A Second Look at Massachusetts Health Care

Obama's health care arguments have been disingenuous as he attempts a government takeover of the health care industry and the creation of a nationalized health care system for people making 88,000 dollars or less. Now Massachusetts has often been called a model for the United States and the annual review of the programs finds a great deal of it lacking. Reading the piece the only positive I can see in that more people have " a steady" source of health care, unfortunately it appears not much else has panned out:

Despite a weakening economy, Massachusetts continued to measure gains in the share of residents who reported having a steady source of health care in 2008, its second year of near-universal coverage, a new study has found.

But the annual survey, taken each fall since 2006, also raised red flags regarding the ability of residents to actually use that care, with growing numbers saying they could not afford needed treatments and many reporting shortages of primary care physicians.The study’s authors wrote that there were lessons for Washington, where Congressional committees are incorporating much of the Massachusetts model into federal health care legislation.

“Although major expansions in coverage can be achieved without addressing health care costs, cost pressures have the potential to undermine the gains,” wrote the researchers, Sharon K. Long and Paul B. Masi of the Urban Institute.

We have seen this with the Massachusetts plan, create a system without paying for it and then hope for the best. In other words its perfect Obama. Of course the shortage of doctors which is going to become a nationwide crisis soon enough is one of the killers for the program:

The difficulties in receiving care were severest among low-income residents, who have gained the most from expanded access under the state’s law, passed in 2006. It requires most residents to have health insurance and provides state-subsidized plans for the poor. Massachusetts now has the country’s lowest percentage of the uninsured — 2.6 percent, compared with a national average of 15 percent.

They reduced the amount of uninsured and ended up with even worse problems. And yes waiting lists have become a norm and you still have people using the emergency room as the doctor's office:

But the study, which was scheduled for publication Thursday in the journal Health Affairs, found that increased demand for care from the newly insured was confronting an insufficient supply of willing physicians. One in five adults said they had been told in the last 12 months that a doctor or clinic was not accepting new patients or would not see patients with their type of insurance. The rejection rates for low-income adults and those with public insurance were double the rates for higher-income residents and those with private coverage.

The authors concluded that the high rejection rates helped explain another important finding: that there has been little change in the use of emergency rooms for non-emergency treatment. Among low-income residents — defined as those with incomes of less than three times the federal poverty level, or $66,150 for a family of four — 23 percent said their last trip to an emergency room had been for a non-emergency, the same as in 2006.

The study itself is recommending a change in payments:

The report sets the stage for legislative recommendations expected next month from a state commission that hopes to slow the growth in health spending. The commission has already drafted principles calling for a system of global payments to networks of doctors, hospitals and other providers. The networks would be paid for an individual’s ongoing care, rather than for each procedure or office visit, providing an incentive to keep patients healthy rather than merely treating their ailments.

I am not a doctor so I can't speak about the merits of pay per visit verse a more salaried approach, although the network would have some discretion in payments to doctors. With that said I can how the changing of payments may have some cost reduction advantages, but how would that confront the issue of doctor shortages? Anyway what are doctors doing after they treat patients ailment, encouraging them to get sick again? By the way the program is to expensive and putting of the costs can only last long.



The Key Findings:

1. From 2006 to 2008, access to care improved markedly. For example, adults were more likely to have: a usual place to go for care (up 4.5 percentage points); a preventive care visit in the past 12 months (up 6.0 percentage points); and a dental care visit in the past 12 months (up 7.6 percentage points).

2. After declining from 2006 to 2007, the share of adults reporting they did not get needed care in the previous 12 months increased from 2007 to 2008. The increases were statistically significant for specialist care and medical tests, treatment, or follow-up care.

3. In 2008, about one of five adults reported being told a doctor’s office or clinic was not accepting new patients or patients with their type of coverage. Problems obtaining care were concentrated among adults with family incomes below 300 percent of the federal poverty level—particularly those enrolled in public programs.

4. From 2006 to 2007, the share of adults reporting problems paying medical bills or having medical debt decreased (by 2.7 and 1.4 percentage points, respectively). But by the fall of 2008, the shares of adults reporting such problems had begun to increase, moving back toward 2006 levels.

The authors of the study argue there have been widespread improvement but then go on to acknowledge the whole system could unravel from increased costs and argue that changing the payment system is the way to solve that riddle. Color me skeptical on that one and if you change the payments system how many dangers and pitfalls await.

For the full article

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w578?ijkey=kq.AYAeHKJBb6&keytype=ref&siteid=healthaff.