a**e
发帖数: 5094 | 1 Boston, MA — Adults who are covered by Medicaid use emergency rooms 40
percent more than those in similar circumstances who do not have health
insurance, according to a unique new study that sheds empirical light on the
inner workings of health care in the U.S.
The study takes advantage of Oregon’s recent use of a lottery to assign
access to Medicaid, the government-backed health-care plan for low-income
Americans, to certain uninsured adults. The research examines emergency room
records for roughly 25,000 people over 18 months.
“When you cover the uninsured, emergency room use goes up by a large
magnitude,” says Amy Finkelstein, the Ford professor of economics at MIT
and a principal investigator of the study, along with Katherine Baicker,
professor of health economics at Harvard School of Public Health.
The study, published January 2, 2014 in the journal Science, also documents
that having Medicaid consistently increases visits to the emergency room
across a range of demographic groups, types of visits, and medical
conditions, including types of conditions that may be most readily treatable
in primary-care situations.
“In no case were we able to find any subpopulations, or type of conditions,
for which Medicaid caused a significant decrease in emergency department
use,” Finkelstein adds. “Although one always needs to be careful
generalizing to other settings, these results suggest that other Medicaid
expansions are unlikely to decrease emergency room use.”
What’s the policy upshot?
The study is highly relevant to the current landscape in the U.S.: With the
implementation of the Affordable Care Act, Medicaid is expanding in many
states to cover a population similar to the one that gained Medicaid through
Oregon’s lottery. The results in this paper, however, suggest nuances to
the current debates over the expansion of Medicaid, medical costs, and the
role of emergency rooms in providing care.
On one level, the results accord with a traditional economics framework
suggesting that insurance, by lowering out-of-pocket costs, would increase
the use of medical care. Or, as Finkelstein observes, “If we’ve lowered
the price of the emergency department, we would expect people to use it more
.”
However, Medicaid also lowers the out-of-pocket costs of other types of
health care, such as primary-care doctors. Some policy analysts have
suggested that expanding Medicaid could reduce emergency department visits
by the formerly uninsured by bringing them into more regular contact with
primary-care doctors and clinics for preventive care. In theory, that could
also reduce overall system costs, since urgent care is expensive.
Indeed, prior work by Finkelstein, Baicker, and others on Oregon’s lottery
applicants showed that people who obtain Medicaid increase their use of
primary and preventive care. But as Finkelstein points out, the net effect
of Medicaid in the study was to also increase use of emergency services.
Hypothetically, Finkelstein notes, the results “could have gone either way,
which makes empirical work all the more important.”
Lottery numbers
The study’s rigor derives from a unique policy the state of Oregon
implemented in 2008. State officials, recognizing that they had Medicaid
funds for about 10,000 additional low-income adults, developed a lottery to
fill those slots, for which about 90,000 Oregonians applied.
From the viewpoint of academic researchers, the lottery system presented the
opportunity for a randomized controlled evaluation of Medicaid, since it
created a group of state residents obtaining Medicaid coverage who were
otherwise similar, on aggregate, to the applicants who continued to lack
coverage.
“It’s not that we’re the first to look at the effects of Medicaid
empirically, but we are the very first to have a randomized controlled trial
of the effect of covering the uninsured with Medicaid,” Finkelstein says.
In Oregon, uninsured adults are eligible for the lottery-based Medicaid
program when their annual income falls below the federal poverty level
established by the U.S. Department of Health and Human Services, which in
2013 is roughly $11,490 for a single person or $23,550 for a family of four.
In addition to Finkelstein and Baicker, the co-authors of the Science paper,
titled “Medicaid Increases Emergency Department Use: Evidence from Oregon
’s Health Insurance Experiment,” were lead author Sarah Taubman of the
National Bureau of Economic Research, Heidi Allen of Columbia University’s
School of Social Work, and Bill Wright of the Center for Outcomes Research
and Education at Providence Health and Services in Portland, Ore.
