The Ontario Health Insurance Plan (OHIP), which covers about 12 million residents of that Canadian province, employs roughly 1500 people. The Connector has 35.6 FTEs. It helps arrange coverage for the 30,000 people with private insurance purchased through the Commonwealth Choice program; 23,000 who get partially subsidized coverage under Commonwealth Care; and 92,000 low income individuals signed up for free insurance. That’s a total of 145,000 people. In other words, the Connector employs twice as many (2.5) people per 10,000 enrollees as OHIP (1.2).
That comparison doesn’t sound too bad, until you realize that OHIP actually pays all of the bills for care in Ontario and administers virtually the entire health care financing system. The Connector merely serves as a glorified insurance broker, signing people up for coverage with plans like Blue Cross and Harvard Pilgrim. So on top of the 4% to 5% cut of every premium dollar that the Connector takes, Blue Cross and Harvard Pilgrim take their 15%. (I can’t tell you what Tufts’ share is – their annual report for 2006 left out the figures – though it does let slip that its net worth rose by $96 million even as enrollment fell). Read more…

As we look ahead to the halfway mark of full implementation of the provisions of the health reform law, we continue to pass the milestones and landmarks along the way – all of them significant and all of them anticipated. And, all of them reminders that our work is not done.

This month alone, some key provisions of reform have taken effect. What was formerly the Uncompensated Care Pool was replaced by the new Health Safety Net Trust Fund in the newly-established Health Safety Net Office at the Division of Health Care Finance and Policy (DHCFP). New regulations for the Health Safety Net Trust Fund represent further progress of reform and will be a key part of the transition to Commonwealth Care for many of our residents. Also this month, the first of the Fair Share Contributions will come due from employers in the Commonwealth who owe the state their fair share of the health care costs of their workers.

It’s no coincidence that several recent Commonhealth blog postings have focused on health care costs, the next frontier of health reform—not just for us here in Massachusetts, but throughout the country. While the appropriate use of resources serves the best interests of patients in the Commonwealth, it is also at the core of containing health care costs. We must take a hard look at how our already outstanding health care delivery system serves its patients with compassion and effectiveness from the cradle to the grave— at birth, throughout a healthy childhood, in long-term care, and at the end of life. We owe it to our residents who are now insured to provide them with the best system we can, with the least number of avoidable medical errors. Read more…

Bit by bit over the past two months or so, the conversation about health care reform has shifted. While there are still complex coverage issues to consider and resolve, public and private health leaders are increasingly focused on the law’s sustainability, which requires us to focus on the growth of health care costs in Massachusetts.

Consider the following examples from the last two weeks alone:

Paul Levy has posted to his blog a list of simple but provocative questions and answers about cost, attracting much discussion. Jon Kingsdale and Leslie Kirwin have both worried publicly about the impact of health costs on the state budget and the health care reform law. At the Quality and Cost Council’s annual meeting, Stuart Altman presented a number of interventions to slow the growth in health spending, arrayed on a spectrum from very limited impact to greatest potential impact. Writers from across the health care community have used the WBUR blog to talk about cost.

I have three small suggestions on this emerging cost conversation:

First, the discussion needs to move beyond the blogs and boardrooms to the broader public. Polls suggest that rising health costs are the public top health concern. Let’s discuss openly the tradeoffs that Stuart Altman outlined in his presentation. Read more…