Five years after Massachusetts adopted the nation’s most sweeping expansion of health care, access to primary care doctors remains a key concern among those who have obtained insurance through the 2006 law.
That’s one finding of a survey of individuals enrolled in the low-cost, subsidized health insurance program known as Commonwealth Care, which provides subsidized insurance to those earning up to three times the federal poverty level.
The telephone and mail survey of nearly 700 Commonwealth Care members was commissioned by the Massachusetts Health Connector, which oversees the health care law.
Overall, those enrolled in the program gave it high marks.
Eighty-four percent of respondents handed the insurance program an overall rating of four or five on a five-point satisfaction scale. Only 4 percent indicated they were dissatisfied.
Nearly two-thirds felt their monthly premiums and co-payments were reasonable.
For many, however, getting in to see a doctor proved frustrating.
Thirty-one percent of those surveyed said they’d been told a doctor’s office or clinic would not accept their insurance, while 23 percent were told an office wasn’t accepting new patients.
Officials overseeing the program said they have worked to make sure every Commonwealth Care member has a primary care doctor, but conceded that the doctor may not be the patient’s first choice because of contractual relationships with certain health plans.
They also said that like many individuals with private insurance, Commonwealth Care recipients can have trouble making an appointment, although officials say more than 80 percent saw a doctor last year.
“We work closely with our members and our partner health plans to help them find a doctor and have been successful in every case,” said Richard Powers, spokesman for the Massachusetts Health Connector. “The doctor may not have been their first choice, but they all have doctors.”
Dr. Alice Coombs, president of the Massachusetts Medical Society said the shortage of primary care doctors isn’t new. The society conducts annual surveys and has found shortages of primary care doctors for each of the past five years.
Coombs said there are lots of reasons, not the least of which is that medical specialists tend to earn significantly more than primary care physicians.
“We need to be able to increase the number of doctors and increase the number of medical students deciding to go into primary care medicine,” she said. “We’re top heavy in specialists.”
She said the state could encourage students to go into primary care by establishing loan forgiveness programs and decreasing the overhead for primary care doctor offices in underserved areas of the state.
Powers said the private sector, with some state contribution, has already developed a loan repayment program for physicians and nurses who make a two- to three-year commitment to practice primary care in a Massachusetts community health center.
Another goal of the 2006 law was to reduce the use of emergency rooms by requiring nearly all Massachusetts residents have insurance.
According to the survey, the use of hospital emergency rooms by Commonwealth Care recipients was nearly the same as emergency room use by all residents. One-third of the members indicated that they had received care in an emergency room during the past year.
One way to decrease reliance on emergency rooms — where care tends to be far more costly than in doctor’s offices — is to increase the number of primary doctors, officials said.
“Expanded hours among primary care providers and increased use of physician assistants and nurse practitioners would go a long way in mitigating emergency room use for not only Commonwealth Care members, but all residents of Massachusetts,” said Commonwealth Care Director Stephanie Chrobak.
The telephone and mail survey of 695 Commonwealth Care members was conducted between Oct. 19 and Nov. 30. The survey had a sampling error of plus or minus 3.7 percentage points.
Commonwealth Care is open to those earning up to $32,676 for an individual and $66,168 for a family of four. Enrollees must be U.S. citizens or legal residents of Massachusetts and can’t have access to employer-sponsored insurance.
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