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To Lower Costs, Mass. May Restructure Doctor Pay
Massachusetts is proud of its landmark 3-year-old health insurance law. It has brought the state's proportion of uninsured down from around 10 percent in 2005 to only 2.6 percent — the lowest in the nation.

But the achievement is in jeopardy. Massachusetts has the highest health costs in the country.

"The critical point is whether or not we can begin to do something about cost control," says Dolores Mitchell, who heads a state commission that buys coverage for 310,000 government workers and their families. "We've just got to do it."...

...But some worry "global payment" sounds suspiciously like the managed care "capitated" HMO plans of the 1990s. Those plans were also based on paying health care providers a fixed amount per patient....