State Reform Dominates Boston Health Care Market Dynamics

A report funded by the Robert Wood Johnson Foundation and authored by the Center for Studying Health System Change (HSC) examines how Massachusetts’ 2006 health reform law has affected the health care arena in Boston, and remarks on how the law has reverberated throughout the Boston health care market as providers, insurers, employers and consumers adjust and adapt to a post-reform world of nearly universal health insurance coverage. The authors also note that now, with nearly universal health coverage attained, policy-makers are turning to the more intractable problem of how to quell the growth of rapidly rising health care costs.

The authors point out that while Massachusetts provides lessons and insights for others, it’s important to take into account several factors unique to the state. Those include the low uninsurance rates prior to national reform—perhaps better positioning the state to achieve universal coverage than other parts of the country. In addition, Boston—an affluent community with better health and greater health care provider capacity than other metropolitan areas—has not experienced significant provider shortages and access issues as a result of coverage expansions. However, the authors argue that Boston’s affluence has made cost containment a particular challenge, because a high proportion of medical care—even relatively routine care—is provided in expensive advanced settings.

Boston is one of 12 communities across the country tracked intensively as part of the Community Tracking Study site visits, which are jointly funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform. HSC has been tracking these communities since 1996.