Massachusetts health care reform: Trends in preventative care for women 1996-2008

Massachusetts health care reform policies are designed to provide near universal insurance coverage to improve access to care. Trends in access and preventive care use have not been fully examined in diverse groups during implementation of health care reform. We examined longitudinal data from the Massachusetts Behavioral Risk Factor Surveillance Survey (BRFSS) with a specific emphasis on preventative health screenings for women. We find insurance rates for women are significantly improved post health care reform when compared to both low and rising unemployment periods since 1996. However, low income women continue to have higher rates of uninsurance post reform than women in the high income group. In Massachusetts, cancer and cardiovascular screening prevalence is high and meets Healthy People 2010 targets for most indicators. With respect to cancer screening among women, neither recent mammography, nor recent Pap smear usage increased in 2008 compared to average use in prior historical periods of either low or rising unemployment. During health care reform implementation, we find unmet needs for care due to cost are disproportionately high in specific groups. Low and middle-income groups are vulnerable to lacking preventive care, as are those in poor health. Additional data are needed to develop strategies to improve unmet needs and preventive care among vulnerable groups. A better understanding of unmet need will enable policy makers to identify and implement models of care that are effective in promoting preventive care utilization for diverse and low-income women as priorities for health care policy.