The Oregon Experiment — Effects of Medicaid on Clinical Outcomes

Abstract

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.

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“…Regarding ex ante moral hazard, the most recent literature has produced some further interesting evidence. The most recent randomized evidence in this sense comes from the Oregon experiment (Baicker et al, 2013), where a group of uninsured low-income adults in…”

“…Since co-payments have not been increased (actually dropped in 2007) and costs of healthcare have been raising constantly, both concerns are still shared among experts from different fields. Indeed, part of these worries were confirmed by the authoritative recent Oregon Experiment (Baicker et al, 2013), where Medicaid has been shown to increase financial protection and accessibility to healthcare services, but with ambiguous impacts on health and healthy behaviours.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…First, socioeconomically disadvantaged populations suffer from a great burden of Framingham risk factors. 34,[268][269][270][271][272][273][274] This is an important consideration because it may be possible to use clinical 109 and public health interventions 92 to reduce this burden, thereby narrowing health disparities. Second, social and economic stresses lead to a biological wear and tear, or allostatic stress response, [275][276][277][278][279][280] involving a number of pathways, including stimulation of stress hormones, [280][281][282] inflammation, 283 endothelial dysfunction, thrombosis, vascular hyperreactivity, 270,274,[284][285][286][287] and metabolic disturbances.…”

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