Health Care Reform and the Health Care Workforce — the Massachusetts Experience

Published in: New England Journal of Medicine, v. 365, no. 12, Sep. 2011, p. e24(1)-e24(3)

Posted on RAND.org on September 01, 2011

by Douglas Staiger, David I. Auerbach, Peter Buerhaus

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The Massachusetts Health Care Reform Plan, implemented in 2007, offered insurance subsidies for low-income individuals, expanded Medicaid coverage, and created an individual mandate to obtain insurance, pay-or-play requirements for employers, and a state insurance exchange through which many of the newly insured Massachusetts residents obtained coverage. The Massachusetts reform experience has been watched closely for indications of what might occur throughout the country as national health care reform is implemented under the Accountable Care Act (ACA). One aspect of the Massachusetts experience that has remained unexplored is the impact on the health care workforce, particularly the question of whether greater numbers of health care professionals or support personnel were needed to ensure the success of the reform. This analysis gathered data on total and occupation- level employment per capita in the health care industry and compared trends before and after reform in Massachusetts with those in all other states. The analysis found that reform may accelerate the trend toward health care's being the dominant employment sector in the economy. More important, the analysis supports physicians' concerns about the administrative burden of health care reforms, an issue that will have to be addressed as the ACA is implemented. Finally, rather than requiring greater numbers of physicians and nurses, reform may require larger numbers of people supporting the work of such health care professionals.

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