OP-ED

Massachusetts has the best health care in America?

A well regarded local hospital administrator last week said, “There is lots of evidence that Massachusetts health care is the best in the country.”

The context was a discussion in which it was pointed out that health care costs in Massachusetts are above the national average, even adjusted for wage differences. The statement was made to suggest that it is worth paying a bit more if what we actually get is better.

I was taken aback. I have never seen any evidence to support this conclusion. Would anyone care to offer quantitative support for the proposition — or against it?

Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. Paul recently became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so. For the past three years he has blogged about his experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

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9 replies »

  1. I agree with you, Larry McKnight…
    I have the experience of health services in Washington. The cost of overnight care is very expensive, what if for days in the hospital?
    Paul,
    I did not know if in Massachusetts applied health care like that. Looks like this is very needed in other areas so that all people receive adequate health care and in accordance with their economic condition.
    Thank you…

  2. Tabulated thru 2004, a good deal of statistics are available at: http://www.statehealthfacts.org/comparemaptable.jsp?ind=596&cat=5
    I find it interesting to note that according to this, the most expensive, generally worst care is in Washington, DC.
    Also of interest is the often sited country comparisons which can be found a number of places (wikipedia, world fact book, who, etc).
    It should be noted that comparing stats like this is difficult at best, however. MANY factors including population size averaging and genetics could more easily explain many of the differences than health care policy.
    I would have your friend explain what ‘best’ means, and then have him identify the most plausible causes and mechanisms that explain the differences. Also ask if and where the same causes and mechanisms could hold true when applied to other areas. Check the stats to see if his theories always hold.
    Compare with Utah, for example, where the costs are substantially lower yet quality also seems pretty good.

  3. According to NCQA rankings of health plans, Massachusetts plans typically score near the top. However, this is more a regional thing than an MA thing. CT, NH and upstate New York plans also do very well, at lower cost than MA. While the rankings are of health plans, really the rankings are mostly about the quality of care and compliance with care guidelines.
    There are several hospital rankings out there and MA does fairly well, certainly top 10, on reputation-based studies like the one found in USNews. But on what appear to be more evidence-based rankings like the Thomson Reuters top 100 and top 50 lists, MA fares less well and seems pretty undistinguished.
    My sense: MA does well above average in preventive care, probably in large part for demographic reasons (education, income, race) and because it has a high level of insurance. MA does a bit above average in hospital care, but, to echo rbar, the same kind of things go on in Chicago and no one makes a big deal out of it.
    And of course, MA is one of the most expensive nations in the country for healthcare on a per capita basis. So, if the question is whether MA provides the best value in the nation for its healthcare dollar, the answer is: Not a chance.

  4. Hmmm, how would you define the term “blind faith”? I would say it infers believing in something without really seeing what that something truly is to those who are more unbiased and objective.
    As the real falsehoods of this legislation continue to be exposed, pay attention to those who continue to preach its wonders and benefits, and either ignore or trivialize the detriments. Their blind faith will be very prevalent then, eh?
    It is almost always those who dismiss cost issues who are not impacted by that problem, true!?

  5. “There is lots of evidence that Massachusetts health care is the best in the country.”
    Is that why Ted Kennedy came to NC’s Duke Medical?

  6. “but also held costs steady”
    Yes, but has it held premium costs steady – whatever steady means.

  7. I interviewed at a major Bostonian academic institution in the late 90 s for specialty residency. The senior resident giving the applicants a tour stated in polite terms that the attendings were full of themselves (sthg like “they believe they are superior physicians and providing the best care and research in the US… whereas the same things may happen in, say, Chicago and no one would think to make a big deal about it”). Until proven otherwise, I would think that the administrator’s is the same stiff.
    But why not ask the originator of the statement him(her)self?

  8. Paul,
    If it did, what would the rest of us do differently?
    The fact of the matter is that in 2008 CMS Region-I outperformed the rest of the regions; ranking #1 on value. In this case Value = Quality, Safety, Efficiency, Affordability, 30-day readmissions, 30-day mortality, and patient experience…a fairly nice set of NQF endorsed metrics. HOWEVER, in 2009 that ranking flip flopped and CMS Region-I moved to last on the list of value. History has a funny way of defining the future. So, NO, the latest data shows that Region-I does no outperform the nation. And for those of you wondering…ME, NH, VT carry their weight quite nicely. Try http://www.HospitalValueIndex.com.

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