THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
Dennis Rosen

Patrick’s cuts pose long-term health risks

By Dennis Rosen
February 24, 2011

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THE STEADY rise in health care costs continues to pose a major threat to the economy. Health care expenditures as a percentage of the gross domestic product were more than 17 percent in 2009 and are predicted to rise to 31 percent by 2035, according to the Congressional Budget Office. Allowing health care expenses to consume such a large proportion of what we produce leaves less for everything else, including education, scientific and technological research, and job creation.

At all levels, efforts are being made to contain and reduce health care costs. including the federal Affordable Health Care Act, though it has been roundly criticized for doing both too little and too much. State governments, struggling with declining tax revenues, are also trying to do their part.

Governor Patrick recently unveiled the 2012 state budget proposal, which increases funding for MassHealth by only $100 million, or less than 1 percent above 2011 projected spending levels ($10.5 billion). This, despite the fact that the projected case load handled by MassHealth is expected to increase in the coming year by 4.6 percent.

In order to cover the $800 million gap between what is being budgeted for Mass Health and predicted costs based on current levels of service, reductions in coverage are being proposed. One of these is the shifting of costs to low-income families by increasing medication copayments and by charging copayments for the use of non-emergency transportation. These measures are expected to save the state $5 million, or 0.6 percent of the expected shortfall.

However, these cuts may wind up causing the opposite of what they are intended to do and may actually increase overall expenses. Many patients require multiple medications, and the costs of their copayments can quickly add up. When forced to choose between medicine and food, many may stop taking their medicines.

Approximately two-thirds of medication-related hospital admissions in the United States are the result of medicine not being taken as prescribed, at a cost of $100 billion annually.

While encouraging the judicious use of pricey medications is laudable, making them more expensive may result in an increase in costlier hospitalizations.

The Patrick administration should reconsider this section of its 2012 budget proposal. Its risks, both to the health of those who rely on MassHealth and to the finances of the state, far outweigh the modest savings hoped to be achieved.

Dr. Dennis Rosen is a pediatric pulmonologist and sleep specialist at Children’s Hospital and an instructor at Harvard Medical School.