New evidence that health reform won't improve health

While there is political and practical opposition to health reform legislation, its probably fair to say that everyone, skeptic and supporter alike, believes that US health care needs a reformation. The current health reform strategy has wrapped itself around the seemingly intuitive concept that increasing insurance coverage will increase health. Mandates for health insurance that go into effect in 2014 will levy fines on individuals who are not insured. While there's a social justice argument to be made for universal health insurance coverage it may not in and of itself improve the health of the population, or your health.

New evidence suggests that mandating health insurance coverage increases the number of insured, but does not increase self-reported health or the ability to access a physician, and it may not decrease health disparities. A study published in the current issue of the Journal of General Internal Medicine by researchers from Harvard Medical School analyzed some 36,500 responses to the Behavioral Risk Factor Surveillance Survey (BRFSS) from residents of Massachusetts, along with an additional 63,200 responses from New England residents (the analysis controlled for age, gender, marital status, education and employment). In 2006 Massachusetts passed their own health reform legislation that required individuals to be covered by health insurance. Since then, numerous studies have looked at the Massachusetts experience for clues to what the nation might face once the full spectrum of Obama health reform legislation goes into effect.

So what has Massachusetts experienced? This new Harvard study reports that between 2006 and 2008, health insurance coverage in the state increased from 94.7% to 97.8%, a statistically significant amount. Base coverage rates in New England have remained constant at 92%. The number of Massachusetts adults reporting financial barriers to health care has declined from 6.1% to 4.6%. The base rate in the rest of New England has remained constant at around 8%.

Interestingly, over this same time period there has been no change in self-reported health or the ability to access a primary care physician, either in Massachusetts or New England as a whole. And disparities in self reported health and access to a primary care physician between blacks and whites have remained essential constant.

The BRFSS is a relatively blunt statistical tool, and this analysis is by no means the final word on how improvements in health insurance coverage may or may not increase actual access to a doctor, or improve your health or the health of your community. But it is a good reminder that determinants of health are multifaceted, and simply insuring more people will not necessarily improve anyone's quality of life. The most powerful determinants of health, after all, are not rooted in the health care system, but tied to education, housing, the built environment, employment, and other social supports.