(Excerpt from Finding the Best Healthcare You Can Afford: Massachusetts Edition)
Purpose & Organization of this Report
This report is designed to help the consumer obtain the best and most cost-effective healthcare available in Massachusetts. The report is divided into three main sections, each of which includes several chapters (see Table of Contents):
The diagram below represents the way the three choices – doctor, hospital and health plan – intersect to narrow and simplify the choices. This is a positive in the Boston area where there are literally thousands of primary care physicians to choose from. Choosing a health plan and a hospital first greatly simplifies the choice of physician. Fortunately, there is much more information available with which to judge the quality of hospitals and health plans than doctors, which this report documents.
If your employer offers a single health plan, that will be your starting point. If you have an established relationship with one or more doctors, they will be your starting point. If neither is the case, the author recommends that you narrow your choices by first choosing the hospital(s) that you would prefer to be admitted to, then choosing an affordable health plan that includes the hospital in its network and a conveniently located doctor with admitting privileges to the hospital(s) of choice and participates in the health plan’s network. Alternatively, seek out a multi-specialty medical group that has admitting privileges to the hospital(s) of choice. There are endless variations, but you get the point.
As health plans’ provider networks become more and more restrictive in order to control costs, your choices of providers are more and more likely to dictate the health plan you choose unless you are willing to let your health plan make your provider choices for you.
Massachusetts: High Quality at a Price
Massachusetts is, in many respects, a leader in healthcare, but an expensive one. It is home to some of the finest teaching hospitals in the country. A recent study ranked Massachusetts second highest in healthcare costs per capita, seventh best for access to healthcare and second best for health outcomes.[1] Another study ranked Massachusetts 17th best in terms of health insurance premiums.[2] The reader can judge whether the high costs are justified by ease of access and superior outcomes. Interestingly, Hawaii ranked last in access but first in outcomes.
In 2006 Massachusetts’ governor signed “An Act Providing Access to Affordable, Quality, Accountable Health Care” into law. It was designed to provide universal health coverage for Massachusetts residents. That law was, in effect, superseded by Obamacare, in connection with which Massachusetts recently obtained a federal waiver enabling the state to overhaul its Medicaid program. It is expected to save the state millions of dollars while maintaining or improving the quality of healthcare for the medically needy.
Yet even in Massachusetts the quality and cost of healthcare varies significantly from one provider and health plan to another. By choosing wisely you can positively impact your finances and the long term health of you and your family.
[1] 2016’s States with the Best & Worst Health Care, WalletHub, by Richie Bernardo – Sept. 6, 2016
[2] 10 Best and Worst States for Health Insurance Costs, Huffington Post – Jan. 20,2016
Beyond Massachusetts
While the geographic focus of this report is Massachusetts (with occasional references to eastern Long Island, and New York City) the approach outlined in the report and most of the resources cited are applicable across the country. Future editions for the New York and San Francisco metropolitan area and South Florida are currently under consideration.
CLICK HERE TO JOIN OUR MAILING LIST
[1] 2016’s States with the Best & Worst Health Care, WalletHub, by Richie Bernardo – Sept. 6, 2016
[2] 10 Best and Worst States for Health Insurance Costs, Huffington Post – Jan. 20,2016
[3] OECD Health at a Glance 2009 – 2007 stats
[4] Commonwealth Fund 2008
[5] World Health Organization
[6] The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid, published by Penguin Group, 2010.