If imitation still is the sincerest form of flattery, Massachusetts received the ultimate compliment in 2010 when the federal government adopted a model of its healthcare reforms for the nation. In mid-April, the Commonwealth quietly marked the sixth anniversary of its law with health insurance coverage rates growing from 86.6% in 2006 to 94.2% in 2010.
Among the statistics the Washington Post includes in a recent slideshow on the law, the data on the accessibility of internal and family practitioners to patients raised questions on whether there needs to be greater buy-in by primary care physicians into the system. The number of general internists willing to accept new patients dropped from 66% in 2005 to 49% in 2011. For family doctors, the figure was 70% in 2007 and 47% in 2011.
Perhaps the limited access to these physicians explains why the state saw minimal changes in residents' visits to the emergency room. The Post collected statistics about ER visits from two sources: One study in Health Affairs reported ER visits decreased by 3.5% between 2009 and 2010. Another by the University of Illinois comparing Massachusetts ER visits to that of other states found an 8% decrease.
In many cases, primary care physicians are the healthcare system's gatekeepers. They funnel patients to specialists for closer attention or prescribe the medications that heal a developing condition before it becomes serious. Their focus is on preventive care, and they work with patients to ensure they receive appropriate screenings as they age. Most importantly, they charge less than specialists and the ER.
That primary care reduces costs is important for Massachusetts. The state is entering the next phase of its reforms by focusing on healthcare spending. It does so as healthcare costs comprise 41% of its fiscal year 2013 budget. To contain costs, the legislature is taking up various bills that shifts the state toward global (flat fees) rather than current fee-for-service payments.
So what's the connection between primary care, fiscal reforms to the Massachusetts budget and chronic disease? The answer is everything. While healthier people need access to preventive care, too, the chronically ill use the system more frequently no matter its shortcomings now. New fiscal reforms that boost access to primary care would implement an immediately useful policy that removes a significant barrier to better disease management.