The Oregon Experiment — Effects of Medicaid on Clinical Outcomes
Background: Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects. Methods: Approximately 2...
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| Format: | Article |
| Language: | en_US |
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New England Journal of Medicine
2013
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| Online Access: | http://hdl.handle.net/1721.1/82640 https://orcid.org/0000-0002-9877-3065 https://orcid.org/0000-0002-9941-6684 |
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| author | Baicker, Katherine Taubman, Sarah L. Allen, Heidi L. Bernstein, Mira Gruber, Jonathan Newhouse, Joseph P. Schneider, Eric C. Wright, Bill J. Zaslavsky, Alan M. Finkelstein, Amy |
| author2 | Massachusetts Institute of Technology. Department of Economics |
| author_facet | Massachusetts Institute of Technology. Department of Economics Baicker, Katherine Taubman, Sarah L. Allen, Heidi L. Bernstein, Mira Gruber, Jonathan Newhouse, Joseph P. Schneider, Eric C. Wright, Bill J. Zaslavsky, Alan M. Finkelstein, Amy |
| author_sort | Baicker, Katherine |
| collection | MIT |
| description | Background: Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects. Methods: Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage. Results: We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures. Conclusions: This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain. |
| first_indexed | 2024-09-23T16:27:02Z |
| format | Article |
| id | mit-1721.1/82640 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T16:27:02Z |
| publishDate | 2013 |
| publisher | New England Journal of Medicine |
| record_format | dspace |
| spelling | mit-1721.1/826402022-10-02T08:00:10Z The Oregon Experiment — Effects of Medicaid on Clinical Outcomes Baicker, Katherine Taubman, Sarah L. Allen, Heidi L. Bernstein, Mira Gruber, Jonathan Newhouse, Joseph P. Schneider, Eric C. Wright, Bill J. Zaslavsky, Alan M. Finkelstein, Amy Massachusetts Institute of Technology. Department of Economics Gruber, Jonathan Finkelstein, Amy Background: Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects. Methods: Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage. Results: We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures. Conclusions: This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain. United States. Dept. of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation California HealthCare Foundation National Institute on Aging (P30AG012810) National Institute on Aging (RC2AGO36631) National Institute on Aging (R01AG0345151) John D. and Catherine T. MacArthur Foundation Robert Wood Johnson Foundation Alfred P. Sloan Foundation Smith Richardson Foundation United States. Social Security Administration (5 RRC 08098400-03-00, to the National Bureau of Economic Research as part of the Retirement Research Consortium of the Social Security Administration) Centers for Medicare & Medicaid Services (U.S.) 2013-12-05T20:19:15Z 2013-12-05T20:19:15Z 2013-05 Article http://purl.org/eprint/type/JournalArticle 0028-4793 1533-4406 http://hdl.handle.net/1721.1/82640 Baicker, Katherine, Sarah L. Taubman, Heidi L. Allen, Mira Bernstein, Jonathan H. Gruber, Joseph P. Newhouse, Eric C. Schneider, Bill J. Wright, Alan M. Zaslavsky, and Amy N. Finkelstein. “The Oregon Experiment — Effects of Medicaid on Clinical Outcomes.” New England Journal of Medicine 368, no. 18 (May 2, 2013): 1713-1722. https://orcid.org/0000-0002-9877-3065 https://orcid.org/0000-0002-9941-6684 en_US http://dx.doi.org/10.1056/NEJMsa1212321 New England Journal of Medicine Creative Commons Attribution-Noncommercial-Share Alike 3.0 http://creativecommons.org/licenses/by-nc-sa/3.0/ application/pdf New England Journal of Medicine PMC |
| spellingShingle | Baicker, Katherine Taubman, Sarah L. Allen, Heidi L. Bernstein, Mira Gruber, Jonathan Newhouse, Joseph P. Schneider, Eric C. Wright, Bill J. Zaslavsky, Alan M. Finkelstein, Amy The Oregon Experiment — Effects of Medicaid on Clinical Outcomes |
| title | The Oregon Experiment — Effects of Medicaid on Clinical Outcomes |
| title_full | The Oregon Experiment — Effects of Medicaid on Clinical Outcomes |
| title_fullStr | The Oregon Experiment — Effects of Medicaid on Clinical Outcomes |
| title_full_unstemmed | The Oregon Experiment — Effects of Medicaid on Clinical Outcomes |
| title_short | The Oregon Experiment — Effects of Medicaid on Clinical Outcomes |
| title_sort | oregon experiment effects of medicaid on clinical outcomes |
| url | http://hdl.handle.net/1721.1/82640 https://orcid.org/0000-0002-9877-3065 https://orcid.org/0000-0002-9941-6684 |
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