Health affairs
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In April 2006, Massachusetts passed its third major health care access reform law since 1988. This law establishes new structures and requirements that have never been attempted by any state. ⋯ Massachusetts will engage in a multiyear implementation process. Only after this process is complete will the law's significance be clear.
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Massachusetts recently enacted a major health reform that could move the state to close to universal health insurance coverage. We describe some of the politics behind the legislation and the law's key details. We discuss four major issues that the plan would face: (1) a definition of affordability-how much should be borne by individuals and how much by government; (2) issues the state will face in implementing the Insurance Connector; (3) whether employers will respond by dropping coverage; and (4) whether the financing would be adequate, both immediately and over time. Massachusetts will face challenges, but it offers a model that could be followed elsewhere.
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The Massachusetts plan to extend health insurance coverage to nearly all of the state's residents offers several lessons related to health reform, including the following: Bipartisan cooperation is possible; multiple policy mechanisms must be employed to achieve meaningful change; the starting point-in terms of the rate of uninsurance, the degree of insurance market regulation, and so on-matters; and implementation details are critical. In addition to these lessons, we argue that objective analysis and a comprehensive framework for evaluating alternative policy options are needed for similar reforms to be enacted elsewhere.
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The Massachusetts health reform law has attracted national attention for its bold vision and its unique combination of tested and innovative policy approaches. Despite the law's promise, implementation challenges lie ahead, including building and sustaining public and legislative support for the law; ensuring care for those who are left out; and containing health care costs. The provisions that are most certain of success should provide coverage to 70 percent of the state's 530,000 uninsured residents. The state's ultimate success in reaching its goal of near-universal coverage will depend on how well the state can respond and adjust as implementation proceeds.
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There are indications that after-hours care in some countries is of poor quality. European after-hours care is shifting away from individual and group practices with local after-hours call schedules toward large-scale after-hours care services. ⋯ Most patients accept these new models but are dissatisfied if they expect to see a physician. Local or regional integration of all emergency services seems to be the most promising model for after-hours care.