In Massachusetts, 'Individual Mandate' Led to Decreased Hospital Productivity

[xchrom]

http://www.sciencedaily.com/releases/2012/07/120730134446.htm

ScienceDaily (July 30, 2012) — As the "individual mandate" of the Affordable Care Act moves forward, debate and speculation continue as to whether universal health insurance coverage will lead to significant cost savings for hospitals. The assumption is that providing appropriate primary care will improve the overall health of the population, resulting in less need for hospital services and less severe illness among hospitalized patients. Findings from a recent study published in Health Care Management Review challenge that assumption.

The new study reports that mandatory individual insurance coverage in Massachusetts was followed by a significant near-term drop in hospital productivity. The results raise the possibility of similar decrease in U.S. hospital productivity once the individual mandate is implemented as part of national health care reform. "As such, current cost estimates of the Affordable Care Act's impact on overall health spending are potentially understated," write Mark A. Thompson, PhD, of Texas Tech University and colleagues.

Hospital Productivity Drops after Mandatory Insurance The researchers used economic models to evaluate the effects of mandatory insurance coverage on hospital productivity. The analysis focused on the impact of the universal insurance coverage mandate implemented in Massachusetts in July, 2007.

Data from 2005 to 2008 was used to compare trends in productivity at 51 Massachusetts hospitals, 197 matched hospitals and other 2,916 hospitals across the United States. The analysis first used "propensity score matching" techniques to match hospitals in Massachusetts with the hospitals with comparable characteristics.

[sinkingfeeling]

1. The important point isn't stressed in the OP title.

Last edited Tue Jul 31, 2012, 12:27 PM - Edit history (1)

"They speculate that increased access to health care may lead to "release of pent-up demand" for costly discretionary hospital services. The researchers add, "In the long-term, universal coverage should lead to significant savings for hospitals if they can shift non-emergent care away from their emergency departments."

[upaloopa]

2. This need a lot more explanation. For profit hospitals most likely look at productivity to measure

success where non for profit hospitals may look at successful patient outcomes as a measure of success.

Productivity does not measure outcomes I think. Productivity to me is a measure of output per dollar of cost. Output is not concerned with the outcome.

[Jeff In Milwaukee]

3. I believe you are correct in that...

Most providers measure productivity in terms of billable services (including tests). It has no bearing on actual outcomes. That's one of the reasons why we pay so much for healthcare in the U.S. and have such poor results.

[1StrongBlackMan]

4. I just pulled the study (I haven't read it yet); but ...

A couple of questions pop up:

1) How does the study define "productivity?

2) While hospitals nation-wide experienced drops in productivity during the survey period, how does the study determine that a 2.4% drop (from the study's abstract) is significant?

3) The study cites "Pent up demand" as an alternative explanation for Massachuetts hospitals' higher rates of drop (and lower rates of increases) in productivity. Doesn't that factor invalidate the study's findings?

4) Relatedly, given the "Pent up demand" premise, wouldn't a short-term decrease in productivity be expected; and wouldn't that decrease in productivity as Massachuetts Hospitals ramp up staffing and services?

Finally, a 7 page report (graphs and citations, inclusive) seems to suggest, either truncated reporting, or a lack of critical examination.

I'll read the study and report back.