Considering Whether Medicaid Is Worth the Cost: Revisiting the Oregon Health Study

Quan, Ryan; Chiuzan, Codruța; Glied, Sherry

doi:10.2105/ajph.2014.302485

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…We excluded 14 studies that failed to meet Criterion 5, ‘produce an incremental cost-effectiveness ratio (ICER)’, and one study that did not use QALY as an output. Thus, the evidence synthesis was conducted using the four studies that remained [ 9 – 12 ]. The small number of relevant studies found in this review is in line with a recent Cochrane review [ 13 ], which found only two relevant studies in the US on strategies to expand health insurance programs to the vulnerable population.…”

Section: Methodsmentioning

confidence: 99%

“…Fortunately, all the selected studies are from the US, so the effect of exchange rates is nil. Two selected studies ([ 9 , 11 ]) used 2013 prices and two studies ([ 12 , 10 ]) used 1994 prices.Thus, we converted the ICER of these two studies to 2013 prices using the US Consumer Price Index (CPI) [ 14 ] (the results were similar when using the Personal Consumption Expenditure Health index).…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of national health insurance programs in high-income countries: A systematic review

et al. 2017

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ObjectivesNational health insurance is now common in most developed countries. This study reviews the evidence and synthesizes the cost-effectiveness information for national health insurance or disability insurance programs across high-income countries.Data sourcesA literature search using health, economics and systematic review electronic databases (PubMed, Embase, Medline, Econlit, RepEc, Cochrane library and Campbell library), was conducted from April to October 2015.Study selectionTwo reviewers independently selected relevant studies by applying screening criteria to the title and keywords fields, followed by a detailed examination of abstracts.Data extractionStudies were selected for data extraction using a quality assessment form consisting of five questions. Only studies with positive answers to all five screening questions were selected for data extraction. Data were entered into a data extraction form by one reviewer and verified by another.Evidence synthesisData on costs and quality of life in control and treatment groups were used to draw distributions for synthesis. We chose the log-normal distribution for both cost and quality-of-life data to reflect non-negative value and high skew. The results were synthesized using a Monte Carlo simulation, with 10,000 repetitions, to estimate the overall cost-effectiveness of national health insurance programs.ResultsFour studies from the United States that examined the cost-effectiveness of national health insurance were included in the review. One study examined the effects of medical expenditure, and the remaining studies examined the cost-effectiveness of health insurance reforms. The incremental cost-effectiveness ratio (ICER) ranged from US$23,000 to US$64,000 per QALY. The combined results showed that national health insurance is associated with an average incremental cost-effectiveness ratio of US$51,300 per quality-adjusted life year (QALY). Based on the standard threshold for cost-effectiveness, national insurance programs are cost-effective interventions.ConclusionsAlthough national health insurance programs have been introduced in most developed countries, only a few studies have examined their cost-effectiveness. All the selected studies revealed strong evidence to support health insurance programs or health reforms in the United States. The average ICER in this study is below the standard threshold for cost-effectiveness used in the US. The small number of relevant studies is the main limitation of this study.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of national health insurance programs in high-income countries: A systematic review

et al. 2017

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“…16 This has been well documented, especially in primary care. 2,17 Even though studies indicate that Medicaid improves the health and well-being of people who would otherwise be uninsured, 18 low payment is an ongoing challenge for Medicaid's operation. 19 In recognition of access problems caused by Medicaid's low payment rates, the ACA increased Medicaid rates to Medicare payment levels for primary care physicians in 2013 and 2014.…”

Section: Medicaid's Safety Netmentioning

confidence: 99%

The Supreme Court Ruling That Blocked Providers From Seeking Higher Medicaid Payments Also Undercut The Entire Program

Huberfeld

2015

Health Affairs

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In Armstrong v. Exceptional Child Center, Inc., the US Supreme Court revisited the question of whether Medicaid providers may seek relief in federal courts when states fail to pay "sufficient" Medicaid rates. A divided Supreme Court held that the Supremacy Clause of the US Constitution does not support such actions, even when states violate the Medicaid Act of 1965. Payment sufficiency is vital to Medicaid's success in expanding health insurance coverage under the Affordable Care Act. By terminating providers' ability to seek relief in federal courts, Armstrong makes it easier for states to cut Medicaid payment rates at the same time that millions of new enrollees will enter the program, undercutting operation of the Medicaid program and its role in health care reform.

