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Social scientists have long suspected that having health insurance coverage makes people healthier. Now there's research to back it up.
Early findings of a groundbreaking study in Oregon show that having health coverage increases how often people visit the doctor and use preventive care services. It also boosts their likelihood of reporting that they're happy and healthy, while reducing their medical debt.
"No other study has done this with this level of scientific rigor," says Chris Perrone, deputy director of the California HealthCare Foundation's Health Reform and Public Programs Initiative, which was among the organizations funding the study. "It's as pure as one can get in social science research."
Many studies have compared the health of insured and uninsured people, but the results were difficult to interpret because the people differed in many other ways, such as income and employment.
This study looked at two similar groups of people in a randomized, controlled design. The opportunity to conduct the research arose when Oregon, short on money, devised a lottery in 2008 to choose new enrollees for its expanded Medicaid program. Medicaid is a federal- and state-funded health insurance program for low-income people. They are mostly children, pregnant women and people with disabilities. Some 90,000 low-income, able-bodied adults applied for the new 10,000 openings.
Researchers compared a group that won the lottery with members of a group that was not selected. They reported their findings after the first year in a paper published recently by the National Bureau of Economic Research. Among the findings:
- People with Medicaid were 25 percent more likely to report they were in good or excellent health and 32 percent more likely to say they were happy than people who didn't have health insurance coverage.
- People with coverage were 35 percent more likely to use outpatient care, 30 percent more likely to be admitted to the hospital, and 15 percent more likely to use prescription drugs.
- Access to Medicaid also increased the use of recommended preventive care. Women with coverage were 60 percent more likely to have a mammogram and 45 percent more likely to have a pap test in the last year, and men and women with coverage were 20 percent more likely to have a blood cholesterol test and 15 percent more likely to have their blood tested for diabetes.
- Having Medicaid decreased the likelihood of borrowing money or having to skip paying other bills to pay for health care by 40 percent. Having medical bills sent to collection organizations was cut by 25 percent.
- People with Medicaid were 70 percent more likely to have a regular office visit for primary care and 55 percent more likely to have a personal primary-care doctor.
"This study shows Medicaid does matter," Perrone says.
Emergency room use did not decrease
Surprisingly, Medicaid coverage did not decrease use of hospital emergency rooms, which often are used by people who lack medical insurance. Overuse of emergency services drives up health insurance rates and leads to overcrowding.
Perrone says emergency departments represent a convenient, one-stop shopping experience for many patients. "They don't have to make multiple trips to doctors and wait six months to see a specialist."
The impact of Medicaid coverage is of particular interest now, as states look toward 2014, when they must expand Medicaid. The federal health care reform law will require states to extend Medicaid eligibility to all adults up to 133 percent of the federal poverty level. Now fewer than half the states offer Medicaid to able-bodied adults.
Applying the Oregon study results to health insurance plans in other states is tricky, however. The expansion of Oregon's Medicaid program represented only a 2 percent increase in enrollees. California, for instance, expects enrollment there to increase 20 percent or more in 2014, and primary care doctors might not be able to meet the demand. In addition, California reimburses doctors for Medicaid services at a lower rate than Oregon.
Medicaid programs differ
"As important as these findings are nationally, every Medicaid program is different, so the findings have to be viewed through that lens," Perrone says.
Researchers included economists and health policy experts from the Massachusetts Institute of Technology, Harvard University, Providence Health & Services Center for Outcomes Research and Education, the National Bureau of Economic Research and the Oregon Health Study Group.
Besides the California HealthCare Foundation, funding came from the U.S. Department of Health and Human Services, the John D. and Catherine T. MacArthur Foundation, the National Institute on Aging, the Robert Wood Johnson Foundation, the Sloan Foundation, the Smith Richardson Foundation, the U.S. Social Security Administration and the Centers for Medicare and Medicaid Services.
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