Byline: Marylou Buyse, M.D.

COLUMN: As I See It

Health care has become the Pac-Man of municipal budgets, devouring an increasingly larger share of local revenues and leaving little left over for essential services such as road and bridge maintenance, education and police and

You need to look no further than the city of Worcester. According to The Regional Research Bureau, municipal employee health insurance accounts for 15.1 percent of the city's budget. While revenues increased just 3.3 percent in 2007, health insurance premiums rose 10 percent, forcing cuts and reductions in services to pay for health care coverage.

The recent requirement that all city retirees enroll in Medicare illustrates the tough choices local leaders face in trying to pay for workers' health care costs while maintaining local services - require workers and retirees to pay more or sacrifice services. Yet, the rising cost of health care has moved this from an either/or proposition to one that is forcing municipalities to choose both.

Municipal officials rightfully are asking why premiums keep increasing. The reason is simple: Health insurance premiums are driven by health care costs.

The new law to give cities and towns the option to join the state's Group Insurance Commission to purchase health insurance has the potential to provide some relief and last year's landmark Health Care Reform Law has done a great job to reduce the number of uninsured.

But if we're going to make these approaches work in the long term for cities like Worcester, tackling health care costs must be the next act.

Nationally and in Massachusetts, a number of factors have contributed to rising health care costs, including higher rates charged by providers, greater use of medical services, and the proliferation of new medical devices and technologies.

Others factors are unique to Massachusetts. Mandated coverage of specific benefits such as prescription drugs, the large number of specialists in the state compared to the U.S. average, the expansion of teaching hospitals and consumers' reliance on them rather than community hospitals for routine care, exacerbate the difference between Massachusetts health care costs and the rest of the country. Because of this, we spend $7,075 per resident every year on health care in Massachusetts, compared to the national average of $5,313.

We need to treat what is ailing the health care system - rising health care costs - and not just the symptoms. Here are some ideas:

Make cost and quality data easy to understand. Information - about price and performance - is essential to cost control. As more consumers begin to purchase health insurance, many will select options with lower monthly premiums that require additional out-of-pocket spending, so they'll need data on the cost and quality of providers. The state Health Care Quality and Cost Council is critical to this and it is important that the council make this information easy for residents to understand so that they can comparison shop.

Give consumers and employers more choices. One size doesn't fit all. Piling on mandated benefits increases premiums. State leaders should allow for more flexibility in benefit design, including products without prescription drugs, to ensure that residents and employers have a wide array of options in deciding the coverage that best meets their needs.

Promote care in the right setting. Five years ago, a state commission sounded the alarm on the growing shift by patients away from lower-cost community hospitals to higher-cost teaching hospitals. Since then, the trend has actually accelerated, even when quality is comparable. Policymakers and employers should support initiatives that encourage consumers to use the most efficient and best performing physicians and institutions.

Improve the quality of care now. Only slightly more than half of the care delivered to adults represents what the medical evidence says is the right thing to do. Public reporting of serious medical errors, better coordination by hospitals in scheduling elective and surgical procedures to decrease ER overcrowding, and reducing duplicative diagnostic tests can improve quality and control costs. Fixing the medical malpractice system by eliminating frivolous claims and fairly allocating damages would rein in a significant cost driver that does nothing to improve the quality of care.

Massachusetts has made a great deal of progress in expanding coverage and offering a helping hand to municipalities, but we need to take steps to keep health care affordable. If we don't, the continued growth in medical costs will cripple our cities and towns and undermine the gains we have made as a result of the Health Care Reform Law.

Dr. Marylou Buyse is a practicing primary care physician and president of the Massachusetts Association of Health Plans.