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“…To extend access to universal healthcare to people living below poverty line, Prime Minister's National Health Insurance Program (PMNHP) was launched on 31st December 2015 in phased manner (5). In low income countries, healthcare services accessible to merely 11% of people living below poverty line due to financial constraints (6,7). In several under developed and developing countries out of pocket spending on purchase of healthcare products exceed more than 50% of total healthcare service expenses (8).…”

Section: Introductionmentioning

confidence: 99%

“…In Indian VAS program, empanelled hospitals do not entertain direct patient, instead they arrange periodic health camps to screen the eligible patients for treatment. PMNHP may be considered more clients friendly in comparison to US Medicaid (6) and Indian VAS(7) programs. Neither Indian VAS program(23) nor RSBY(24) provide access to healthcare services to people living below poverty line for any disease under study except coronary angioplasty that cost INR* 70000 in 2016 VAS packages(23).…”

Section: Introductionmentioning

confidence: 99%

Prime Minister's National Health Programme (Pmnhp): A Cost Comparison Analysis

Hussain

Hafeez

et al. 2018

PJPH

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Background: Prime Minister's National Health Programme (PMNHP) is a publically funded cashless scheme at point of service, which was initiated in December 2015 to provide access to universal healthcare to people living below poverty line for indoor secondary and tertiary healthcare services for priority diseases in Pakistan. Objective: Our study aimed to compare prices of PMNHP districts packages, compare PMNHP with average payments made to healthcare providers by various health insurance companies, and compare prices among PMNHP itself, public sector not supported by the programme, and private healthcare not supported by the programme in Islamabad Methods: We conducted this comparative descriptive cross sectional study. For first two objectives, we collected secondary data, and for the third objective, we did convenient sampling of the treated patient (n-158) from PMNHP, public and private hospitals for selected diseases. Results: PMNHP district comparisons showed no significant difference among districts except Normal Delivery (NVD) at Rahim Yar Khan had lowest cost (mean=10111.11). For Diabetes Mellitus, Muzaffarabad had lowest (mean=1733.33), and Quetta had highest (mean=5300). Average price paid to healthcare providers by various insurance companies are on higher side as compared to PMMHP. Price differences were significant among PMNHP, Public Out of Pocket Spending (OOPS) and Private For NVD, [F(2, 27)=3364, p=0.000] with PMNHP (mean=15.000, SD=0.000) Public (OOPS) (mean=2.127, SD=0.221) and Private (mean=14.702, SD=0.658) For caesarian section [F(2,27)=2850, p=0.000], and Cholecystectomy, [F(2, 28)=221, p=0.000]. While in comparison with Private, PMNHP were cost beneficial for caesarian section (mean=32.016, SD=1.31) and Cholecystectomy (m=43.133, SD=6.648). Conclusion: PMNHP district wise packages are almost same among and for all the districts. Program is fairly and competitively priced against public and private healthcare providers, and private health insurance healthcare provider payments. PMNHP design features may be used to extend program in other districts.

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Considering Whether Medicaid Is Worth the Cost: Revisiting the Oregon Health Study

Cited by 15 publications

References 17 publications

Cost-effectiveness of national health insurance programs in high-income countries: A systematic review

Cost-effectiveness of national health insurance programs in high-income countries: A systematic review

The Supreme Court Ruling That Blocked Providers From Seeking Higher Medicaid Payments Also Undercut The Entire Program

Prime Minister's National Health Programme (Pmnhp): A Cost Comparison Analysis

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