It is the latest paper to emerge from an ongoing study, led by Finkelstein
and Baicker, of the lottery applicants in Oregon’s Medicaid system. In a
2011 paper published in the Quarterly Journal of Economics, they showed that
Medicaid coverage increases doctor visits, prescription drug use, and
hospital admissions; reduces out-of-pocket expenses or unpaid medical debt;
and increases self-reported good health. In a 2013 paper published in the
New England Journal of Medicine, they showed that Medicaid coverage reduces
the incidence of depression but does not produce measured improvements in
physical health.
Finkelstein says she has been motivated by the Oregon study, and its
reception, to create a new research group, J-PAL North America. Co-founded
with Harvard economist Lawrence Katz, the group is meant to encourage
randomized evaluations on policies and social issues in the U.S. It is the
newest branch of MIT’s Abdul Latif Jameel Poverty Action Lab, which was
founded in 2003 to support randomized trials in development economics
globally.
“It’s relatively rare to have this kind of randomized controlled trial on
a major [policy] issue,” Finkelstein says. “And I’d like that to become
less the exception, and closer to the norm.” | k********n
发帖数: 756 | 2 The only thing explained by the paper is that the expansion allowed more
necessary access to the health care in the first 12 months in a white
dominated state. | A*******s
发帖数: 9638 | 3 No surprise. Free means over use.
the
★ 发自iPhone App: ChineseWeb 7.8
【在 a**e 的大作中提到】
: Boston, MA — Adults who are covered by Medicaid use emergency rooms 40
: percent more than those in similar circumstances who do not have health
: insurance, according to a unique new study that sheds empirical light on the
: inner workings of health care in the U.S.
: The study takes advantage of Oregon’s recent use of a lottery to assign
: access to Medicaid, the government-backed health-care plan for low-income
: Americans, to certain uninsured adults. The research examines emergency room
: records for roughly 25,000 people over 18 months.
: “When you cover the uninsured, emergency room use goes up by a large
: magnitude,” says Amy Finkelstein, the Ford professor of economics at MIT
| A*******s
发帖数: 9638 | 4 I have migraines everyday and only dilaudid helps me. Doc, what day is
necessary for me to visit ER and what day is unnecessary ? I am craving for
dilaudid IV everyday. :)
★ 发自iPhone App: ChineseWeb 7.8
【在 k********n 的大作中提到】
: The only thing explained by the paper is that the expansion allowed more
: necessary access to the health care in the first 12 months in a white
: dominated state.
| a**********2
发帖数: 3726 | 5 Case scenario the liberals will never understand !
for
【在 A*******s 的大作中提到】
: I have migraines everyday and only dilaudid helps me. Doc, what day is
: necessary for me to visit ER and what day is unnecessary ? I am craving for
: dilaudid IV everyday. :)
:
: ★ 发自iPhone App: ChineseWeb 7.8
| a**********2
发帖数: 3726 | 6 And non-medical personnel will never fully understand as well!
for
【在 A*******s 的大作中提到】
: I have migraines everyday and only dilaudid helps me. Doc, what day is
: necessary for me to visit ER and what day is unnecessary ? I am craving for
: dilaudid IV everyday. :)
:
: ★ 发自iPhone App: ChineseWeb 7.8
| l*****9
发帖数: 9501 | 7 不证明现有医疗体系问题更小
要想办法制止abuse and fraud | k********n
发帖数: 756 | 8 You presented a case that was, is and will be happening everyday in any
system. So, what is your point?
for
【在 A*******s 的大作中提到】
: I have migraines everyday and only dilaudid helps me. Doc, what day is
: necessary for me to visit ER and what day is unnecessary ? I am craving for
: dilaudid IV everyday. :)
:
: ★ 发自iPhone App: ChineseWeb 7.8
| k********n
发帖数: 756 | 9 Therefor, this Science paper was not valid because Amy was not a physician.
【在 a**********2 的大作中提到】
: And non-medical personnel will never fully understand as well!
:
: for
| l*****9
发帖数: 9501 | 10 To be fair, when something is free, it tends to be over-used.
【在 k********n 的大作中提到】
: You presented a case that was, is and will be happening everyday in any
: system. So, what is your point?
:
: for
| | | A*******s
发帖数: 9638 | 11 I am talking about your medical necessity and human nature is underestimated
by school children.
