The Oregon Health Study — one of the most important public-policy studies of the last decade — released a new round of results on Wednesday, showing that Medicaid coverage does not seem to make low-income adults much healthier, judging by biometric data. At least, that is one fair way to interpret the results, and it is basically the way the authors put it at the top of their new paper.
But here is another good way to put it: The Oregon Health Study released a new round of results on Wednesday, showing that Medicaid coverage does not seem to improve low-income adults’ blood pressure, blood sugar or weight in a two-year time frame. It says nothing about the chance of diagnosis of, eventual health outcomes for or costs associated with any form of cancer, Alzheimer’s, Parkinson’s or dozens of other debilitating medical conditions. It also says nothing about health results outside of a two-year time frame.
It does tell us that Medicaid coverage increases the chance that diabetes will be diagnosed in a low-income adult. It also tells us that diabetes in these low-income adults does not seem to improve much within the first 24 months or so, judging by blood-sugar tests. But the study is silent on whether Medicaid might reduce the amputation rate.
The study presents strong evidence that Medicaid recipients spend more on health care, and not just because of pent-up demand: they just seem to spend more, full stop. But it does not say anything about whether Medicaid coverage might reduce spending on avoidable but high-cost procedures, like treatment for advanced cervical cancer that was never caught with a Pap smear.
The Oregon Health Study results are extremely closely watched, given how rare the opportunity to perform a textbook randomized control experiment is in public economics, and given the pending Medicaid expansion.
Where it says something, it says a lot: it provides strong evidence that Medicaid recipients will spend more, use more tests, experience less depression, have fewer bills sent to collection agencies, and so on. It shows health insurance working just the way insurance is supposed to work: protecting the financial stability of the people purchasing it.
The biometric results are compelling, too. The authors chose a handful of conditions that were common, important, easy to test for and treatable to include in the study. Medicaid does not seem to do much to improve health outcomes related to those conditions in two years.
But there are many more questions that the Oregon Health Study simply cannot answer, despite the overheated rhetoric out there today. Does Medicaid improve health over a decade? What might Medicaid do for lifetime health costs? We do not know, even if the study provides some clues. Nor could this study answer the question of whether the Medicaid expansion will be “worth it,” and why. What study could?
Article source: http://economix.blogs.nytimes.com/2013/05/01/what-the-oregon-health-study-cant-tell/?partner=rss&emc=rss