Many people have written in this space about cost control, and agreement is widespread that doing so is critical to the success of the new state health plan.

One effective way to decrease overall costs would be to guarantee preventive health care services for all the state’s children.

In child health, prevention is the cornerstone. Prevention is cheaper than treatment of illness, healthier children grow up to be healthier adults, and health care for children is much cheaper than health care for adults. Health care for children is an investment; healthcare for adults is often payment for services long overdue.

We need to re-order our priorities, which will make the cost of health care much less in the long run. First we must offer universal access to preventive services. As long as we have a system that creates disparities in access to care, holes in health care will cause pockets of illness in every community, and these spread like wildfire through families, to newborns, the elderly, and the chronically ill, and through schools, churches, stores, and public transportation to whole communities.

Massachusetts needs to guarantee access to certain preventive child health services. The plan must be universal, simple to administer, seamless, and provided by health care professionals who know the children and have their medical records.

This guaranteed care could be limited to three basic services: Read more…

Part of the stated mission of the Health Care Quality and Cost Council, established by the health care reform law, is “to develop and coordinate the implementation of health care quality improvement goals that are intended to lower or contain the growth in health care costs while improving the quality of care.”

One approach that I feel should not be used to accomplish this mission, as it relates to physicians, has become known as “tiering,” a process that, in theory at least, is supposed to improve physician performance as it relates to efficiency and quality. This program, currently using claims data from health plans, is being used now by the State’s Group Insurance Commission for its 285,000 state employees and retirees. Similar physician rating programs have come under fire (and the object of lawsuits) by physicians in Washington state and Connecticut. And New York’s Attorney General has called the practice into question, saying it could be deceptive and confusing.

I am not opposed to cost and quality measurements. Indeed, I welcome whatever information that will help me improve patient care and outcomes. But I am concerned about unintended consequences of the current system of tiering; I believe it is simply the wrong approach.
Some of the flaws: Read more…

I have been very fortunate to practice general internal medicine in Ipswich, Massachusetts for the past 27 years. I have listened to the insured and the uninsured worry about the cost of their healthcare, the price of co-pays, drugs, deductibles, tests, and the annual increases in their health insurance premiums that seem to have no end. Lack of insurance has been viewed as a roadblock to healthcare. Many of the uninsured are unable to receive preventive care and immunizations proven to have benefit or to purchase prescription medicines for hypertension, diabetes, or many of the other chronic medical conditions that there are effective treatments for.
I applaud the Commonwealth of Massachusetts for recognizing that the lack of affordable health insurance is a deterrent to health care services and has taken the first step at correcting this with passage of Chapter 58. Unfortunately, it gives people access to the same health care system that is accused of being too costly, to have variable quality, be inefficient, unfriendly, and inaccessible. Read more…