At current system, those uninsured will go bankrupt if they abuse the system.
★ 发自iPhone App: ChineseWeb 7.8
【在 k********n 的大作中提到】
: You presented a case that was, is and will be happening everyday in any
: system. So, what is your point?
:
: for
| s********e
发帖数: 1596 | 12 It is for sure. I rotated in a clinic, which takes medicaid, and have seen
enough of such cases, e.g. kids have a temp at 38.3 the night before ->
urgent visit. Those people have nothing but time. We, so called middle class
, give our kids Tylenol and send them to school instead, because we can't
afford to take a day off for such minor illnesses.
【在 l*****9 的大作中提到】
: To be fair, when something is free, it tends to be over-used.
| l*****9
发帖数: 9501 | 13 I think zero copay is a bad idea for medicaid patients. A $10 copay at
clinic and $40 copay at ER will go a long way in curbing over-use. For
patients that over-use ER, it should be mandatary for them to have a primary
care physician.
class
【在 s********e 的大作中提到】
: It is for sure. I rotated in a clinic, which takes medicaid, and have seen
: enough of such cases, e.g. kids have a temp at 38.3 the night before ->
: urgent visit. Those people have nothing but time. We, so called middle class
: , give our kids Tylenol and send them to school instead, because we can't
: afford to take a day off for such minor illnesses.
| k********n
发帖数: 756 | 14 Therefor, this Science paper was not valid because Amy was not a physician.
【在 a**********2 的大作中提到】
: And non-medical personnel will never fully understand as well!
:
: for
| k********n
发帖数: 756 | 15 People who will be abusing the system is abusing the system now. They are
not going to go bankrupt in any system because they already have nothing to
go bankrupt.
You can not reverse/convert this population in America by any means. So,
move on and try to help who need the access.
underestimated
system.
【在 A*******s 的大作中提到】
: I am talking about your medical necessity and human nature is underestimated
: by school children.
: At current system, those uninsured will go bankrupt if they abuse the system.
:
: ★ 发自iPhone App: ChineseWeb 7.8
| k********n
发帖数: 756 | 16 based on what you concluded , you would still bring your kid in if you could
afford to take time off. So, what is wrong by bringing the kid in?
class
【在 s********e 的大作中提到】
: It is for sure. I rotated in a clinic, which takes medicaid, and have seen
: enough of such cases, e.g. kids have a temp at 38.3 the night before ->
: urgent visit. Those people have nothing but time. We, so called middle class
: , give our kids Tylenol and send them to school instead, because we can't
: afford to take a day off for such minor illnesses.
| A*******s
发帖数: 9638 | 17 I could not believe it is from a doc to be.
could
★ 发自iPhone App: ChineseWeb 7.8
【在 k********n 的大作中提到】
: based on what you concluded , you would still bring your kid in if you could
: afford to take time off. So, what is wrong by bringing the kid in?
:
: class
| k********n
发帖数: 756 | 18 I have no interest discussing about the competence and qualification at the
personal level and have no intention to dismantle your pride.
【在 A*******s 的大作中提到】
: I could not believe it is from a doc to be.
:
: could
: ★ 发自iPhone App: ChineseWeb 7.8
| n*******c
发帖数: 501 | 19 It's probably more because you, so called middle class, are more likely to
have the knowledge knowing this is a minor disease and you would not
jeopardise your working hours or put your kids at higher risk of hospital
acquired infection....
And lay people or non medical personnel would never understand this fully
well.
People should not be declined of ED access based only on their economic
status. You just cannot expect them to 'triage' their kids properly. Rather,
it's medical people in ED to decide what their patients can or should get
based on medical urgency (and partially limited by economic status) which
lay people
can never know.
