Massachusetts can be considered the test ground for examining the effects of providing mandatory universal health care coverage. Despite putting this in place over two years ago, there has been little change in controlling the spiraling health care costs.

Two articles in the Boston Globe over the past week highlight the changes that are being proposed to stop the uncontrolled rise in health care costs. The first is by Blue Cross Blue Shield of Massachusetts where bundled payments (a fixed amount of dollars are provided for a patient on an annual basis) were tested and resulted in cost savings (Boston Globe, January 23, 2011 by Robert Weisman – “Blue Cross Blue Shield CEO Says Providers Must Control Costs, or Else”). However, patient satisfaction did not improve. In the second article, (Boston Globe, January 27, 2011 by Kay Lazar and Stephen Smith – “Hospitals, poor patients face new costs”), Governor Deval Patrick is proposing to save $1 Billion alone using a similar global payment system for Medicaid patients which now makes up 39% of the state budget.

There is no question that at both the federal and the state level as well as the insurers, the fee for service structure is being transitioned to some degree of a global payment system where a fixed amount of money will be provided to providers and hospitals on a per patient basis. The problem is that the solutions are being left up to hospitals and providers to determine how to provide optimum health care in a way that is fiscally sound.

We have seen how businesses responded to the world-wide financial meltdown from Wall Street. Those that thought out-of-the box and streamlined operations succeeded. Those that did not, went bankrupt or significantly downsized. We are a similar critical moment in time in health care. Reform is no longer an option to be debated but rather is now forced upon us by the spiraling health care costs that affect everyone – businesses, health care providers, federal and local budgets, and us citizens. The focus needs to be on how we address what type of infrastructure is needed and reassess how we think about and provide care. Both caregivers and patients and their families need to become informed partners in their care. It can no longer be one-sided. Important questions need to be asked – how will tests or treatments change management, is going to the Emergency Room needed or, as in the Blue Cross Blue Shield study, can this be decreased by extending physician office hours and accessibility?

As a nation, we have come to expect that it is our right to have the most expensive testing and treatments. Instead, we need to ask how do we re-train and educate both caregivers and hospitals, as well as patients and their families to use health resources in a thoughtful manner. This is likely to result in cost savings but not at the expense of health outcomes.