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NLM Director’s Comments Transcript
Assessing Health Insurance’s Benefits: 06/17/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

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A 2008 Medicaid lottery that provided health insurance to selected Oregon recipients comparatively fostered some clinical benefits, more use of preventive services, and less financial strain, finds a timely study and accompanying editorial recently published in the New England Journal of Medicine. However, the availability of health insurance did not result in uniformly improved health measures for Medicaid recipients.

The research, from the Oregon Health Study Group, stemmed from a rare opportunity to assess the two-year impact after Medicaid (government supported health insurance) became available to some — but not all — randomly selected, low income Oregonians in 2008.

The study’s 10 authors, who are part of a larger research team, tracked an array of clinical and other impacts among 6,387 adults who received expanded Medicaid coverage — compared to 5,842 adults, who were not selected by the Oregon lottery to receive health insurance. Since the U.S. Affordable Care Act’s implementation will expand the availability of Medicaid and other health insurance plans to more Americans in the near future, the study’s authors suggest Oregon’s recent experience is a possible preview of health insurance’s expansion in other states.

Specifically, the study found the diagnosis of diabetes and use of diabetes medications comparatively increased significantly among the adults who received Medicaid coverage. Overall, the study’s authors found Oregon’s recent Medicaid recipients experienced higher rates of diabetes detection and management.

The study found the use of some preventive services, including pap smears and mammograms, comparatively increased among the health insurance recipients. The Medicaid recipients also were less likely to test positive for depression.

In addition, the study found Medicaid recipients experienced reduced financial challenges to cover medical expenses compared to adults without insurance. For example, the frequency health insurance recipients needed to borrow money or skipped paying other bills to reimburse medical expenses comparatively declined significantly.

Nevertheless, the study found favorable health outcomes were not uniformly skewed towards Oregon’s Medicaid recipients. For example, there were no differences in overall cholesterol and blood pressure levels as well as some other clinical measures between the groups. The prevalence of diagnoses for hypertension also was statistically similar between the recipient and non-recipient groups.

The authors conclude and we quote: ‘we found that insurance led to increased access to and utilization of health care, substantial improvements in mental health and reductions in financial strain, but we did not observe reductions in measured blood pressure, cholesterol, or glycated hemoglobin levels’ (end of quote).

An editorial that accompanies the study explains protecting financial assets when illness occurs — and improving access to care — represent two of the three core reasons to provide access to health insurance.

Yet, the editorial adds the study did not find Medicaid extension is linked consistently to improved recipient health, which the authors propose is a third foundational reason to provide health insurance.

The editorial’s authors suggest future studies should assess the impact of receiving health insurance on other health dimensions, such as early cancer detection, a reduction in sick days from work and school, as well as declines in mortality rates.

The editorial’s authors add the timing of Medicaid expansion — via the Affordable Care Act’s implementation — provides new opportunities (and we quote): ‘to more fully assess the effects of insurance expansion on health’ (end of quote).

Meanwhile, MedlinePlus.gov’s Medicaid health topic page provides background information about this health insurance plan, which varies by state. A comparison of Medicaid plans by state (provided by the Centers for Medicare and Medicaid Services) is available in the ‘overviews’ section of MedlinePlus.gov’s Medicaid health topic page.

A website that provides succinct answers to frequently asked questions about Medicaid (from the Rural Assistance Center) is available in the ‘specific conditions’ section of MedlinePlus.gov’s Medicaid health topic page.

MedlinePlus.gov’s Medicaid health topic page also contains an online database of insurance benefits (from the Henry J. Kaiser Family Foundation) within the ‘Directories’ section.

From the Medicaid health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s Medicaid health topic page, just type ‘Medicaid’ in the search box at the top of MedlinePlus.gov’s home page. Then, click on ‘Medicaid (National Library of Medicine).’ MedlinePlus.gov also has health topic pages devoted to health insurance and Medicare.

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A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.

It was nice to be with you. I look forward to meeting you here next week.