Does Massachusetts need more cost control?
posted at 7/1/2012 8:47 AM EDT
Although history-challenged Globe reporters seem unaware, Massachusetts has set up and sometimes abandoned one medical cost-control effort after another over the past 40 years. The early 1970s "certificate of need" requirements aimed to hold down proliferation of new hospital progams. They were soon exploited by bigger hospitals seeking to protect themselves from smaller competition. [A.E. Reider, J.R. Mason and L.H. Glantz, Certificate of need: the Massachusetts experience, American Journal of Law and Medicine 1(1):13-40, 1975]
Hospital rate-setting in the late 1970s disintegrated as emergency rooms started churning patients and hospitals laid off nursing staffs. HMO capitation in the 1980s became another failed experiment, producing massive rejection by health-care insurance subscribers. At one time or another, the state has experimented with almost every popular medical cost-control notion except single-payer care.
Does Massachusetts need more medical cost-control now? Perhaps not. Last year, Globe columnist John McDonough showed that relative to its personal incomes, its medical spending places Massachusetts among the half-dozen lowest-cost states. The others are Connecticut, Maryland, New Hampshire, New Jersey and Utah. [ Does Massachusetts have the nation's highest health insurance premiums?, at http://www.boston.com/lifestyle/health/health_stew/2011/11/does_massachusetts_have_the_na.html ]
The highest-cost states for medical spending, relative to personal incomes, are in a corridor of misery stretching out of the Deep South into the Southwest: Mississippi, Louisiana, Texas and New Mexico. The disparity between highest-cost and lowest-cost states is large, with health-care spending taking 25 percent of personal incomes in Mississippi but only 13 percent in Connecticut.