.1 After reform, the proportion of adults of working age in Massachusetts who were uninsured decreased from 12.5% in 2006 to 5.2% in 2012.2 Lasser and colleagues examined whether the Massachusetts reforms were associated with favourable changes in readmission rates. Readmissions represent an outcome that imposes a burden on individuals and the healthcare system, which are also amenable to improvements in healthcare quality.

Studying the effect of healthcare insurance strategies on population health and healthcare utilization is challenging. A few investigators have had the opportunity to do so using randomized controlled trials.3 4 5 The RAND Health Insurance Experiment of the mid-1970s recruited more than 2000 households and found that higher co-payments within insurance products reduced resource use without large impacts on health or quality of care for …

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