Medicaid is only Marginally Better than Being Uninsured

Once they see a doctor, patients get the same treatment, regardless of insurance status according to a RAND study.  But do the uninsured delay seeing doctors when they need attention?  Apparently, according to an American Cancer Institute study (full study is gated).  Unfortunately, rationing by waiting and other obstacles, makes Medicaid enrollment almost as bad.

Comments (7)

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  1. Linda Gorman says:

    Hmmmmm, last week I had a local newspaper reporter give the American Cancer Institute (ACS) study as a reference to support her claim that all kids need to be covered because uninsured children use the ER more, don't get immunizations, and are absent more days at school.

    The ACS study is so new that PubMed, the online database of medical journal articles, hasn't even linked to the full article yet; it only lists the abstract. It is unusual for something so recently published in the specialist literature to already be cited as a reference by a local reporter.

    The PubMed abstract waffles on the results. The findings are that the privately insured get treatment at an earlier state of cancer, boosting the chances of cure. Specifically, it says, "Although many factors other than insurance status also affect the quality of care received, adequate insurance is a crucial factor for receiving appropriate cancer screening and timely access to medical care." It's a pretty big step from "many factors" to "adequate insurance is crucial."

    And the results suggest that Medicaid is not adequate. Patients on Medicaid apparently do worse than those who are privately insured. For advanced-stage melanoma, you may be better off being uninsured. The odds ratio of having advanced-state disease at diagnosis for uninsured patients was 2.3 compared to the insured. For those with Medicaid the odds ratio comparison to the insured was 3.3. So much for putting all the uninsured kids on Medicaid.

    Better off uninsured than on Medicaid? Probably not. There likely are a lot of SES factors that explain differences in when people seek and receive treatment. We know that the Medicaid, privately insured, and uninsured populations differ in important respects. It will be interesting to see which of those are taken into account in this study.

  2. […] than Medicaid patients. An American Cancer Society study [gated, but with summary] reported on here found that being in Medicaid was only marginally better than being uninsured with respect to delays […]

  3. […] the number of uninsured in half, this will be offset by greater enrollment in Medicaid, which is only marginally better than being uninsured. Even though more people will have insurance, overall access to care may actually […]

  4. […] no idea what the satisfaction rate is in Medicaid generally. But since being in Medicaid is only marginally better than being uninsured, I suspect it is not very […]

  5. Sammy Finkelman says:

    The problem that immediately comes to my mind with the cancer study is that many cases that are diagnosed as cancer never would have gotten any worse – it really can be left alone. That’s what a lot of other studies – about mammograms nd prostate cancer – are now demonstrating conclusively. So if someone gets diagnosed with cancer and the cancer gets “cured” even though it would never have been a problem in the first place – or never been a problem until when it would have been noticed anyway – he will show up as an example of early detection and treatment benefitting people.

    If you want to show that people without heaklth insurance have worse outcomes- you ned to show statistics on life expectancy or ceratin diseases. Limiting this to cancer gives rise to the suspicion that the whole study has been rigged to maximize differences.

    One reason that early detection may not help as much as you might think also could be that sometimes doctors kill people.

  6. Sammy Finkelman says:

    It makes perfect sense that people who are uninsured have worse outcomes than those on Medicaid. People who are uninsured now may get insurance later – and in any case may belong to a different subset of people and wind up with better doctors. This makes perfect sense.

  7. Sara Mackey says:

    If Obamacare goes through, all we will have is rationed healthcare. Better get your operations done now… sadly enough. One can hope that Obama does not get reelected, but it’s bound to happen with Romney as the GOP nominee. People should have voted for Paul…

    -Sara Mackey