Sep 1, 2011
In 2006, Massachusetts passed sweeping health reforms designed to extend coverage to all residents of the state. Because the national policy changes contained in the 2010 Affordable Care Act (ACA) were modeled on the Massachusetts reforms, the effects of the Massachusetts law have been watched closely as an indication of how the national experience with ACA is likely to unfold. One area of impact in particular has been largely unexplored: how reform affects the health care workforce. Will increased demand for care require a larger health care workforce to meet the need? Will near-universal coverage intended to improve access to care strain the existing provider workforce? If so, then ACA may cause expected shortages of health care providers to become more severe, especially among primary care physicians and nurses, and increase costs.
To examine the impact of the Massachusetts law on the state's health care workforce, researchers from RAND, Dartmouth College, and Vanderbilt University analyzed data on health care industry employment before and after reform in Massachusetts and compared health care employment trends in Massachusetts with those in the rest of the nation. Findings showed that since 2006, health care employment in Massachusetts has grown more rapidly than in the rest of the United States.
Most of the health care job growth occurred not among physicians and nurses, but among administrative personnel (such as health information technicians) and patient care support staff (such as therapists and aides; see figure). Though the causes of this trend are uncertain, it is plausible that additional administrative and support personnel were needed to handle the demands of the estimated 400,000 newly covered Massachusetts residents. In addition, the growth in administrative positions is consistent with a recent survey of Massachusetts doctors that found the main downside of reform to be coping with a heavier administrative burden.
|Massachusetts Has Added Health Care Jobs at a Faster Rate Than the Rest of the United States, Mainly Administrative and Patient Care Support Positions|
It is uncertain whether trends in Massachusetts predict what will happen on the national stage. Unlike many states, Massachusetts had a low proportion of uninsured residents before reform, as well as high per capita rates of physicians and nurses, and this sizable workforce may have been able to absorb high numbers of new patients without compromising access. In addition, the results are not necessarily causal; changes in the health care workforce could have been influenced by other changes in the insurance market. Nonetheless, the researchers draw three implications from the Massachusetts experience for the likely impact of ACA: