Massachusetts Health Insurance Law Highlights Doctor Shortage
While the Massachusetts health insurance law has led to about 440,000 newly insured state residents, the demand for primary care physicians has outpaced the supply, NPR's "All Things Considered" reports. The law, passed in 2006, requires most state residents to be covered either through a state-subsidized plan, an employer-sponsored plan or an individual policy.
Jacqueline Spain, medical director for Holyoke Health Center, said, "It's entirely reasonable for somebody who's now got insurance and maybe has a whole list of things that's worried them and troubled them" to "expect that they should be able to go out in the market and get all of that care. There just aren't enough [primary care physicians] to give it to them." She said about 1,600 people currently are on the facility's waiting list and patients must wait an average of four months to be seen.
Primary care doctors are leaving the field in part because insurers, Medicare and Medicaid pay less for primary care than for visits to specialists. Dan Levy, a physician who left primary care for medical administration, says the problem is being exacerbated as new patients arrive at PCPs with a long list of pent-up health concerns. He said, "You have someone on your hands with five separate medical problems, 15 minutes to see them. If you spend the extra half hour, you don't get paid for it, so the pressure is to refer them to a subspecialist."
According to NPR's "All Things Considered," the trend could raise health care costs, as people unable to see PCPs often visit emergency departments and let small medical problems grow into larger, more costly problems. John McDonough, who played a role in drafting the insurance law and now serves as an adviser to Sen. Edward Kennedy (D-Mass.), said, "What has happened is that Massachusetts health reform has put a spotlight on the work force shortages that don't get meaningfully talked about in just about any other state."
State lawmakers recently approved legislation aimed at making primary care more attractive to physicians through loan forgiveness, home buying assistance and increased reimbursements. However, NPR's "All Things Considered" reports that it will "not be easy to pay for change, especially in this budget climate" (Brown, "All Things Considered," NPR, 12/1).
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