Primary Care Gap Affects Bay State Reforms

A national shortage of primary care doctors is hindering the Massachusetts health reform initiative, by causing delays for many residents who are seeking checkups and other preventive care, experts interviewed say.

The gap can make life difficult for all patients, says Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, Boston.

Reports on the first year of health coverage access efforts have focused on newly insured residents’ problems with getting primary care, but anecdotal evidence – consumer physician practice reviews on Web sites such as Yelp – suggests that some patients who will be paying cash or have always had private insurance also face long delays in scheduling checkups.

Some privately insured Massachusetts patients talk about having to schedule checkups and examinations for non-urgent matters 3 or 4 months in advance.

“Massachusetts’ health reform has shed light on the problem of [physician] shortages,” says Cheryl Parcham, a deputy director at Families USA, Washington.

Massachusetts is requiring most residents to have health coverage or face the loss of their state income tax exemption.

The state provides free coverage for low-income residents and subsidized coverage for moderate-income residents. It also has established a new agency, the Commonwealth Health Insurance Connector Authority, that is supposed to help individuals with relatively high incomes and small businesses find affordable private coverage.

The subsidized program, Commonwealth Care, has exceeded initial expectations and enrolled 176,000 residents.

Commonwealth Choice, the private coverage access program, had enrolled 18,000 as of June 1.

The program has helped many residents, supporters say.

One Commonwealth Care plan member, a woman who was uninsured for years, tried to get treatment for her sore throat by going to the emergency room, says Commonwealth Connector spokesperson Richard Powers.

The ER doctors would give her throat lozenges.

After the woman obtained Commonwealth Care coverage, an evaluation revealed she had throat cancer, and she began getting treatment, Powers says.

Surveys suggest that Massachusetts residents, including those with private coverage, like the health reform program.