Summary: Rochester, New York, has succeeded in keeping health care costs lower than costs in other communities without sacrificing its residents' access to care. Health insurance costs per employee in Rochester were 33 percent lower than comparable costs in the nation, and Rochester residents were more likely to have health insurance. Relative to the general U.S. population, people in Rochester seem happier with their health care system and say that they have an easier time obtaining care. Recently, only five percent of Rochester residents--compared with 13 percent nationally--said that they had gone without needed care in the last year. These results are due to the interaction of several factors, beginning with a long history of community-based health planning. Local initiatives have limited the expansion of hospital capacity, controlled the diffusion of medical technology, and maintained the practice of community rating of health insurance. All of these efforts have benefited from the active support of Rochester's employers, who have worked with insurers, health providers, and government to control health care costs and improve access to care. The Rochester experience provides important insights for other communities trying to gain control over rising health care costs and diminished access. It must be noted, however, that Rochester's successes have resulted from decades of effort. Further, many of the problems that Rochester has avoided, such as the excessive growth of hospital beds and the erosion of health insurance coverage, are entrenched elsewhere. It may be more difficult to change practices that people are accustomed to than it is to prevent them from taking hold in the first place.
