Lessons from the Oregon Health Study about Medicaid

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Suzanne B. Robotti
Suzanne B. Robotti Executive Director
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This should have been the breakthrough, definitive, sledge-hammer answer to one nagging question on Obama-care: “will it improve the health and lives of the previously uninsured?” Social sciences are among the most difficult to measure. I’m not a history buff, but I imagine that the introduction of Medicare and Medicaid was done with more guesses as to the outcome than facts. And with Obama-care enactment hovering in our near future, we are asking the same questions: How do you know that universal health care will make people healthier? Will universal health care overwhelm the system we have now? Are healthier people more productive and likely to add to the GDP? If they don’t, will the rest of society go broke paying for it? How does one measure “better health care?” What exactly constitutes an improvement in quality of life?

A rare opportunity to measure the seemingly unmeasurable was given to the U.S. in the form of a budget excess in Oregon several years ago. In 2008, the great state of Oregon determined there was enough in their budget to add another 10,000 uninsured, low-income adults to the Oregon Health Plan Standard (OHP) program (Medicaid).

Because 90,000 people applied for the insurance, a lottery was held. And that created the opportunity to have two random groups, those who won and received healthcare insurance (OHP) and a randomly selected group who didn’t, the control group. Tens of thousands of people received mail surveys and thousands received in-person health screening interviews. In-depth interviews were conducted. Socio-demographic information on transit access, walkability indicators and food availability, etc., was gathered and factored in when contrasting the differences in the two groups. This was a well-run study.

The goal of the Oregon Health Study was to determine if access to Medicaid had an effect on: physical outcomes (BMI, blood pressure, cholesterol, blood sugar), mental health, access to health care services, personal finances, stress and strain, and care utilization (how often a person seeks out health care and where that person tends to go for care).

The answers were muddy.

Q. Did the new access to medical care  Medicaid create a spike in usage (all the previously uninsured rushing to the doctors’ offices or the ER), which could tax the medical system?

A. No. Use of medical system on all levels — doctor appointments, test taking, hospital visits — increased and stayed level. It was anticipated by many that a pent up demand would create a spike in health care potentially overwhelming the system temporarily and then drop  to low levels. However, for the two years of the study the increase remained steady.

Q. Were non-insured adults already getting health care through charity care? In that case OHP wouldn’t change their health care.

A. No, the newly insured made appointments, received tests, went to hospitals and in general spent 35% more in health care than their peers without insurance.

Q. Did new access to medical care benefit health?

A. Yes and no. Depression was down 30%, a vast amount. There were many more diagnoses of diabetes and much more use of diabetes medication. But in a general comparison of blood pressure, blood sugar, cholesterol, etc., there was no measurable difference by the end of the two-year study. One has to wonder why our health care system can’t deliver better immediate health.

Q. Will the benefits of better health care accrue over time?

A. We don’t know for sure. The study doesn’t speculate, but I will. Now that the test subjects are getting regular health screenings, it’s my personal guess that over time the improvement in health will be great. And that the early treatment the OHP recipients will receive from conditions caught by screenings will substantially lower the much higher costs of late and/or emergency treatment.

Q. What were the financial effects?

A. Compared to the control group, the OHP recipients were 40% less likely to have to go into debt to pay their medical bills. There were many fewer unpaid hospital bills. From an insurance standpoint, OHP functions exactly as it should – protect the individual from financial catastrophe, protect hospitals and doctors from unpaid bills. However, the control group spent more on health care throughout the two years, about 35% more than those without insurance.

It seems to me that the insurance part of this grand experiment did its job. We need to look more closely at health care’s performance. I believe that the access to screening tests will be a health benefit in the long run, but we deserve answers on why health measurements such as blood pressure, glucose and cholesterol couldn’t be improved in two years,

In answer to the question: will Obama-care improve the health and lives of the previously uninsured? Yes. But not a heck of a lot immediately, it will take time. And the cost to society will be measurably higher. What are the lessons gleaned from the Oregon experience? Both sides of the great health care Medicaid debate have received support for their points of view.



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