A study published this afternoon in the New England Journal of Medicine finds that the vast majority of physicians practicing in Massachusetts support the State's health reform law and they report it has had a positive or neutral impact on their medical practice.
The paper, conducted by researchers at Harvard, and funded by the Robert Wood Johnson Foundation, presents the results of a recent poll of 2,135 Massachusetts physicians (primary care and specialists) regarding their perceptions of the comprehensive health reform law that was enacted three years ago. The poll was conducted between August 11 and September 15, 2009 and has a sampling error of +/-1.9.
The poll assessed Massachusetts’s physicians’ perceptions in three areas:
- Their overall support for the State’s health reform legislation,
- Their views of the law’s impact on their own practice of medicine, and
- Their views of the law’s impact on health care across Massachusetts.
Massachusetts's health reforms have been very successful in reducing the number of uninsured in the state. Three years after enactment of the law, Massachusetts now has the lowest proportion of uninsured residents (2.6%) in the U.S. This is extraordinary.
But what impact have these reforms had on practicing physicians in Massachusetts?
Three years into the implementation of the law, nearly twice as many physicians give high overall ratings (excellent/good) to the Massachusetts system for providing medical care compared to the national system (63% vs. 33%).
In addition, the poll found that 70% of practicing physicians support the Massachusetts Health Reform Law, while only 13% oppose it. Support for the reforms did not vary among primary care doctors, specialists, and safety net physicians.
When asked about the law’s future, 75% of practicing physicians wanted to continue the law – 46% with some changes and 29% as is. Only 7% of physicians favored repealing the legislation and this did not vary among specialists or primary care doctors.
The poll also asked about the impact the reform law had (positive, neutral or negative) on 22 different areas of physician practice.
For 21 of these 22 areas, a majority of physicians said that the law either “did not have much of an impact or was having a positive impact on their practice. “
Some examples of the practice areas where the majority of Massachusetts physicians said the law had a positive or neutral impact were:
- the quality of care their patients receive (85%)
- their medical practice overall (79%)
- decreasing the number of patients in their practice who were uninsured (77%)
- your patients’ continuity of care (75%)
- your uninsured patients’ ability to pay for care (69%)
- your ability to order diagnostic tests or procedures for your patients (68%)
- the amount of time their patients wait to get an appointment (62%)
- the financial situation of their practice as a whole (56%).
The practice area that elicited the most negative response (35%) was the law’s administrative burden on their practice.
The author’s conclude:
This suggests that it is possible to provide near-universal coverage of the population and have a resulting system that physicians believe improves care for the uninsured without undermining their ability to provide care to their patients.
This study bodes very well for likely physician response to national health care reform. Many of the reform bills in the US Congress share similar features to the Massachusetts law including offering expanded private coverage through an insurance exchange, expanding coverage for existing public programs, and including an individual mandate to buy coverage.
What is most interesting about physician reactions in Massachusetts is the overall positive impact they perceive the law has had on their practices, not just in reducing the number of uninsured but also in increasing their ability to pay for care, and in improving the quality of care they deliver to their patients.
The results of this study, combined with the previous RWJ survey of physician support for national health care reform, suggest that physicians will benefit from comprehensive reforms that will improve access to and the quality of care delivered in the US health care system.
One of the concerns of physicians is that the law did not do enough to control costs. With a public option, it would achieve all the desired goals.