Public Release: 

Better insurance access leads to more hip, knee replacements among minorities

Boston University Medical Center

BOSTON, MA -- Researchers at Boston Medical Center (BMC) have found that the expansion of insurance coverage in Massachusetts increased the number of elective knee and hip replacement procedures by 4.7 percent, with greater increases among black and Hispanic patients. The findings are published online in advance of print in the British Medical Journal.

The insurance coverage expansion in Massachusetts in 2006 set the framework for the Affordable Care Act, which was created with the goal of increasing access to healthcare, and thereby reducing disparities in access to care based on race and income. The new findings, which compared utilization of elective hip and knee replacements pre-reform (2004-2006) and post reform (2008-2010), suggest an improvement in access to healthcare, particularly among racial/ethnic minorities.

"The need for knee and hip replacements is fairly universal among various ethnic groups," said Amresh Hanchate, PhD, of the Section of General Internal Medicine at BMC, and the Healthcare Disparities Research Program in the Department of Medicine at Boston University School of Medicine, and the first author of the study. "However, access to care has not been universal. Our findings suggest that there may have been a pent-up demand for these procedures among racial/ethnic minorities, and once these patient populations received insurance, they were able to move forward with the procedures."

Researchers concluded that, while more information is needed to confirm the clinical need for hip and knee replacements, the findings suggest that improved access to medical insurance for racial/ethnic minorities leads to increased elective joint replacement procedures, which can significantly improve a patient's overall health and quality of life. For patients with osteoarthritis of knee and hip, these procedures have been shown to be cost-effective.

According to the study's findings, joint replacement procedure use increased 22.4 percent overall during the 2½-year period following insurance expansion; Massachusetts reform was associated with a 4.7 percent increase. The increase associated with reform was significantly higher among Hispanics (37.9 percent) and blacks (11.4 percent) than whites (2.8 percent). Lower income was not associated with larger increases in procedure use. The share of knee and hip replacement procedures performed in safety-net hospitals in Massachusetts decreased from a pre-reform level of 12.7 percent by 1 percent.

"Our findings clearly demonstrate that limited insurance coverage has been a real barrier to receiving some forms of medical care such as joint replacement surgery, among racial/ethnic minorities," said Nancy Kressin, PhD, of the Section of General Internal Medicine at BMC, and Director of the Healthcare Disparities Research Program in the Department of Medicine at Boston University School of Medicine, and the senior author. "And that by opening that door, by providing access through insurance, we can help many people receive the care they need to live healthier lives."

In the U.S., 18 percent of the population ages 18-64 do not have health insurance. But large-scale insurance coverage expansions could significantly reduce barriers to health care, particularly among racial/ethnic minorities and low-income populations.


Funding for this study was provided to Boston Medical Center by the National Institutes of Health (1U01HL105342-01, 1R01MD007705-01); Dr. Kressin was supported in part by the Department of Veterans Affairs, Health Services Research & Development Service (RCS 02-066-1). Other researchers involved in this study include Nancy R. Kressin, PhD, Boston University School of Medicine and VA Boston Healthcare System; Alok Kapoor, MD MSc, University of Massachusetts Medical School; Jeffrey N. Katz, MD MSc, Brigham and Women's Hospital and Harvard Medical School; Danny McCormick, MD MPH, Cambridge Health Alliance and Harvard Medical School; Karen E. Lasser, MD MPH, Boston Medical Center and Boston University School of Medicine; Chen Feng, MA, Boston Medical Center; and Meredith G. Manze, PhD, MPH, City University of New York, School of Public Health, New York, New York.

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 482-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $118 million in sponsored research funding in fiscal year 2014. It is the 11th largest recipient of funding in the U.S. from the National Institutes of Health. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. It does business in Massachusetts as BMC HealthNet Plan and as Well Sense Health Plan in New Hampshire, serving more than 315,000 people, collectively. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit

Contact: Ellen Slingsby,, 617-638-8489

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