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Primary Care Gap Affects Bay State Reforms

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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.

Analysis of data from Massachusetts 2006 and 2007 health care surveys shows that support for the program from the uninsured residents – who will face a new mandatory insurance purchase requirement -fell to 44%, from 64%, according to Sharon Long, a research associate at the Urban Institute, Washington.

But the percentage of insured residents that support the reform program increased to 84%, from 70%, Long writes in the study, which was published in the medical journal Health Affairs.

So far, the increased crowding at primary care physician practices has been the most noticeable drawback.

Half of the primary care practices in Massachusetts are closed to new patients, Buyse says.

Many community health centers, which typically serve the poor, have placed temporary freezes on enrollment.

But, even outside Massachusetts, primary care tends to be scarce in the United States, chiefly because specialists are better paid, Buyse says.

Medical school debt also discourages physicians from going into primary care, Powers says.

In 2007, new doctors carried an average of $139,517 in medical school debt, according to the American Medical Association, Chicago.

The primary care shortage is worse in Massachusetts than in other states, because the percentage of doctors who are specialists is much higher there than in the rest of the country.

Bank of America Corp., Charlotte, N.C., has tried to ease the shortage by donating $5 million to help repay medical school loans of primary care doctors who have agreed to practice in the state’s community health centers. The grant repays up to $25,000 in medical debts a year for 3 years, with a maximum repayment amount of $75,000, about 60% of the average medical school debt.

The Massachusetts Legislature has taken up Senate Bill 2526, which includes a section intended to establish a center for primary-care physician recruitment.

Critics of the Massachusetts health reform effort argue that the state should have addressed the care shortage and other issues before undertaking coverage reform.

Health reform supports disagree.

Once the new program works out the kinks, “the situation will right itself,” Buyse says.


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