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Massachusetts shows increases in health care delivery effectiveness

February 6, 2012
SPRINGFIELD — Five years after the enactment of Massachusetts health reform, gains in residents’ access to needed health care have been sustained and first-time reductions in emergency room visits suggest improvements in the effectiveness of health care delivery in the state.
These are among the findings from the latest Massachusetts Health Reform Survey, which has tracked the impact of reform since fall 2006. The survey, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, is the basis for Health Reform in Massachusetts as of Fall 2010, a report written by researchers from the Urban Institute and the University of Minnesota. Also released as a Web First was a related article published by the journal Health Affairs, which will also appear in the journal’s February issue.
“This comprehensive assessment of health reform shows that the Massachusetts model for expanding access to coverage and needed care has held up well during some of the worst economic conditions in decades,” Sarah Iselin, the Foundation’s president, said. “It also shows that there’s an urgent need for the state’s health care community to address rising costs with the same level of commitment, creativity, and unified action.”
Highlights of the report include:
  • Gains in health insurance coverage have continued: Health insurance coverage remained at high levels in Massachusetts, with coverage among non-elderly adults at 94.2 percent in fall 2010. This finding is consistent with the state’s health insurance survey, which estimated that only 1.9 percent of the entire population was uninsured in 2010. Insurance coverage for non-elderly adults in the nation as a whole was 78.5 percent in 2010, and has declined since 2006, when it was 80.2 percent.
  • Gains in access to and use of health care have continued: For example, compared to pre-reform levels, non-elderly adults are more likely to have a place they usually go to when they are sick or need advice about their health, more likely to have had a preventive care visit, more likely to have had multiple doctor visits, more likely to have had a specialist visit, and more likely to have had a dental care visit.
  • Health status has improved since implementation of reform: There have also been improvements in self-reported health status, with 65 percent reporting their health as “very good or excellent,” up from 60 percent pre-reform.
  • Use of the Emergency Room has declined: For the first time since fall 2006, there were reductions in emergency room use overall and in the use of the emergency department for non-emergency conditions.
  • Employers continue to play a critical role: A core element of the success of health reform in Massachusetts has been the high level of employer-sponsored coverage. More than two-thirds of non-elderly adults received coverage through an employer, and there was no evidence of employers or workers dropping coverage because of the availability of public coverage (commonly called “crowd-out”).
  • Support for reform remains high: Support for health reform remained strong in 2010 at 66 percent, although those who do not support reform have shifted from mostly neutral to mostly opposed; a change that coincides with the hardening of positions on national reform.
  • Affordability remains a challenge: The overall cost of health care, which was not directly addressed by the health reform law, remains an issue for many, as the state, like the nation, continues to struggle with the problem of rising health care costs and the lingering effects of the recession. More than a quarter of adults reported that their health care spending in 2010 had caused financial problems, including the need to cut back on health care services and other spending or to reduce savings.
“The future success of health reform in Massachusetts, and in the rest of the country, will depend on the ability of policymakers and stakeholders to take on the challenge of reining in health care costs,” said study author Sharon Long of the Urban Institute and the University of Minnesota. “Massachusetts has the opportunity to lead the way here, much as the state did in the push toward universal coverage. The pre-2010 status quo of health care costs growing faster than wages year-after-year is not a sustainable option for Massachusetts or the nation.”
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