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American Medicine

One of the major types of insurance available to patients with low incomes is Medicaid.  Access to Medicaid is being expanded through the Affordable Care Act (ObamaCare).  The question is, how does Medicaid insurance really help people?

The answer is in part provided by an excellent article by K. Baicker and co-authors (New England Journal of Medicine 2013, Volume 368, Page 173) and an accompanying editorial by R. Kronick and A. Bindman (New England Journal of Medicine 2013, Volume 368, Page 1744).  Oregon selected only some patients to be able to apply for Medicaid. The health data from over 6,000 adults who were selected to apply for Medicaid was compared to the health data of 5,800 adults who were not selected.  The results were surprising.

Patients who obtained Medicaid insurance had protection against high medical bills.  Since one of the major causes of bankruptcy is high medical bills that people are unable to pay,  patients with Medicaid insurance were protected against bankruptcy.

Healthcare processes were also improved. Patients who had Medicaid insurance had  higher numbers of office visits, because there was easier access to medical care.  This resulted in more Pap smears screening for cervix cancer, double the frequency of mammograms screening for breast cancer, and an overall increase in higher quality care.

It is expected that this better access to care and improvement in the activities characteristic of higher quality care would ultimately lead to better healthcare outcomes that can be measured.  However,

Get medical insurance so your medicines and health care does not bankrupt you

follow-up at present has not shown many improvements in health outcomes. So far, blood pressure, cholesterol, and diabetes outcomes have not improved. The only measurement of healthcare outcomes that improved so far was reduced depression.

This is important information for people who are eligible for Medicaid.  Here are my tips:

• If you are eligible at all for Medicaid, apply and get the insurance.
• If you do not know if you are eligible for Medicaid, contact your State Health Department.
• Make certain you check with physicians, and nurses and nurse practitioners in your area to see which high quality physicians accept Medicaid insurance.
• When you have found a doctor that accepts Medicaid, be certain that you see the physician or nurse practitioner so that you can get preventive care, screening for disease and control of symptoms.
• Be certain that your physician is controlling your conditions, especially blood pressure, diabetes, cholesterol, and obesity.

For more information about insurance and finding the right physician, see my book, “Surviving American Medicine.”