The Oregon experiment--effects of Medicaid on clinical outcomes.
The Oregon experiment--effects of Medicaid on clinical outcomes.
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DOI：
10.1056/nejmsa1212321
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发表时间：
2013-05-02
期刊：
影响因子：
--
通讯作者：
Oregon Health Study Group
中科院分区：
文献类型：
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作者：
Baicker K;Taubman SL;Allen HL;Bernstein M;Gruber JH;Newhouse JP;Schneider EC;Wright BJ;Zaslavsky AM;Finkelstein AN;Oregon Health Study Group
尽管医疗补助计划即将扩大对低收入成年人的覆盖范围，但扩大覆盖范围的影响尚不清楚。2008年，俄勒冈州的医疗补助计划扩大了，该计划基于从等待名单中抽取彩票，这为评估这些影响提供了一个机会。大约2年后，彩票，我们获得了6387名成年人谁是随机选择的，能够申请医疗补助覆盖和5842名成年人谁没有被选中的数据。测量指标包括血压、胆固醇和糖化血红蛋白水平;抑郁症筛查;药物库存;自我报告的诊断、健康状况、医疗保健利用率和此类服务的自付支出。我们使用彩票中的随机分配来计算医疗补助覆盖范围的影响。我们发现医疗补助覆盖范围对高血压或高胆固醇水平的患病率或诊断或对这些疾病的药物使用没有显着影响。医疗补助覆盖率显着增加了糖尿病诊断和糖尿病药物使用的概率，但我们观察到平均糖化血红蛋白水平或水平为6.5%或更高的参与者百分比没有显着影响。医疗补助覆盖率降低了抑郁症阳性筛查的概率（-9.15个百分点; 95%置信区间，-16.70至-1.60; P = 0.02），增加了许多预防服务的使用，几乎消除了灾难性的自付医疗费用。这项随机对照研究表明，医疗补助覆盖范围在前2年内没有显著改善测量的身体健康结果，但它确实增加了医疗保健服务的使用，提高了糖尿病检测和管理率，降低了抑郁症的发病率，并减少了经济压力。
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. 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. 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. 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.