5 Things the Oregon Medicaid Study Tells Us About American Health Care

This is a terrific eye-opening review of a recent study!  Very thought-provoking. – Reeve

By May 02, 2013 | Time U.S.

Among all the criticisms of President Obama’s health care reform law,
the most salient may be that the Affordable Care Act focuses on access
to insurance at the expense of cost and quality care. A new set of results
from a study on Oregon’s Medicaid program supports this critique and
offers a window into the broader shortcomings of the U.S. health care

The results, published this week in the New England Journal of Medicine,
found that in a randomized controlled trial, the health of Oregonians
on Medicaid did not differ significantly from a control group left off
the rolls of the public insurance program. Researchers looked at the
health of some 12,000 people, measuring their cholesterol and
blood-sugar levels, among other factors. The results also indicated that
Medicaid enrollees were less prone to depression, less likely to incur
catastrophic out-of-pocket health expenses and much more frequent users
of health care services. (Study participants were gathered from a group
of Oregon residents eligible for Medicaid and put on a waiting list for
the program. Those able to enroll in Medicaid were chosen by lottery and
compared against those left on the waiting list.)
These findings can tell us many things about American health care. Here are a few:
Preventive care isn’t all it’s cracked up to be. The
Oregon study found that people on Medicaid got more preventive care —
including mammograms, flu shots and Pap smears — than those in the
uninsured control group. While it might seem logical that heading off
and identifying potential health problems early through screening tests
and doctor visits will lead to faster, cheaper treatment, the truth is much more complicated.
Prevention as a population-based health strategy saves money only if
the savings generated by preventing or catching health problems early in
some people outweighs the cost
of all the doctor visits and screening tests performed on people who
are well and don’t need treatment. In addition, some screening tests —
particularly those intended to catch certain cancers early — lead to
lots of unnecessary harm and false positive tests.
We need more quality control in medicine. The
Affordable Care Act includes programs and funding to add more quality
control to health care, but this priority is eclipsed by the law’s
emphasis on expanding health-insurance coverage, largely through
Medicaid. The fact that payments to doctors and hospitals don’t depend
on health outcomes in most cases is an enormous problem. As the Oregon
results showed, Medicaid enrollees got more care, in doctor’s offices in
particular, when they had insurance but didn’t necessarily have better
health. This is partly because their doctors got their Medicaid payments
regardless of whether the care they provided was effective.
This leads directly to another insight we can glean from the Oregon results: patients need to be more involved in managing their health.
Chronic conditions like hypertension and diabetes have a lot to do with
weight, diet and adherence to medication regimens, which patients can
control. Without a patient’s commitment to carefully manage these
factors, the best and most available doctor on the planet won’t make
much difference in the overall health of many people. It’s hard to think
of a way that the government can address this. Revoking insurance for
patients who don’t take good of themselves would never fly, although the
Affordable Care Act does allow insurers to charge smokers higher
premiums and some corporations offer cash payments or breaks on
insurance premiums if workers participate in wellness programs.
Medicaid is not enough. The Medicaid and control
groups in the Oregon study are statistically identical in terms of race,
age and gender. In addition, everyone in the study was eligible for
Medicaid, meaning they were all poor. But as policy experts know, poor
people have health risk factors that don’t include access to insurance
and doctors. Getting on the Medicaid rolls doesn’t automatically
eliminate factors like lack of education, lack of access to healthy food
and household financial strain that can impact health and health
Insurance is about health, but it’s also about money.
A major value of comprehensive health insurance is that it protects
people from financial ruin if they have a horrible health emergency or
an expensive long-term condition that requires treatment. A homeowner
living near a river doesn’t buy flood insurance to prevent floods or
protect his home if a flood occurs. He buys flood insurance so that if
his house is destroyed, he will be able to recover financially. This too
is a major purpose of health insurance. The latest results from Oregon
showed that being on Medicaid “nearly eliminated catastrophic
out-of-pocket medical expenditures.” This matters and may be part of the
reason earlier results from the ongoing Oregon study indicated that
those on Medicaid were happier.