So in the above case, such a kid should be triaged at category 5 and
probably would wait in ED for over 10hrs before he can be seen. It's fair
for middle class who knows this is gonna happen and choose not to go while
poor
people who may not know or have nowhere to go anyway choose to wait in ED.
class
【在 s********e 的大作中提到】
: It is for sure. I rotated in a clinic, which takes medicaid, and have seen
: enough of such cases, e.g. kids have a temp at 38.3 the night before ->
: urgent visit. Those people have nothing but time. We, so called middle class
: , give our kids Tylenol and send them to school instead, because we can't
: afford to take a day off for such minor illnesses.
| l*****9
发帖数: 9501 | 20 I think zero copay is a bad idea for medicaid patients. A $10 copay at
clinic and $40 copay at ER will go a long way in curbing over-use. For
patients that over-use ER, it should be mandatary for them to have a primary
care physician.
to
Rather,
【在 n*******c 的大作中提到】
: It's probably more because you, so called middle class, are more likely to
: have the knowledge knowing this is a minor disease and you would not
: jeopardise your working hours or put your kids at higher risk of hospital
: acquired infection....
: And lay people or non medical personnel would never understand this fully
: well.
: People should not be declined of ED access based only on their economic
: status. You just cannot expect them to 'triage' their kids properly. Rather,
: it's medical people in ED to decide what their patients can or should get
: based on medical urgency (and partially limited by economic status) which
| | | A*******s
发帖数: 9638 | 21 The middle class are more likely to have knowledge to do either way: take a
severe symptom as a minor disease or take a minor symptom as a severe
disease to rule out. Right?
So there is no such a thing that lay people tends to go to ER because they
are lay, instead, lay people also could ignore severe disease symptoms due
to being lay.
A system is the KEY.
to
Rather,
【在 n*******c 的大作中提到】
: It's probably more because you, so called middle class, are more likely to
: have the knowledge knowing this is a minor disease and you would not
: jeopardise your working hours or put your kids at higher risk of hospital
: acquired infection....
: And lay people or non medical personnel would never understand this fully
: well.
: People should not be declined of ED access based only on their economic
: status. You just cannot expect them to 'triage' their kids properly. Rather,
: it's medical people in ED to decide what their patients can or should get
: based on medical urgency (and partially limited by economic status) which
| n*******c
发帖数: 501 | 22 Exactly. People should not be expected to triage properly before they get to
ED. They can always make their own judgmental calls regarding going or not.
And under no condition should they be blamed by going. There are
people intentionally abusing the ED access but there is no way to tell from
the whole system.
It is medical people who work in ED can make decisions based on medical
knowledge and experience. The system should allow all people at least a
chance to be decided before declined, if they want to. And the cutting off
criteria is far better using a some sort of medical filter (triage in ED)
rather than economic factors.
a
【在 A*******s 的大作中提到】
: The middle class are more likely to have knowledge to do either way: take a
: severe symptom as a minor disease or take a minor symptom as a severe
: disease to rule out. Right?
: So there is no such a thing that lay people tends to go to ER because they
: are lay, instead, lay people also could ignore severe disease symptoms due
: to being lay.
: A system is the KEY.
:
: to
: Rather,
| A*******s
发帖数: 9638 | 23 In US, we can not decline an ER visit. Once you are there, you will be seen.
My Medicaid patients with Migraines tends to go to ER much more frequently
and more inclined to be admitted. The patients with high deductible
insurance do opposite.
Ironically, Medicaid patients have higher no show rates in clinic.
to
not.
from
【在 n*******c 的大作中提到】
: Exactly. People should not be expected to triage properly before they get to
: ED. They can always make their own judgmental calls regarding going or not.
: And under no condition should they be blamed by going. There are
: people intentionally abusing the ED access but there is no way to tell from
: the whole system.
: It is medical people who work in ED can make decisions based on medical
: knowledge and experience. The system should allow all people at least a
: chance to be decided before declined, if they want to. And the cutting off
: criteria is far better using a some sort of medical filter (triage in ED)
: rather than economic factors.
| a**e
发帖数: 5094 | 24 确实是，medicaid病人complaince相对差，不知道为什么。天天也不上班,没别的事情
啊。我上次倒是见了一个特别执着的，暴风雪非要来看门诊，我都快哭了。其实她在
retail 工作，圣诞期间正是忙的时候。
seen.
【在 A*******s 的大作中提到】
: In US, we can not decline an ER visit. Once you are there, you will be seen.
: My Medicaid patients with Migraines tends to go to ER much more frequently
: and more inclined to be admitted. The patients with high deductible
: insurance do opposite.
