Some small group health insurance purchasing cooperatives seem to work much better than others, according to health care access specialists in Massachusetts.

Staffers at the Massachusetts Health Care Access Bureau, the managed care bureau and other state offices include the health co-op reviews in a report on small group health purchasing co-op informational sessions that the state held in late 2009 and earlier this year.

Many commenters had the sessions had views about strategies for managing co-ops, and many commenters disagreed sharply about whether to permit use of purchasing co-ops, the staffers write.

Some groups have predicted that permitting use of purchasing co-ops would destabilize the Massachusetts individual and small group market, staffers say.

In Ohio, the Council of Smaller Enterprises (COSE), Cleveland, is a co-op that has succeeded at providing high-quality coverage for 200,000 northern Ohio residents at rates “slightly better than those available through the normal market,” staffers say.

But “COSE stands out as a success because most cooperatives have not brought meaningful product options to the small group market,” the staffers say.

Co-ops in Florida and Texas have stayed small and not worked very well, the staffers say.

A successful co-op should be big enough to able to negotiate and not have more permissive rating rules than the outside market, staffers say.