Out in Chicago this weekend at a conference for new state legislators and legislators new to health care policy – organized every other year by Nat. Conf. of State Legislatures and the Agency for Healthcare Research and Quality. Rep. Steve Kulik, new House vice chair of Health Care Financing Committee, was there for MA. Interesting session on healthcare workforce with state-by-state professional data. See if you can observe a trend: (Data is federal from 2002-05.)
1. Category/2. MA Rank among 50 States (low # equals highest) / 3. MA Rate Per 1,000 Pop./ 4. US Rate Per 1,000 Pop.
Physicians/ #1/ 303.19/ 214.09
Allopathic Med School Enrollment/#2 – /38.31/22.62
Registered Nurses/ #4 /1,173/ 802
Nurse Practitioners/ #4/ 89.92/ 42.04
Dentists/ #2/ 80.15/ 59.4
Dental Hygienists/ #4/ 94.6/ 53.9
Physician Assistants/ #28/ 17.27/ 16.87
Chiropractors/ #28/ 29.22/ 29.14
Podiatrists/ #4/ 9.35/ 6.13
Optometrists/ #31/ 7.17/ 7.83
Pharmacists/ #31/ 75.59/ 77.02
Psychiatrists/ #3/ 13.56/ 5.21
Psychologists/ #3/ 57.51/ 33.52
Social Workers/ #6/278.03/ 158.27
Physical Therapists/ #1/ 87.12/ 49.45
Occupational Therapists/ #3/ 58.6/ 29.53
Speech Language Pathologists & Audiologists/ #5/ 51.59/ 34.8
Respiratory Therapists/ #22/ 32.42/ 32.1
Emergency Medical Technicians & Paramedics/ #18/ 77.46/ 65.06
Med & Clinical Lab Techs/ #1/ 184.06/ 101.32
Med Records & Health Info Technicians/ #6/ 81.04/ 53.43
Radiologic Technologists/ #8/ 79.33/ 62.01
Dieticians & Nutritionists/ #1/ 27.43/ 16.28
Home Health Aides/ #21/ 212.11/ 212.64
Out of 24 categories, we’re among the top eight states 17 times – 14 times among the top five. And we tend toward the highest rates in the highest paid professions. Not that there’s anything wrong with this. Just seems pretty obvious – more professionals, more services provided, both necessary and unnecessary. As we keep asking ourselves the question, why is per capita health spending in MA so high even relative to inflated US spending, a lot more professionals doing a lot more services seems a logical piece of the answer. Not the only one, but a piece of the explanation.
John McDonough
Which services are unnecessary? Maybe if there were a consensus on that, we could start paring them down.
On my blog, I have pointed out the unnecessarily large number of solid organ transplant programs in the state as an example, some doing only a few dozen cases a year yet incurring the costs of physician recruitment and capital expenditures. But this observation gets no traction from the insurance companies, who could limit the number of centers to a more rational number by disqualifying sites that do too few procedures.
Surely, if this issue is as big a problem as John suggests, other people could nominate their own examples. Now is as good a time as any.
BTW, in the opposite direction, there appears to be a growing shortfall of primary care doctors in the state. Certainly, the low reimbursement rates for those providers is the cause of that. With a limited amount of money to spread around the system, PCPs always seem to get the short end of the stick.
I think a better explanation of why health care is so expensive in MA is because everything is more expensive in MA. There’s no good ranking of states by cost of living expenses but this database of cities suggest that the most expensive states in the US are California, Connecticut, Hawaii, MA, New Jersey, and New York.
http://www.census.gov/compendia/statab/tables/07s0709.xls
It’s no wonder MA ranks in the top 5 or top 8 for health care.
(I’m assuming that your rankings don’t factor in cost of living, of course. I don’t think they do considering how hard it is to find state-by-state comparisons.)
Also, having more professionals does not inherently lead to higher costs. A greater supply of something relative to demand should lead to *lower* prices due to more competition.
So there’s much more to the story. For starters, demand in MA must still be outpacing supply.
Notice that low cost, low tech Acupuncture and Oriental Medicine (AOM)that requires no expensive diagnostic or lab tests, has few adverse side effects, is ultra safe ( see Malpractice rates)is great for prevention And Chronic diseases, is proven effective for over 45 health diseases and disorders according to World Health Organization, is advocated by Prince Charles of England and renowed NY Cardiologist Dr. Oz of Columbia Presbyterian Hospital to be fully integrated into Western Medicines health insurance systems is NOT include. We also don’t employ expensive lobbyists, lawyers and PR people and past the cost on to the patient.
AOM is Not Included in Mass Health Plan, not included in Commonwealth Care etc. And Asian Americans are denied equal access to their traditional medicine -AOM. If we want to reduce the cost of medical care, the easy first step is to include the lowest cost provider, the 1000 MA Licensed Acupuncturists and AOM as a covered benefit under universal health care insurance. Look at the highest income communities around Boston and you’ll see big clusters of Acupuncturists. If its good enough for those rich enough to pay out of pocket, how about the rest of us?
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