The cost of quality in health
PEOPLE IN the Boston area are proud of their healthcare system, and with good reason. It is one of most powerful engines of the regional economy, and has helped produce a 79 1/2 -year average life expectancy in Massachusetts, 18 months longer than the US average, which places the state between Italy and Austria in word rankings.
But the system is among the most expensive in the world, and faces a threat from unexpected sources -- sluggish economic growth and the high cost of housing. The New England Healthcare Institute, supported by the Boston Foundation, is to be applauded for bringing attention to the issue and seeking a consensus for solutions.
The institute explains the problem in its report "The Boston Paradox: Lots of Healthcare, Not Enough Health." With young people leaving the state for more affordable locations, the workforce increasingly includes older people, more likely to be afflicted with such ailments as cancer and heart disease. The problem is worsened by the state's rising obesity epidemic, since overweight people are more prone to diabetes. Chronic diseases mean higher costs.
And don't expect the state and private payers to be able to spend their way out of trouble. When adjusted for living expenses, notably the high cost of housing, incomes in the suburbs of Boston are below that of comparable areas around Atlanta, Washington, Houston, and Raleigh-Durham, N.C., all of which have younger populations. If the trends continue, people in Massachusetts will have to trim back on healthcare to save money for such essential items as education, transportation or housing.
The Boston Foundation has already done admirable work on increasing the housing supply. A panel convened by the foundation last week suggested that more can be done to spread healthcare resources wisely. This would involve a change of emphasis. Instead of focusing so much on episodic treatment of illnesses without regard to whether the procedures are effective, more resources would be devoted to preventive steps and proven, high-quality treatment.
That sounds a lot like managed care, a movement that was supposed to provide the solution to rising healthcare costs in the 1990s but turned out to be widely unpopular. Many people feared that it saved money by denying people necessary care.
Over the next few months, the New England Healthcare Institute will work on a strategy for controlling costs. The institute, a coalition of healthcare providers, technology companies, and health policy specialists, will have to prove that more care does not necessarily mean better health. If private entities cannot achieve consensus, the state will have to consider taking action to protect the public health without breaking the bank.
