Many use safety-net health care despite MA reform

NEW YORK Tue Aug 9, 2011 11:10am EDT

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NEW YORK (Reuters Health) - Health care reform in Massachusetts hasn't lessened the pressure on providers that care for the poor, a new study shows.

In fact, visits to community health centers climbed by 31 percent between 2005 and 2009, and charity and public hospitals also saw a fast rise in patient numbers.

The findings hold some lessons for the nationwide health care overhaul, said Leighton Ku, who led the study.

"We are now concerned about how we can rein in spending in healthcare, so there will be a certain temptation to cut back on the funding to safety-net providers," said Ku, who heads the Center for Health Policy Research at The George Washington University in Washington, D.C.

"But the answer is, you may still see a lot people using these services, so cutting funding would short-change the system," he told Reuters Health.

Ku and his colleagues tapped into data for community health centers and hospitals, as well as the 2009 Massachusetts Health Reform Survey that included some 3,000 adults.

The reform required all state residents to have health insurance and made subsidized insurance available to those who were uninsured or had limited coverage. Massachusetts enacted the legislation in 2006, when Mitt Romney -- now an opponent of current national health reform legislation -- was governor, and had fully implemented it by 2008.

As a result, fewer than two percent of residents in Massachusetts were without health insurance in 2010, the researchers write in the Archives of Internal Medicine.

Ku said some policy makers had thought the reform might lift the pressure off community health centers, which provide medical services to low-income people regardless of insurance coverage.

But contrary to those expectations, his team found the number of patients at the centers jumped from about 431,000 to nearly 565,000 between 2005 and 2009.

From 2006 to 2009, non-emergency visits to safety-net hospitals also rose -- by twice as much as they did for non-safety-net hospitals, when hospitalized patients were excluded. For hospitalizations, patient numbers rose in sync.

"In Massachusetts they did see a big reduction in the number of uninsured people," Ku said, "however the demand for care at safety-net providers continued to increase."

More than 70 percent of the survey respondents said they'd chosen a safety-net facility because it was convenient or affordable.

Only a quarter said they had done so because they had trouble getting an appointment elsewhere. To Ku, that suggests the bad reputation such providers have gotten may be partly unjustified. But as an editorial in the journal notes, it's still uncertain whether that would be true for the rest of the country as well.

SOURCE: Archives of Internal Medicine, August 8, 2011.

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