Medicaid enrollment does help patients' mental health, financial well-being and utilization of healthcare services, but the program does not show evidence of improved health outcomes, according to a study published in the New England Journal of Medicine.
The study, titled "The Oregon Experiment – Medicaid's Effects on Clinical Outcomes," is the first of its kind to collect a truly randomized controlled selection population to study Medicaid.
Oregon used a lottery system to enroll 10,000 of its 90,000 low-income and uninsured residents onto Medicaid in 2008. Researchers analyzed data from two years after the drawing for about 6,400 adults who were selected in the lottery and 5,800 more who weren't as lucky. They looked at health indicators such blood results, vital signs, prescription medications and mental health status, as well as economic metrics like healthcare utilization and out-of-pocket spending.
No significant correlation between Medicaid enrollment and lower rates of hypertension or high cholesterol turned up in the results, and those with Medicaid coverage were more likely to be diagnosed with, and medicated for, diabetes. Only 9.2 percent of those with Medicaid coverage had a positive screening for depression in the two years, compared with 30 percent of the unenrolled. Medicaid also appeared to encourage the use of more preventive services, such as 50 percent more cholesterol monitoring procedures and 100 percent more mammograms. The program also protected almost all beneficiaries from catastrophic out-of-pocket medical spending, according to the study.
Medicaid enrollees were 30 percent more likely to be admitted to a hospital than their eligible-but-unenrolled counterparts, but these admissions did not more commonly originate in emergency departments. In fact, beneficiaries were 35 percent more likely to use less costly outpatient care and 15 percent more likely to use prescription medication, without an effect on emergency department use.
Financially, Medicaid beneficiaries were 25 percent less likely to have debt collectors attempting to recover payment for unpaid medical bills, which the authors note is beneficial for hospitals as these payments are rarely obtained.
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The study, titled "The Oregon Experiment – Medicaid's Effects on Clinical Outcomes," is the first of its kind to collect a truly randomized controlled selection population to study Medicaid.
Oregon used a lottery system to enroll 10,000 of its 90,000 low-income and uninsured residents onto Medicaid in 2008. Researchers analyzed data from two years after the drawing for about 6,400 adults who were selected in the lottery and 5,800 more who weren't as lucky. They looked at health indicators such blood results, vital signs, prescription medications and mental health status, as well as economic metrics like healthcare utilization and out-of-pocket spending.
No significant correlation between Medicaid enrollment and lower rates of hypertension or high cholesterol turned up in the results, and those with Medicaid coverage were more likely to be diagnosed with, and medicated for, diabetes. Only 9.2 percent of those with Medicaid coverage had a positive screening for depression in the two years, compared with 30 percent of the unenrolled. Medicaid also appeared to encourage the use of more preventive services, such as 50 percent more cholesterol monitoring procedures and 100 percent more mammograms. The program also protected almost all beneficiaries from catastrophic out-of-pocket medical spending, according to the study.
Medicaid enrollees were 30 percent more likely to be admitted to a hospital than their eligible-but-unenrolled counterparts, but these admissions did not more commonly originate in emergency departments. In fact, beneficiaries were 35 percent more likely to use less costly outpatient care and 15 percent more likely to use prescription medication, without an effect on emergency department use.
Financially, Medicaid beneficiaries were 25 percent less likely to have debt collectors attempting to recover payment for unpaid medical bills, which the authors note is beneficial for hospitals as these payments are rarely obtained.
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