Is Healthcare in Maryland Affordable?
Americans consistently rank the affordability of healthcare as a top financial concern, yet only Maryland has dramatically transformed its provider payment system in response. Under the state’s “all-payer” system, a hospital service costs the same for every patient from the same facility, no matter what insurance coverage the patient may hold. Unlike any other state, Maryland sets hospital rates for services rather than relying on Medicare's national fee schedules and negotiated rates between each hospital and each insurance carrier that vary widely in other states. The Maryland Model, touted by some experts as a template to reform the U.S. healthcare system, aims to control the growth of healthcare costs at hospitals and community providers while improving patient outcomes and the quality of care. Though its performance has been uneven in recent years, data from earlier evaluations suggests that the system has potential to save billions of dollars. But does the Maryland Model successfully consider what people need and want from their healthcare experience?
The Survey
Earlier this year, CareFirst BlueCross BlueShield (CareFirst) commissioned NORC at the University of Chicago—an independent, nonpartisan research organization—field a survey to provide us with insights on the public's awareness of and experience with the Maryland Model. We believe that healthcare consumers should be represented and considered as the payment system in Maryland continues to grow and evolve. We wanted to see how engaged they are.
Survey topics included the following:
- Affordability of healthcare
- Satisfaction with the quality of care received
- Access to healthcare
- Experiences with the healthcare system
The Results
Overall, survey respondents were pleased with the high levels of access, affordability and quality of care in Maryland. Accessibility, affordability and quality are goals under the Maryland Model.
86%
of respondents said it was easy to find care they could afford.
76%
of respondents believe the care they receive in Maryland is affordable.
90%
of respondents were satisfied with the quality of care from a Maryland healthcare provider.
Adults aged 65 or older reported the highest satisfaction with healthcare and were the least likely to forego healthcare appointments due to cost. However, 53% of men under 35 went without a routine physical or preventive health appointment because of cost. While the overall perceptions of affordability of care in Maryland are high, people with insurance through their employer, young adults and women were the most likely to say that care is unaffordable. This indicates that the Maryland Model may not benefit all Marylanders equally.
Key Themes
- Low Levels of Awareness
Only 14% of adult Marylanders who consumed healthcare within the past year know the Maryland Model exists. This low level of awareness suggests that the Maryland Model is not engaging the people it is intended to serve. It is concerning that most Maryland residents are unaware of the model or the benefits that accrue to them from it because the Maryland Model is not a permanent arrangement. It is a contract with the federal government that must be extended if the state meets specified goals. With the contract expiring this year, Maryland healthcare consumers have a lot on the line. - Marylanders with Insurance Through Their Employer Face Greatest Barriers to Access and Affordability
Despite the Maryland Model's efforts to expand access to and the affordability of care, residents forgo healthcare at rates much higher than national averages because of its cost. Nearly ¼ of Marylanders who consumed healthcare within the past year report that care in the state is unaffordable. While the Maryland Model makes care more affordable, employers and people with insurance through their jobs are still struggling with healthcare costs. Those with employer-sponsored insurance are the most likely to say that care is unaffordable.
Interviews revealed that not only did employers and brokers–those who determine health benefits for employees–misunderstand the Maryland Model, but they were also unaware that one of its objectives is to lower the cost of care. - Gaps Between Perceptions of Care and Outcomes
Maryland residents believe they receive high-quality care, but health outcomes data suggests a sizable gap between perceptions of quality and the health of residents. Maryland performs poorly on several health outcomes metrics. It is among the lowest in the nation across several key indicators, including pre-term and low birth rates, heart disease, diabetes, and incidence of septicemia1.
Consumers, employers and brokers do not sufficiently understand the Maryland Model. This lack of understanding may impact perceptions of affordability among employers, who generally share concerns about current and rising healthcare costs. Most consumers perceive healthcare as affordable overall, but their actions contradict that. As the state considers further innovations to the Maryland Model, more engagement from employers, brokers and consumers is necessary to ensure future changes make healthcare more affordable, accessible and responsive to all.
CareFirst's role in ensuring affordable, accessible healthcare
CareFirst is a not-for-profit company with a mission to ensure that care is accessible and affordable for our 3.6 million members and the communities we serve. We advocate for policies that empower providers and members, and we work to advance access for those that need it most. Understanding the patient's experience informs how we view the quality of care and how much value we place on specific parts of that experience.
To learn more about how CareFirst is working to promote the affordability and accessibility of high-quality care, visit www.carefirst.com/transformation.
1. Stats of the State of Maryland. (2022). Cdc.Gov. https://www.cdc.gov/nchs/pressroom/states/maryland/maryland.htm