{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T09:03:36Z","timestamp":1744103016195},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,7,25]],"date-time":"2016-07-25T00:00:00Z","timestamp":1469404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000879","name":"Alfred P. Sloan Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000879","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the impact of the 2006 Massachusetts health reform, the model for the Affordable Care Act, on short\u2010term enrollment and utilization in the unsubsidized individual health insurance market.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Source<\/jats:title><jats:p>Seven years of administrative and claims data from Harvard Pilgrim Health Care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Research Design<\/jats:title><jats:p>We employed pre\u2010post survival analysis and an interrupted time series design to examine changes in enrollment length, utilization patterns, and use of elective procedures (discretionary inpatient surgeries and infertility treatment) among nonelderly adult enrollees before (<jats:italic>n<\/jats:italic>\u00a0=\u00a06,912) and after (<jats:italic>n<\/jats:italic>\u00a0=\u00a029,207) the<jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>reform.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>The probability of short\u2010term enrollment dropped immediately after the reform. Rates of inpatient encounters (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a00.83, 95 percent<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.74, 0.93), emergency department encounters (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a00.85, 95 percent<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.80, 0.91), and discretionary inpatient surgeries (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a00.66 95 percent<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.45, 0.97) were lower in the postreform period, whereas the rate of ambulatory visits was somewhat higher (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a01.04, 95 percent<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.00, 1.07). The rate of infertility treatment was higher after the reform (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a01.61, 95 percent<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.33, 1.97), driven by women in individual (vs. family) plans. The reform was not associated with increased utilization among short\u2010term enrollees.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>health reform was associated with a decrease in short\u2010term enrollment and changes in utilization patterns indicative of reduced adverse selection in the unsubsidized individual market. Adverse selection may be a problem for specific, high\u2010cost treatments.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.12532","type":"journal-article","created":{"date-parts":[[2016,7,26]],"date-time":"2016-07-26T02:12:40Z","timestamp":1469499160000},"page":"1118-1137","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Massachusetts Health Reform on Enrollment Length and Health Care Utilization in the Unsubsidized Individual Market"],"prefix":"10.1111","volume":"52","author":[{"given":"Laura F.","family":"Garabedian","sequence":"first","affiliation":[{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"Ross\u2010Degnan","sequence":"additional","affiliation":[{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B.","family":"Soumerai","sequence":"additional","affiliation":[{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niteesh K.","family":"Choudhry","sequence":"additional","affiliation":[{"name":"Harvard Medical School Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine Brigham and Women's Hospital Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey S.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,7,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2307\/1879431"},{"key":"e_1_2_7_3_1","unstructured":"American Society for Reproductive Medicine.2013. \u201cFrequently Asked Questions about Infertility\u201d [accessed on Mar 24 2015]. 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