Tufts Clinical and Translational Science Institute (CTSI) Stakeholder Expert Panel (SEP) members met recently with Karen Freund, MD, MPH to chat about her recent publication, Racial Differences in Insurance Stability After Health Insurance Reform (Med Care. 2019 Apr;57(4):256-261). The discussion included six SEP members and was moderated by Robert Sege, MD, PhD, Tufts CTSI’s Lead Navigator and Co-Director of Stakeholder and Community Engagement.
About the study: Using data from hospitals that provide a disproportionate share of care for low-income communities, Dr. Freund looked at the impact of health insurance reform on health insurance instability. She and her team examined the insurance coverage status of more than 48,000 Massachusetts patients with hypertension (high blood pressure) in six-month intervals from 2005 (before the Massachusetts insurance reform law was passed in 2006) to 2013 (the year before the federal Affordable Care Act’s major provisions were enacted). Her team found that Massachusetts insurance reform resulted in stable insurance coverage and a reduction in disparities in insurance instability, having a greater positive impact on Hispanic (29.7%), non-Hispanic Black (24.8%), and non-Hispanic Asian (26.8%) patients than on non-Hispanic white (14.9%) patients.
What it means: Dr. Freund explained why insurance stability is important. “When your insurance switches, it’s more than just your insurance that changes,” she said. “You may have to see different doctors, or the medications you’ve been taking for years are no longer covered. Your co-pays may go up. And the higher the co-pays, the less likely people are to take their medications. These factors can have a big impact on overall health.”
Panel discussion: Panel members asked probing questions about how patients were selected for the study; what has happened since 2013; how the results can be disseminated; and the implications for the Affordable Care Act and federal health care reform.
“As voters, we need to be educated about issues like these that we need to concern ourselves with, and support the candidates we need to rally behind,” said Panel member Beverly Cohen. “How can we build upon what you’ve done?”
“Showing policy-makers the impact of these studies is really important,” said Dr. Freund. “It’s important to show them that insurance stability is good for patients.”
“What should we do with this information?” asked Panel member Apolo Cátala. “What is our call to action?”
“I think it would be helpful for people to hear that the reason they’re not getting better is partially because the system isn’t giving them the care they need,” said Dr. Freund.
Panel members expressed interest in meeting with elected officials and residents in their communities to discuss health insurance stability and Dr. Freund’s study findings.
Research Results: Stakeholder Conversations is a series of discussions about published research between members of Tufts CTSI’s Stakeholder Expert Panel and Principal Investigators (PIs). Panel members review journal articles written by researchers affiliated with Tufts CTSI, select the studies most interesting and applicable to them, and then invite the PIs to talk about their work and answer questions.
Karen M. Freund, MD, MPH is Professor of Medicine at Tufts University School of Medicine. She is the Director of the Career Development Award (KL2) Program at Tufts Clinical and Translational Science Institute (CTSI), and teaches in the Graduate School of Biomedical Sciences.
Dr. Freund’s research focuses on addressing the social determinants of health which influence the receipt of health care services, which in turn lead to disparities in mortality. She has addressed a broad number of issues in the screening, diagnosis and treatment phases of health care. This has included looking at the role of patient beliefs and behaviors, physician attitudes and decision making, and the role of systems barriers, especially navigating the increasingly complex health care system. Breast cancer has been a major focus, but the research has also addressed cervical and colon cancer, cardiovascular disease, diabetes, exercise, depression, eating disorders and domestic violence. Her current research is focused on systems interventions to reduce health disparities.
Tufts Clinical and Translational Science Institute (Tufts CTSI), established in 2008, supported by the National Institutes of Health (NIH), is dedicated to stimulating innovative broadly-engaged team science across the translational research spectrum to improve clinical care and health. Founded by Tufts University and Tufts Medical Center, it also includes other academic institutions (including all the schools of Tufts University, Brandeis University, MIT, Northeastern University; and RAND), the hospitals affiliated with Tufts University School of Medicine, community stakeholders, and various members of the health care industry. Tufts CTSI’s purpose is to accelerate the translation of laboratory and medical research into clinical use, widespread medical practice, and into improved health care delivery and health policy. It connects people to research resources, consultation, and education, and fosters collaboration with scholars of all disciplines and with community members, with the ultimate goal of improving the health of the public. Tufts CTSI is funded by a Clinical and Translational Science Award (CTSA) from the NIH National Center for Advancing Translational Sciences, award number UL1TR002544.