Map of life expectancy at birth from Global Education Project.

Monday, June 24, 2013

Why do we even bother?

I often ask myself. I'm at the Academy Health Annual Research Meeting, which as I believe I mentioned is the bit health services research shindig. What most of these people do is crunch huge so-called administrative data sets -- that's like Medicare and Medicaid billing data, for example, combined with other available data that give some idea of outcomes, be it deaths or diagnoses  -- so they can look at things like hospital admissions and readmissions, screening rates, and other outcomes associated with various policies and practices. The idea is to inform policy makers. If you ask almost anybody here, they'll tell you that what we really need is single payer national health care, but it ain't gonna happen.

Anyway, this morning we heard from my colleague Chima Ndumele, who finds that when Massachusetts and other states expanded Medicaid eligibility to include people with incomes above poverty, it did not, repeat did not, lead to reduced access for people who already were covered. This is a big objection that many people have to the Affordable Care Act, i.e. there aren't enough primary care providers so you're just going to make it harder for people who are already covered. Don't know what will happen in the Republican states, but so far the states that did it on their own haven't had major problems.

Susan Haber of RTI finds that states that offer higher Medicaid reimbursement for primary care visits also have higher rates of cervical, colorectal and breast cancer screening -- regardless of the reimbursement for those services. Makes sense. You have to get in to see the doctor in order to get referred for screening. Less colorectal cancer will also save money in the long run, given that nobody cares whether poor people get cancer.

Suk-Fong Tang finds that pediatricians are more likely to accept new Medicaid patients when, yes, they are paid more, but also when it's easier for them to get their patients referred for specialty care, including dentistry. Also makes sense, it's a big pain if they have to spend all their time tracking down somebody who will meet their patients' needs.

Yeah yeah. If we pay primary care doctors half decently (Medicaid pays a fraction of private insurance and less than Medicare), if we make more people eligible for health insurance, if we have a better integrated system, more people will get the care they need and get and stay healthier. We'll have a more productive society and it will be well worth it. But that doesn't matter. Public policy isn't built on facts and reason, it's built on ideology and the will of the powerful. You can tell all this to your congressional representatives and state legislators, but they won't care.

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