The Impact Of Health Insurance On Health – What is the Impact of Medicaid on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on Evidence
The IOM stated the purpose of health insurance in the first of its six reports: “For individuals and families, health insurance improves access to health services and offers financial protection against high costs. costs that are relatively impossible to do as well as those that are more modest but still out of reach for others.”1 Three points of explanation help to explain the mechanisms of health insurance, and to highlight its potential and of its limitations.First, health coverage helps connect people with care, in many cases by linking them to a network of providers who participate in their health insurance plan. This is how managed care and selected provider organizations work. Second, health insurance lowers financial barriers to access. It does this by reducing out-of-pocket costs for of medical care, which disproportionately burdens low-income and people with high health care needs. Common measures of financial access to care (or lack thereof) include delayed or missed care or unmet needs due to cost, and medical cost burden, such as out -of-pocket expenses that exceed certain thresholds and rates of medical debt and medical bankruptcy.
The Impact Of Health Insurance On Health
Finally, conceptual models of access and health recognize health insurance as one factor among many, including social, family, genetic, health care systems and others, whose interaction determines how individuals and populations fare.2 Figure 1 provides a simplified depiction of just a few of the variables at play. Because of the complex influences involved in determining access, quality, and outcomes, expectations that health insurance alone can correct care deficiencies or health disparities, are misplaced. Health insurance cannot overcome systemic barriers to access such as a shortage of health care workers in low-income communities, or the higher prevalence of chronic diseases in certain populations. . The impact of health insurance – whether public or private – must be considered in this broader context, and researchers and users of research must ask whether observed deficiencies in health care outcomes reflect failures. of health insurance or the contribution of other things that may ask for different policy responses.
How Much Does Health Insurance Cost?
Medicaid is designed to provide health coverage for low-income children and families who lack access to private health insurance due to their limited finances, health conditions, and/or severe physical, mental health, intellectual, or developmental disabilities. Medicaid also helps low-income seniors and disabled Medicare beneficiaries with their Medicare premiums and cost-sharing and covers important benefits not covered by Medicare, especially long-term care . Most states expand coverage for low-income children beyond the federal minimum requirement so that children with family incomes up to at least 200% of the federal poverty level (FPL) are eligible for Medicaid or the Children’s Health Insurance Program (CHIP). [In 2013, 200% FPL was $47,100 for a family of four] However, state Medicaid eligibility standards for parents are stricter and, in half of the states, childless adults under the age of 65 – no matter how low their income – are not eligible for Medicaid unless they are disabled or pregnant. Therefore, the adult population studied in most Medicaid research is extremely poor.
Because of Medicaid’s eligibility criteria and the strong correlation between poverty and poor health and disability, Medicaid beneficiaries are poorer and have poorer health profiles compared to the privately insured and uninsured. This is true even within the low-income population, as illustrated in Figure 2 for adults. The clearly higher rates of poverty, chronic disease, and disability in the Medicaid population are important to keep in mind when considering the evidence on Medicaid’s impact. These disadvantages make access and quality benchmarks based on the experience of the privately insured population more challenging to meet in Medicaid. Studies that control for observable differences between Medicaid and comparison populations provide a fairer assessment of the program’s impact on access and quality. However, researchers often cite as a limitation of their studies the possibility that they could not fully control for underlying population differences that could help explain their findings. This limitation may be more consequential in analyzes that examine how health outcomes (as opposed to access or quality of care) compare between Medicaid beneficiaries and other populations, because as a larger set of factors may reduce the impact of health coverage on outcomes.
Consistently, research shows that people with Medicaid coverage do better than their uninsured counterparts on various measures of access to care, utilization, and unmet need. A large body of evidence shows that, compared to low-income uninsured children, children enrolled in Medicaid are more likely to have a usual source of care (USOC) and receive better child care, and are less likely to miss or delay needs for medical care, dental care, and prescription drugs because of cost.3 4 5 6
Research findings with adults generally mirror those for children. A synthesis of the literature on the impact of Medicaid expansions for pregnant women concluded, “…the weight of evidence is that the expansions led to modest increases in the use of prenatal care, in terms of any prior prenatal care or more adequate prenatal care, at least in some states and for some groups affected by the expansions.”7 Mothers who Medicaid-eligible mothers are more likely than low-income uninsured mothers to have USOC, doctor visits, and dental visits, and to receive cancer screening services.8 Non-Elderly Medicaid-eligible adults are more likely more likely than uninsured adults to report general health care visits and visits for specific types of services; they are also more likely to report timely care and are less likely to delay or go to unnecessary medical care because of costs.9 Projects from a recent analysis show that, if Medicaid beneficiaries instead do not’ y certainty, they are significantly less likely to have USOC and more likely to have unmet health care needs; outside of emergency department care, their use of key types of services will also decrease significantly. At the same time, their out-of-pocket spending increases significantly – nearly four times the average.10 Other research provides evidence of increased access to care and use of health care for previously uninsured low-income adults who obtain Medicaid coverage under state eligibility expansions.11
How Does Cost Affect Access To Healthcare?
Recently, the Oregon Health Insurance Experiment provided remarkably strong evidence about the effect of Medicaid coverage on uninsured adults.12 13 14 The evidence is compelling because the study was a randomized controlled trial (RCT ), the gold standard in research design. Taking advantage of a lottery held in Oregon in 2008 to allocate a limited number of new Medicaid slots for low-income, uninsured non-elderly adults, a group of researchers assembled a data on access, utilization, and clinical health measures for adults who obtained Medicaid through the lottery and adults who did not. Two rounds of findings were published in the New England Journal of Medicine, which can be summarized, in part, as follows:
Analyzes that examine how Medicaid beneficiaries with chronic diseases, such as diabetes, are of particular interest because of the prevalence of these conditions in the Medicaid population and the consequences of undertreatment care A recent series of studies specifically focused on low-income non-elderly adults with major chronic diseases showed statistically significant and clinically important differences between Medicaid beneficiaries and the uninsured on important measures of access and care. For example, adults with diabetes who are covered by Medicaid are less likely than those who are uninsured to report delaying or not getting needed care. They also make more office visits, fill more prescriptions, and are more likely to receive key elements of recommended diabetes care.15 Two related studies of other major diseases chronic showed similar results.16
Maintaining Medicaid coverage can make a difference. Research shows that disruptions in Medicaid coverage can lead to greater use of the emergency department as well as significant increases in hospitalizations for conditions that can be managed on an ambulatory basis. evidence of the impact of Medicaid. California and Oregon studies of low-income adults who lost their Medicaid coverage found significant declines in basic access measures, such as having a USOC, unmet need for care of health and medicine, and possibility of a new visit to primary care, as well as significant. decreased health status.20 21 In focus groups conducted with adult Medicaid beneficiaries in Massachusetts following the state’s elimination of adult dental benefits, nearly all participants reported serious oral health problems that , for many, results in chronic and severe pain.22
In addition to showing better access to care and use of recommended care for Medicaid beneficiaries relative to the uninsured, research also provides evidence that broader eligibility for Medicaid at the state level is associated with significant reductions in child mortality23 and adult mortality.24 A study examining the relationship between broader state Medicaid coverage in adults and access to physician and preventive services found- that higher levels of Medicaid coverage are associated with better access to care for all low-income adults in the state, and also that access gaps between low and high. -income adults is great
The Effects Of Medicaid Expansion Under The Aca: Studies From January 2014 To January 2020
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