Gaming the system… The Massachusetts Health Care Experiment

Well, the returns are rolling in, and a useful case study comes from the community-based health plan Harvard-Pilgrim. CEO Charlie Baker reports that his company has seen an “astonishing” uptick in people buying coverage for a few months at a time, running up high medical bills, and then dumping the policy after treatment is completed and paid for. Harvard-Pilgrim estimates that between April 2008 and March 2009, about 40% of its new enrollees stayed with it for fewer than five months and on average incurred about $2,400 per person in monthly medical expenses. That’s about 600% higher than Harvard-Pilgrim would have otherwise expected.

The individual mandate penalty for not having coverage is only about $900, so people seem to be gaming the Massachusetts system.

Since Dr. Gwande’s article on McAllen, TX and the impression that docs were overt-ulizing services out of greed— a number of pols and pundits have jumped on the “bad, bad doctor” bandwagon. A brief read of the WSJ article on the MA health care experiment shows that anyone is capable of a gaming a system that was not established with appropriate controls. Patients are signing up for coverage, having their health care needs met ( at a very significant cost to the insurer… and eventually the taxpayer) and then they are dropping their coverage when their needs have been met.

The MA experiment has not been a resounding success by any measure. Yes it has resulted in *everyone* having the possibility of being covered… but they do not have enough docs to cover the new patient load, they have suffered through enormous cost over-runs and the viability of the system as an effective health care delivery tool remains open for determination.

We should be dissecting this to death, we should put our best and brightest in charge of determining what is working and what is not working. Once analyzed we can determine how this could potentially work on a national roll-out. Otherwise we are in for a lot of change, a ton of debt, and a health care system that will not improve the quality of care it delivers, the quality of those who deliver it, access or in the end costs…


About hjluks

A busy Academic Orthopedic Surgeon, Digital Strategist, Chief Medical Officer and father... intently and efficiently navigating the intersection of Social Media and Health Care.
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