Massachusette’s Plan Gobbling up State Funds

Since instituting mandatory health insurance for all residents of Massachusette’s, a recent study finds that one of the plan’s goals of connecting more patients with PCPs has failed miserably.  Accordign to the Boston Globe,

Thousands of newly insured Massachusetts residents are relying on emergency rooms for routine medical care, an expensive habit that drives up healthcare costs and thwarts a major goal of the state’s first-in-the-nation health insurance law.

The law framers had hoped that instituting mandatory health insurance, would open the door to primary care offices for many previously unisnured patients.  But instead what they are finding is that these patients are still using ERs as their primary care, increasing the burden on overworked ERs.

People flock to ERs for primary care because they are accesible, convenient, don’t require upfront payment prior to evaluation and as a bonus, you can get a “free ride” by calling an ambulance.   It’s clear that the solution to these times of problems do not rely directly with health care insurance, but rather health care access.

Do these results surprise anyone?  Certainly no one who works on the front lines in the ER…

  4 comments for “Massachusette’s Plan Gobbling up State Funds

  1. rjh
    October 12, 2008 at 7:46 pm

    The Globe is often confused and difficult concepts like healthcare generally escape its understanding. This is one such.

    The first step in understanding is to split the healthcare problem into three still large, different, but interrelated problems:
    1.) Picking the proper kind and quantity of healthcare.
    2.) Establishing and reducing the cost of a particular treatment. (It is important here not to confuse price and cost.)
    3.) Deciding how to pay for the care.

    The MA plan dealt with number 3. Instead of having uninsured patients go to the ER, and have the hospitals and state cover their care as charity care; all patients are required to have insurance. The low income patients have the cost of insurance covered by the state, so this is still money coming from the state. It is just from a different pocket. This does not save money, it just changes the accounting, which confuses a great many people.

    The hope was that the high income uninsured and reduced fraud rate would compensate for the increased number of participants. It did not, in part because those who don’t grasp finances seem to think insurance is free and they added many “must cover” requirements to the most basic low cost coverage. But, many part time workers, consultants, start ups, and small businesses now have coverage and do pay for their own insurance. It has helped them a lot.

    Another hope was that eventually the ability to use insurance would lead to the use of personal physicians. But, since the payment to PCPs is steadily being cut by insurers and medicare, there is a decreasing number of PCPs and these newly insured have had great difficulty finding a PCP. So, they continue to use the ER. The papers were also full of complaints about how difficult it was to find a physician accepting new patients. Some patients were definitely trying to change.

    The transition to lesser use of the ER will probably happen, but it will be very slow unless insurers and medicare change their payment policies. At present, adding another patient to their list decreases the take home income of a physician. Until payments exceed costs, the number of PCPs will continue to drop and it will be very hard to reduce the ER use.

    Finally, there is hope that the insurance will allow those with chronic illnesses to start using a pharmacy and prescriptions, rather than an ER visit for more drugs. This will only reduce ER visits a little bit. A few diseases (like diabetes) have a significant drop in ER use if prescriptions are filled regularly. Most of the other chronic illnesses are either already low ER load (e.g., high blood pressure) or unresponsive to treatment (e.g., alcoholism). Having insurance does not change the actual ER demand for most chronic illnesses.

  2. Daniel
    October 13, 2008 at 3:42 am

    I can’t recall the refernces right now, but people have been having trouble PCP’s willing to take on new patients. It seems to be a very common complaint

  3. Doc Shazam
    October 13, 2008 at 7:31 am

    RJH, thank you for the informative comment…that’s far more detailed than I have thought about it before, but it makes sense. Looking forward to additional commentary from you.

  4. Doc Shazam
    October 13, 2008 at 7:31 am

    Daniel….is this specifically in Massachusettes that you are referring to?

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