We need docs, not blocks

A TEETERING ECONOMY already hangs over the state's bold attempt to provide health insurance for almost all its residents. Now a new threat is forming: a spate of health-facility construction in Massachusetts that will inevitably add to the medical bills that employers and consumers must pay. This boom in bricks and mortar is coming just as new data on patients' long waits for appointments with primary-care physicians show that the real need in the healthcare system is for more of these front-line practitioners.

While expanding the corps of primary-care doctors is a vexing problem that will require long-term changes in the incentives for medical students choosing specialties, the state can use its regulatory authority to crack down on questionable new health construction projects. This year, the Legislature decided that outpatient facilities of $25 million or more would need state approval.

On the North Shore, three capital projects totaling more than $200 million are in the works. In Plymouth, Jordan Hospital in 2006 opened a $40 million pavilion, part of a $57.5 million expansion, only to see admissions drop by about 9 percent this year. Massachusetts General Hospital in Boston is planning a half-billion-dollar expansion and replacement of older buildings. In Springfield, Baystate Medical Center got the green light a year ago for a $259 million expansion that also includes replacing old buildings.

Each of these new facilities has arguments in its favor. But their collective impact is to add hundreds of millions of dollars to the cost of healthcare, without addressing the worsening shortage in primary-care physicians. A recent Globe report found that the wait for an appointment has grown to as long as 100 days, and that the number of practices accepting new patients has declined in the last four years.

Advocates of the state's health reform law had hoped that enrolling more of the uninsured in free or subsidized plans would lead them to build relationships with primary-care physicians. Not only would this improve their care, it would also reduce their reliance on high-cost emergency rooms for routine health problems.

To their credit, some hospitals are working to address this situation. The Legislature has granted the University of Massachusetts Medical School funds to expand its enrollment and to waive tuition and fees for students who agree to work in primary care in Massachusetts for four years after graduating. Now, on the other side of the ledger, state officials must use their new authority to make sure new building proposals are justified and not just costly ways to grab more market share.