• The Massachusetts Solution

    National health reform looks a lot like what has been implemented in Massachusetts. Will Massachusetts lead the way on cost control too? If so, it might look like this:

    There is fairly broad agreement on how to fix the system. A state commission —including representatives of government, insurers, doctors and hospitals—recommended in July that Massachusetts adopt a “global payment” system. Health professionals would be paid for caring for patients over a certain period of time, rather than compensated for each test or treatment.

    That’s from today’s Wall Street Journal (h/t Ezra Klein’s Wonkbook). I’ll believe that there’s “broad agreement” when I see the new payment system based on it implemented. How long will that take?

    • Wonder how they propose to pay us specialists? This will almost require that physicians be employed by hospitals/clinics. Employed physicians are not always very productive.


    • Isn’t a global payment much like capitation, except it involves multiple providers? Or is it more like a DRG code – a payment for a type of problem and anything else that you have to get during that visit? The quote sounds like capitation, which was in favor in the 1990s and appears to still be in favor in certain parts of the country. It wiped out docs who ended up bearing too much risk in some parts of the country, but I understand it’s still common in the Southwest. But capitation, where you pick a primary care doctor, and he gets a monthly payment whether you’re seen or not, has its own problems. With my capitated doctor, it was hard to get a receptionist on the phone to get an appointment and it was impossible to get a sick visit in a few days. Doctors can also try to game the patient population – appealing to patients who are healthier and thus less likely to need services (while trying to provide worse service to sicker populations).

      In the discussion in Massachusetts, is there any effort being made to deal with the problems of capitation?