Thursday, July 14, 2011

The Data Is In – Medicaid Works

A few years ago, Oregon sought to increase the number of its citizens on Medicare, but only had the funding to accommodate 10,000 new applicants, though 90,000 applied. Oregon was faced with the problem of having to distribute those 10,000 memberships at random. Realizing the opportunity present, social scientists seized on the situation, because it allowed them to conduct a thorough study of the effects of government-sponsored medical insurance. Prior to this, arguments had largely been made using epidemiologic data, with supporters arguing that countries with universal health care had better outcomes than those without. Oregon’s quandary gave the opportunity to study how health insurance affects the medical and economic lives of Americans, as compared to a similar group who don’t have insurance. The results were clear: Medicaid improves perception of health, improves use of preventive medicine, and improves the economic well-being of its users. And as a side note, Oregon has since found funding for the 80,000 initially denied access to Medicare.

I’ve written occasionally on the social and economic aspects of medicine, and I have to say that this is one of the most important studies to be published in some time. Never before has the effect of having health insurance been studied with the rigor that was possible here, and this study is likely to be cited by politicians for years to come, if not wholly shift the current discussion.

One of the basic findings of the study is that people with health insurance, even health insurance as flawed as Medicaid, are more likely to use healthcare services, including being 35% more likely to go to a doctor as compared to those without healthcare. Accessing doctors doesn’t mean that all of our problems are solved, but it greatly increases the likelihood that negative outcomes are prevented down the road. That said, the study didn’t indicate any difference in amount of ER visits, so it’s unclear as to whether the increased access to doctors had an effect on morbidity and mortality. The effect of Medicaid on the health outcomes of subscribers is currently being studied, and I’m anxiously awaiting results.

However, what is clear is that Medicaid subscribers were significantly more likely to access preventive health services, including mammograms and cholesterol checks. These factor are indeed likely to decrease morbidity and mortality. Similarly, people with insurance were overwhelmingly more likely to have an established doctor or clinic, adding greatly to continuity of care, an important factor in the quality of healthcare a patient receives. Additionally, patients with Medicaid were more likely to rate their health as being good or excellent, and significantly less likely to report deteriorating health.

Finally, the study shows that Medicaid provides significant financial benefit to its beneficiaries. People on Medicaid were significantly less likely to have unpaid medical bills sent to collection agencies, as well as being less likely to fail to pay other bills or borrow money because of medical expenses. This demonstrates that Medicaid works as a social program. While it is yet undetermined whether or not Medicaid improves health outcomes, it is clear that it is an effective economic safety net for those most in need – this alone vouches for its value.

This study and its yet-to-be-completed sequel are likely to shape public policy for years to come. It’s rare that we have the opportunity to study the effect of government programs with the same rigor as medical trials, but here the opportunity fell on the laps of a few lucky researchers. In a controlled study, Medicaid showed that it works to improve access to physicians, improves utilization of preventive medical services, and decreases economic hardship – if that’s not reason to keep it up and running, if not expand and improve it, I don’t know what is.