Medicaid coverage improved healthcare utilization, but not outcomes

An experiment to expand Medicaid coverage in Oregon did not produce measurable improvements in physical health over a two-year period, but did increase use of medical services and detection of management of diabetes, a study published Thursday in the New England Journal of Medicine found.

The study also found that newly covered Medicaid patients had lower rates of depression and less financial strain. They used preventive services more and were free of catastrophic out-of-pocket medical expenditures, according to the study abstract.

In the first year of expansion, the Oregon Health Insurance Experiment found that Medicaid coverage:

  • increased the likelihood of a non-emergency admission to the hospital by 30 percent.
  • increased the likelihood of using outpatient care by 35 percent and prescription drugs by 15 percent, but did not affect emergency department use 

After two more years, research found:

  • No statistically significant improvements in blood pressure, cholesterol or of blood-sugar control for diabetics.
  • A significantly higher probability (3.8 percentage points) of being diagnosed with diabetes and taking medications to control the condition (5.4 percentage points).
  • Depression diagnoses fell by 30 percent.
  • Twice as many women underwent mammograms, and cholesterol monitoring increased by half.

"We found big improvements in self-reported health," Harvard helath economist and project researcher Katherine Baicker told NPR. "We asked people how they felt, how their health interfered with their normal daily activities. And they reported substantial gains when they got Medicaid coverage, relative to the randomly assigned control group that didn't have Medicaid coverage."

But the follow-up showed that didn't translate into measurably better outcomes. "People on Medicaid consume a lot more resources and that means they spend more money," she said.

The findings come as 16 states weigh whether to sign on to Medicaid expansion under the Affordable Care Act.

Fourteen other states have already said they will decline expansion and the federal funds that come with it, the Washington Post noted in a blog post. Twenty states and the District of Columbia plan to sign on to the expansion, the Post said.

With legislative sessions coming to a close, states still wavering on Medicaid are running out of time, the article noted. At the same time, states must roll out their health-insurance exchanges by Oct. 1 to comply with the Affordable Care Act. More than half have declined to set up their own insurance marketplaces, leaving the federal government to do it for them.

To learn more:
- check out the study abstract
- go to the Oregon Health Insurance Experiment website
- read the Washington Post blog post

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