Medicolegal Issues

Access Problems Persist Despite Health Insurance: Lessons from Massachusetts


A surprising lesson from Massachusetts is that expanding health insurance coverage does not automatically improve access to healthcare services. Here’s proof:

  • More than half of primary-care physicians (PCPs) in Massachusetts are not accepting new patients.
  • Wait times to see PCPs remain high: 48 days for internal medicine, 36 days for family medicine.
  • The percentage of internal medicine physicians accepting Medicaid has decreased by double digits.
  • Many physicians who accept Medicaid report that a lack of qualified specialists in their area is a major problem that limits their ability to provide high-quality care.
  • Many physicians who accept a high proportion of Medicaid patients are in solo or two-physician practices, and have limited ability to expand hours of availability.
  • ED use increased 10% from 2004 to 2008, and high levels of ED use have persisted since the reform law was enacted—a strong indicator of PCP shortages. Massachusetts has 491 ED visits per 1,000 residents, compared with a national average of 401 visits per 1,000 residents.
  • Preventable hospitalization rates have not decreased, and are comparable to that of Medicaid patients and uninsured patients—remaining at about 10% from 2004 to 2008.

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