7.2 Unimpeded Access to Health Care Services

Boston boasts an extensive network of community health centers offering free and excellent primary care in most Boston neighborhoods.  Many factors affect access to health care, however, including health insurance coverage, literacy, language and cultural sensitivity, immigration status, availability of primary care physicians and even transportation.

Massachusetts’ health care reform legislation has led to a significant drop in the number of uninsured residents and improved access to health care statewide.  The Massachusetts Health Care Access Survey conducted by the University of New Hampshire Survey Center for the Blue Cross Blue Shield of Massachusetts Foundation and The Boston Globe in October 2008 reported that 92% of Massachusetts residents say they have a person they think of as their primary health care provider. Only 5% of Massachusetts residents said there was a time in the past year that they needed medical care, tests or treatments which they did not get. 

Lower income and minority residents, however, remain more likely to face issues of uninsurance, underinsurance and affordability.  Residents are considered to be underinsured if they either pay too much for insurance or lacking needed coverage. 

Rising health care costs pose a growing barrier to unimpeded access to health care.  Spending on health care by individuals, businesses, the City of Boston and the Commonwealth has been increasing dramatically. The Commonwealth’s health care costs are rising both for providing health insurance to state employees and for state health care subsidy programs.  An analysis by theMassachusetts Budget and Policy Center found that health care costs rose 51% between FY 2004 and FY 2008.  Spending to implement health care reform has exceeded budget estimates, largely because the Commonwealth Care program enrolled considerably more residents than anticipated in fiscal year 2008.  For FY08, the original budget was $472 million while final spending came to $628 million. For FY09, which began July 1, 2008, the budget is $869 million. Similarly, theCity of Boston’s FY 2008 budget summary report indicates that the City’s health insurance costs have risen by 52% since 2004 to $270.08 million, 11.2% of the fiscal 2008 budget.  Rising costs are also affecting employers, who in turn are shifting higher costs to their employees.  The2007 Employer Health Insurance Survey, conducted by theDivision of Health Care Finance and Policy, found that from 2001 to 2007, median employee contributions more than doubled for individual health plans, from $40 to $101 per month and contributions for family plans increased from $172 to $298.