When it comes to ensuring health care is a right and not a privilege, Massachusetts has paved the way.Our hospitals and doctors are world class, we were the first state with universal health insurance coverage, and our exchange is the model for the Affordable Care Act.But we have more to do to make sure every […]
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When it comes to ensuring health care is a right and not a privilege, Massachusetts has paved the way.
Our hospitals and doctors are world class, we were the first state with universal health insurance coverage, and our exchange is the model for the Affordable Care Act.
But we have more to do to make sure every resident has access to affordable health care. Massachusetts families and small businesses are spending more on health care than ever. In 2018, total healthcare spending grew 3.1%, and the average monthly insurance premium is more than $500 per month. Increasingly, residents have high-deductible health plans, potentially paying thousands more out-of-pocket.
In an October report from my office, we found two key initiatives put in place to control costs aren’t doing enough for Massachusetts residents.
First, despite a lot of fanfare, online pricing tools allowing patients to choose lower-cost providers by comparing the price of services from different doctors and hospitals just aren’t having the hoped-for impact. Studies show most patients look to their doctor to tell them which hospital, lab, or specialist to go to. And once patients reach their deductible and out-of-pocket maximum, there’s no financial incentive to shop for the lowest-cost care. Very few people are using these online pricing websites, and the tools aren’t having a significant impact on overall costs. This doesn’t mean the tools aren’t providing good information, but we simply can’t rely on them to keep costs down.
Second, we analyzed alternative payment arrangements, which are agreements between healthcare systems and health insurance companies to pay doctors and hospitals for keeping patients healthy and avoiding unnecessary, high-cost services (as opposed to traditional fee-for-service payments). These arrangements aren’t controlling costs as well as they could because they’re too complicated and patients frequently switch health plans. Our report concluded nearly half of patients switched health plans or products within a two-year period, making it difficult for the insurance companies, doctors and hospitals to work together to save costs.
Over the last five years, inpatient spending has fallen at lower-priced hospitals and risen at higher-priced ones, even though policymakers have tried to encourage patients and doctors to choose quality, affordable healthcare services.
Bottom line: We can do more. While price transparency for consumers is essential, we must get serious about establishing real incentives for high-quality, low-cost care.
We should encourage patients to select primary care providers who keep costs down; take a close look at the incentives for healthcare providers to direct patients to lower-cost settings; and acknowledge that doctors and hospitals want to keep patients in their own systems, even if that means not referring patients to high-quality, lower-priced competitors. Minor financial incentives won’t overcome this reality.
Together, we can get to the accessible and affordable healthcare system our state, our businesses and our residents deserve.
Maura Healey is the Massachusetts attorney general.
