Health Care Equity in Massachusetts

While Massachusetts has made significant strides to mitigate barriers to access and affordability through legislative reforms and the implementation of the Affordable Care Act (ACA), substantial disparities persist among specific subpopulations in health insurance coverage, access, utilization, and affordability. Using data from multiple sources, CHIA seeks to prioritize the collection and analysis of reliable and meaningful health care information on subpopulations to inform policymakers, health care providers, payers, and other industry partners.

CHIA uses several data sources to explore equity issues facing the Commonwealth:

• Massachusetts Health Insurance Survey
• Massachusetts Acute Hospital Case Mix Database (Case Mix)
• Massachusetts All-Payer Claims Database (MA APCD)
• Health plan expenditure and quality measure reports

Hospital Utilization in Massachusetts: An Assessment by Race and Ethnicity (August 2023)

CHIA’s most recent report, Hospital Utilization in Massachusetts: An Assessment by Race & Ethnicity (SFY 2021) was published in August 2023. Using the Massachusetts Acute Hospital Case Mix Database (Case Mix), this report focuses on differences in acute care utilization by race and ethnicity.

Measures of acute care hospital utilization are often used to assess hospital quality and performance, monitor changing demand for acute care services, and estimate the overall health and disease burden of the population. CHIA regularly reports on inpatient, emergency department, and outpatient observation stay utilization in the Case Mix Standard Reporting series, as well as all-payer unplanned hospital readmissions and revisits. This reporting includes an initial examination of utilization patterns for patients by racial and ethnic groups across acute care settings, providing a more comprehensive look than previously reported in the Commonwealth.

Key Findings

• Non-Hispanic Black patients had disproportionately higher acute care utilization compared to patients of other racial and ethnic groups, accounting for a greater share of inpatient and ED visits, longer average length of stay (ALOS) and higher readmission and revisit rates.
  
  
• Among Hispanic patients, ED utilization and revisits were disproportionately higher compared to non-Hispanic White patients.
  
  
• While non-Hispanic Asian patients had lower acute care utilization, they had the longest ALOS for discharges resulting in a readmission and those associated with behavioral health compared to other racial and ethnic groups.

Previous Health Equity Publications

Research Briefs

• Massachusetts Foreign-born Residents, Particularly Non-citizens, Are Less Likely to Have Continuous Health Insurance Coverage
  (April 2023)
  
  
• Black and Hispanic Residents Report Higher Likelihood of Potential Reliance on the Emergency Department for Health Care than White Residents in the Commonwealth
  (November 2022)

Reports

• Health Insurance Coverage and Care in Massachusetts, 2015-2019: A Baseline Assessment of Gaps by Region
  (April 2022)
  
  
• Health Insurance Coverage and Care in Massachusetts, 2015-2019: A Baseline Assessment of Gaps by Age, Race and Ethnicity, and Income
  (December 2021)