Thursday, May 2, 2013

Medicaid Expansion Doesn’t Necessarily Lead to Better Health
Medical care accounts for about 15 percent of the health status of any given population, life style for 20 percent to 30 percent, and other factors – poverty, inferior education, income differences, and lack of social cohesion – for the other 55 percent.
David Satcher, MD, et al, Multicultural Medicine and Health Differences, MvGraw-Hill, 2006
This morning's press  is full of stories about a May 2 New England Journal of Medicine article “The Oregon Experiment – Effects of Medicaid on Clinical Outcomes.”
I won’t bore you with details, but will share with you the conclusions:
“This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured health outcomes in the first 2 years, but it did increase use of health care services, raise rate of diabetes detection and management , lower rates of depression, and reduce financial strain.”
It’s a bad news, good news story.  It did not improve health. It  improved access.  It raised costs.  It helped find and manage diabetes. It elevated the spirits of the depressed. It  eased financial strains.
·         Michael Cannon of the conservative Cato Institute treated it this way.
Today, the nation’s top health economists released a study that throws a huge “STOP” sign in front of ObamaCare’s Medicaid expansion."
"The Oregon Health Insurance Experiment, or OHIE, may be the most important study ever conducted on health insurance. Oregon officials randomly assigned thousands of low-income Medicaid applicants – basically, the most vulnerable portion of the group that would receive coverage under ObamaCare’s Medicaid expansion – either to receive Medicaid coverage, or nothing. Health economists then compared the people who got Medicaid to the people who didn’t. The OHIE is the only randomized, controlled study ever conducted on the effects of having health insurance versus no health insurance. "
·          Alvin Tran of the Independent Kaiser Health News had this to say,
Although expanding Medicaid coverage to some low-income Oregon residents substantially improved their mental health and reduced financial strains on them, it didn’t significantly boost their physical health, according to a study published Wednesday in the New England Journal of Medicine.”
B"ased on analyses of 12,229 people – 6,387 of whom gained coverage – the study’s results did not show any significant difference in the levels of high blood pressure, high cholesterol and diabetes between the two groups two years after the lottery.
“ ‘We were able to provide a multifaceted picture of what happened when people gained insurance through Medicaid, versus those who did not,’ said Dr. Katherine Baicker, the study’s lead author, in an interview.”
Dr. Devon Herrick, senior fellow at the National Center for Policy Analysis, a nonpartisan research organization, said he was shocked to see so little data suggesting that Medicaid expansion improved overall health.”
‘It didn’t seem to affect the outcome of those with diabetes,’ Herrick said in an interview. ‘It boosted their use of medication but didn’t seem to improve their health – that’s something we would all assume.’
The expansion of Medicaid, called for by the 2010 health care law, is being intensely debated in many states since the Supreme Court made that provision voluntary last year. Fifteen states, many in the Republican-controlled South, have already rejected the idea, while 20 have agreed to comply with the law, “
As for me,  I am surprised  the study’s findings surprised anybody.   You can lead people to the healing health care waters, but you can’t always make them drink.  Life style, behavioral patterns, and other socioeconomic factors are more important than access and affordability to health care in determining health. Social engineering has limits – it may make health care less painful financailly  but it doesn’t improve overall health.
Tweet:   In a randomized controlled study,  Oregon found Medicaid expansion did not improve overall health of Medicaid recipients.

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