Massachusetts health insurance mandate: effects on neurosurgical practice

Clinical article

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Massachusetts' health insurance mandate and subsidized insurance program, Commonwealth Care, have been active for 2 years.


The financial impact on the neurosurgery division and demographics of the relevant patient groups were assessed. The billing records of neurosurgical patients from January 2007 to September 2008 were collected and analyzed.


Commonwealth Care comprised 2.2% of neurosurgical inpatients, and these patients did not have significantly different acuity or lengths of stay from the average. Length of stay of MassHealth patients was significantly greater, although acuity was significantly lower than the average. Increased free care reimbursement and increased MassHealth/Commonwealth Care enrollment resulted in a net gain in reimbursement of hospital charges.


The increased insurance rates have resulted in increased reimbursement for the neurosurgical division.

Abbreviations used in this paper: DRG = diagnosis-related group; LOS = length of stay.

Article Information

Address correspondence to: Julie G. Pilitsis, M.D., Ph.D., UMass Memorial Medical Center, 55 Lake Avenue North, S2-850, Worcester, Massachusetts 01655. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Bar graphs showing the assessment of insurance flux. These graphs show the type of insurance patients with Commonwealth Care (CC) and Free Care (FC) coverage in 2007 and 2008 had previously. The Total FC and Total CC columns represent the number of patients with the specified type of insurance in 2007 and 2008, and the columns for Existing CC and Total Free Care represent the number of patients who were preexisting patients at our institution who had the same insurance the previous year. MH = MassHealth; PI = private insurance; SP = self-pay.

  • View in gallery

    Bar graph showing the number of neurosurgical (NS) inpatients, neurosurgical same-day surgery (SDS) patients, and surgical patients treated by insurance subtype in 2008 (annualized data), expressed as a percentage of increase (decrease) from 2007 data. A percentage of 100% assumes no change from 2007. Inpt = inpatient.


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