Sunday, June 28, 2009

Access-to-care problems are resurfacing in Mass.

There is no free lunch. Massachusetts required health care insurance. Easy. Costs the state nothing. Didn't make things better. AMNews: June 29, 2009. Access-to-care problems are resurfacing in Mass. ... American Medical News: Massachusetts' Commonwealth Connector health reforms have reduced the state's uninsured population to less than 3% of residents, the lowest among all states. But a recent survey found an uptick last fall in adults reporting difficulty accessing certain types of care. The outcome of the Massachusetts health system reforms has national implications. Democrats in Congress have offered or are drafting health reform bills based on many of the state-adopted principles, including a health insurance exchange, subsidized private health insurance for low-and moderate-income residents, a requirement for individuals to have health insurance, and a mandate for employers to offer health insurance to their employees or else contribute to a health care fund. ... But not all care access gains have held, the report found. The percentage of non-elderly adults who reported that they did not get needed care from specialists in the last 12 months dipped from 7.1% in fall 2006 to 4% in fall 2007, but then bounced back up to 7% in fall 2008. The survey revealed less significant but similar trends for those having access problems for physician care, medical tests and follow-up care. The recent uptick in access issues may be due to increased demand for follow-up care from the newly insured that is not being matched by available doctors, according to the article's authors. Most of those surveyed who reported problems said they were told by physicians they were not accepting new patients or patients with their type of coverage. Some initial gains in affordability also appear to have eroded. Lower-income residents and those with public coverage reported more access difficulties than higher-income people, which may be due to lower payment rates or the more limited physician networks of the four health plans serving Medicaid enrollees, the authors wrote. The state's reforms also have not produced a decrease in emergency department visits for non-emergency conditions, the article found. Of all the non-elderly adults in the state who said in fall 2008 that they had visited an ED in the last year, the percentage who said the visit was for a condition that could have been treated in a physician's office was just over 15%, roughly the same as in 2006. ED usage can be reduced over time, said Georgia Maheras, private markets policy manager for the patient advocacy organization Health Care For All. "Suddenly giving someone that piece of plastic isn't going to change their behavior right away."

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