October 12, 2015

Health Care Provider Supply

I am continually frustrated when I read about the laser-like focus elected officials and advocates for health care reform have with respect to universal, affordable insurance, but without a comparable focus on addressing supply imbalances with respect to health care professionals.

I was reminded of this in reading an article in the August 7 Wall Street Journal (page D4) relative to the increased waiting time in emergency departments all over the country.  Among the reasons cited in the article entitled “Average ER Waiting Time Jumps to Nearly an Hour” is the difficulty patients have in getting appointments at doctor’s offices.

There is anecdotal evidence that this problem is particularly an issue in Massachusetts, where many hundreds of additional residents were covered as a result of the 2006 reform legislation.  Many individuals are finding waiting times for doctor’s appointments, screenings, and immunizations to be significantly longer than they were before the legislation was passed.

Medicaid recipients are a victim of this supply-demand imbalance, since the physicians who treat them are reimbursed at the lowest rates.  I did learn that four of the top five academic medical centers in Massachusetts are refusing to contract with the Connector, the state agency responsible for organizing coverage for those individuals and organizations that had previously found coverage unavailable, because reimbursement rates are too low.

Until we address the supply-demand imbalance, particularly for primary care providers, providing universal, affordable insurance will be a cruel illusion for people who get coverage for the first time.  They will have affordable coverage, but no health care providers available for them to access.

Moreover, a supply-demand imbalance will inevitably have one or more of three consequences:

  • A denial of coverage to the poorest citizens for whose care reimbursement rates are the lowest;
  • Longer waiting times for everyone; and/or
  • Systems for rationing care to everyone to reduce demand.  Rationing will either affect the availability of a particular kind of care, or it will result in reduced choice.

As uncomfortable as it may seem, we must focus on what kind of delivery system we want and what standard of care we want in parallel to addressing the urgent issues of universal and affordable insurance coverage.