Tuesday, May 10, 2011

A Vision of the Future on Health Care Access?

As has been pointed out by a Wall Street Journal editorial and other publications, the Massachusetts Medical Society released its annual survey of physician access yesterday – and the results show continued access problems following that state’s health care overhaul.  Waiting times increased for most specialties, and were reduced in only one (internal medicine).  For family practitioners, waiting times increased by an entire week (36 days in 2011 versus 29 days last year).  The report also notes that “the largest year-on-year changes recorded by this study date back to the initial implementation of [the] state health care reform law,” when waiting times to see an internist “increased by more than 50 percent” and waiting times to see an OB/GYN “also increased drastically.”  Also of interest: Access to physicians for patients without them remains limited in primary care fields – fewer than half of specialists in internal medicine (49%) and family medicine (46%) are accepting new clients.

This year’s report also analyzed acceptance of various government insurance products for the first time.  As might be expected, a sizable number of physicians do not accept Medicaid – only 62% of family physicians and 53% of internists accepted the Commonwealth’s Medicaid product.  Perhaps even more significant though is this finding:  In every medical specialty, the percentage of physicians who accepted Commonwealth Care (the subsidized insurance product sold through the Connector) was LOWER than the percentage of physicians who accepted Medicaid – and the percentage of physicians accepting Commonwealth Choice (the Connector’s unsubsidized insurance product) was even LOWER than the percentage who accepted Commonwealth Care.

One can reach several conclusions based on the survey results:

  • Massachusetts’ lack of primary care physicians mean the promise of lower emergency room costs as a result of greater insurance coverage have thus far proved illusory; even liberals like the New Republic’s Jonathan Cohn have admitted that the Massachusetts law “obviously hasn’t” reduced ER usage “and critics have every right to point that out.”
  • The physician shortage in Massachusetts echoes the concerns raised by Medicare actuary Rick Foster, who last year wrote that “the additional demand for health services could be difficult to meet initially with existing health provider resources and could lead to price increases,” meaning health “reform” could have significant inflationary effects.
  • Despite claims that the Connector offers “good value” plans, insurance policies offered through the Connector actually have WORSE access to physicians than even Medicaid patients receive – results that may not exactly reassure those likely to end up on state-based insurance Exchanges beginning in 2014.