Massachusetts Health Reform's Effect on Hospitalizations with Substance Use Disorder-Related Diagnoses

Health Serv Res. 2018 Jun;53(3):1727-1744. doi: 10.1111/1475-6773.12710. Epub 2017 May 19.


Objective: To examine whether Massachusetts (MA) health reform affected substance (alcohol or drug) use disorder (SUD)-related hospitalizations in acute care hospitals.

Data/study setting: 2004-2010 MA inpatient discharge data.

Design: Difference-in-differences analysis to identify pre- to postreform changes in age- and sex-standardized population-based rates of SUD-related medical and surgical hospitalizations, adjusting for secular trends.

Data extraction methods: We identified 373,751 discharges where a SUD-related diagnosis was a primary or secondary discharge diagnosis.

Findings: Adjusted for age and sex, the rates of drug use-related and alcohol use-related hospitalizations prereform were 7.21 and 8.87 (per 1,000 population), respectively, in high-uninsurance counties, and 8.58 and 9.63, respectively, in low-uninsurance counties. Both SUD-related rates increased after health reform in high- and low-uninsurance counties. Adjusting for secular trends in the high- and low-uninsurance counties, health reform was associated with no change in drug- or alcohol-related hospitalizations.

Conclusions: Massachusetts health reform was not associated with any changes in substance use disorder-related hospitalizations. Further research is needed to determine how to reduce substance use disorder-related hospitalizations, beyond expanding insurance coverage.

Keywords: Health reform; substance use.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Alcoholism / epidemiology
  • Female
  • Health Care Reform / legislation & jurisprudence
  • Health Care Reform / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Insurance, Health / statistics & numerical data
  • Male
  • Massachusetts
  • Middle Aged
  • Sex Factors
  • Socioeconomic Factors
  • Substance-Related Disorders / epidemiology*
  • Young Adult