It has been a while since we looked at Massachusetts’ experience with health care reform, but a new report from the state gives us an opportunity to do so. (Mass. Mkt. Report) The report contains a great deal of useful information, but the very concentrated structure of the Massachusetts payer and provider markets may not make the lessons applicable to all states. Most of the analysis relates to commercial insurance, which covers about 62% of residents, a total which has declined since the state reform. About half the commercial market is self-insured employers. Blue Cross has 45% of the commercial market and the three largest payers have 80%. Don’t expect much competition. The average monthly premium was $421 in 2011, up 9.7% since 2009, almost double the rate of inflation. That is $5000 a year, but all that money is buying less value, the benefits have declined 5.1% in the same period, largely due to higher deductibles and copays, so really the cost of insurance has gone up at triple the rate of inflation. And wow, here is a shock, the three largest insurers had the highest premiums. So much for benefits of scale or leverage. But things are just as bad on the provider side, with a few large systems accounting for a large percent of all health care, inpatient and outpatient. And here is another shock, the largest systems charge the highest prices. Maybe there is some leverage from size on the provider side! Fee-for-service payment is most common, but there has been good growth in global or capitated-type payments or budgets. But there is a little good news–quality is above national averages for both payers and providers.
Massachusetts Market Update
By Kevin RocheAugust 22, 2013Commentary
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
Another example of over-priced companies trying to find some way to survive in the post-epidemic financial world. Transcarent, which does something, somehow to “access high quality, affordable care” is buying...
March 6, 2023
In an attempt to swiftly revive two floundering health care companies, a PE firm has announced the merger and recapitalization of Revive Health and SwiftMD. You know they are...
January 30, 2023
Investors have not yet learned their lesson, as Pearl Health gathers a new round of $75 million in capital for its business of supporting physicians who want to participate in...
January 30, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace
March 25, 2023
Coronamonomania Lives Forever, Part 201
Tired of March Madness? A boringly refreshing dip into some CV-19 research summaries is recommended.
March 24, 2023
The CDC Is a Font of Methodological and Statistical Error
Several times in the last three years I and others have pointed out serious flaws…
March 24, 2023
A Couple of Health Care Notes
A couple of pieces of health care research focus on high health care spending and…