For low-income Americans wishing to improve their health care, getting health insurance under Medicaid is just the first step towards obtaining care to meet her needs. Next they have to figure out how the system works—which can be a tall order, says Assistant Professor Heidi Allen, the lead author of a paper on this topic for the journal Health Affairs (Monday, February 3rd). Go to abstract.
Through in-depth interviews with 120 of Oregon's new Medicaid enrollees, Professor Allen discovered that 40 percent sought care infrequently because of one or more of the following reasons:
- They were confused about coverage. Some became confused after learning dental care was only for emergencies and assumed other care would be too. Others didn’t understand what was covered and what wasn’t and feared hidden costs.
- They faced access barriers. A subset of those who used little coverage had difficulty finding a provider that would take Medicaid or arranging transportation.
- They had bad interactions with providers. Poor experiences with the health care system led some adults to avoid going back for more care.
- They felt that care was unnecessary. The relatively healthy often seemed unaware of the need for routine health screenings.
The other 60 percent of the 120 new enrollees regularly used the health care system with mixed success. About ten percent within this group reported rapid improvements in health, usually related to obtaining a needed prescription or procedure. Forty percent of regular users were getting some, but not all, needs met. These individuals were experiencing known challenges within the health care system, such as uncoordinated care, rushed appointments, and poor follow-up. However, the remaining forty percent of regular users had formed a positive relationship with a provider and were starting to see real gains in health.
"These findings suggest that it isn't enough simply to extend Medicaid to people who may not have had health care for a really long time. We also need to take steps to socialize these new enrollees about the benefits," Allen says, adding that she hopes policymakers involved in expanding Medicaid coverage under the Affordable Care Act will address such needs in the near future.
"For the people who used health care on a regular basis over the three years, there was a group of people whose lives were just transformed," Allen says. "Those are the people who had been waiting for surgeries, or needed a medication and felt so much better."
Professor Allen's study used interviews from the qualitative component of the Oregon Health Insurance Experiment, which has published four other articles:
- "Medicaid Increases Emergency-Department Use: Evidence from Oregon's Health Insurance Experiment," in Science (17 January 2014). Key Finding: Expanding Medicaid coverage led to increased emergency room use.
- "The Oregon Experiment — Effects of Medicaid on Clinical Outcomes," in the New England Journal of Medicine (2 May 2013). Key Findings: Medicaid coverage reduced the incidence of depression but did not produce measured improvements in short-term measures such as diabetic blood sugar, high blood pressure, or high cholesterol.
- "The Oregon Health Insurance Experiment: Evidence from the First Year," in the Quarterly Journal of Economics (3 May 2012). Key Findings: Medicaid coverage increases doctor visits, prescription drug use, and hospital admissions; reduces out-of-pocket expenses or unpaid medical debt; and increases self-reported good health.
- "What The Oregon Health Study Can Tell Us About Expanding Medicaid," also in Health Affairs (August 2010). Key Findings: People who signed up for the waiting list and enrolled in the Oregon Medicaid program were likely to have worse health than those who did not. However, actual enrollment was fairly low, partly because many applicants did not meet eligibility standards.
—Contributed by ML Awanohara
Image: "Doctor Consults with Patient"; photo credit: National Cancer Institute via Wikimedia Commons.
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