: Ironically, Medicaid patients have higher no show rates in clinic.
:
: to
: not.
: from
| n*******c
发帖数: 501 | 25 ED frequent fliers are everywhere. And ED system abuse and unnecessary
admissions are similarly world-wide issues. Although the level of insurance
does affect it but setting any bars using the insurance would not solve the
problem. It is just because there is no way to define an unnecessary ED
visit or admission without a case-by-case review.
What happens to American citizens with no medical insurance if they visit ED
?
seen.
【在 A*******s 的大作中提到】
: In US, we can not decline an ER visit. Once you are there, you will be seen.
: My Medicaid patients with Migraines tends to go to ER much more frequently
: and more inclined to be admitted. The patients with high deductible
: insurance do opposite.
: Ironically, Medicaid patients have higher no show rates in clinic.
:
: to
: not.
: from
| A*******s
发帖数: 9638 | 26 It is a "law": Cash pay = no pay
Their credit, however, could be ruined.
insurance
the
ED
【在 n*******c 的大作中提到】
: ED frequent fliers are everywhere. And ED system abuse and unnecessary
: admissions are similarly world-wide issues. Although the level of insurance
: does affect it but setting any bars using the insurance would not solve the
: problem. It is just because there is no way to define an unnecessary ED
: visit or admission without a case-by-case review.
: What happens to American citizens with no medical insurance if they visit ED
: ?
:
: seen.
| s******v
发帖数: 477 | 27 这正是我想说的，Medicaid covered 有多少是真正应该covered的人，享受welfared
又有多少是应该享受的。在O8这里真有点“横行有理，流氓无罪”的味道
for
【在 A*******s 的大作中提到】
: I have migraines everyday and only dilaudid helps me. Doc, what day is
: necessary for me to visit ER and what day is unnecessary ? I am craving for
: dilaudid IV everyday. :)
:
: ★ 发自iPhone App: ChineseWeb 7.8
| M****a
发帖数: 577 | 28 这文章挺无聊的，把很明显的事情用randomized trial包装一下，就成了香饽饽，跟
CNS里面大量的灌水文章没区别。
Wait a minute，靠，原来就是一篇CNS的文章也！
Anyway，我的two cents
1. 没有医疗保险的人群，现在有了医疗保险，干吗不用啊？普罗大众有多少对
healthcare cost有概念（除了知道看病贵，医生收入高之外）？不是每个低收入的病
人都是瘾君子，我见过不少没医疗保险的人连急诊都不敢去，怕付不起账单。文章自己
也说了，有了Medicaid之后，primary/preventive medicine也提高了，这不是好事么
？要是中国也有Medicaid，全国医疗开支恐怕要涨几个数量级。
2. 不知道怎么回事，这个版老是对其他有色人种耿耿于怀，好像自己交点税，全落到
医院的腰包让这些人吸毒了，送到伊拉克阿富汗的炮弹坦克美国大兵，花的都不是你的
税钱。大家对Inner City的贫困人口的生活，除了停留在吸毒吃救济这些老生常谈之外
，还有别的概念么？要是有机会对这些人做一个完整的psychiatry intake级别的问卷
调查，也许你会发现，有些问题是可以通过努力解决的，但是大部分问题是不行的。
3.突然想起中学时政治学过的东西：民族矛盾实质是阶级压迫。正确与否姑且不论，但
是总有它的道理。
the
room
【在 a**e 的大作中提到】
: Boston, MA — Adults who are covered by Medicaid use emergency rooms 40
: percent more than those in similar circumstances who do not have health
: insurance, according to a unique new study that sheds empirical light on the
: inner workings of health care in the U.S.
: The study takes advantage of Oregon’s recent use of a lottery to assign
: access to Medicaid, the government-backed health-care plan for low-income
: Americans, to certain uninsured adults. The research examines emergency room
: records for roughly 25,000 people over 18 months.
: “When you cover the uninsured, emergency room use goes up by a large
: magnitude,” says Amy Finkelstein, the Ford professor of economics at MIT
| l*****9
发帖数: 9501 | 29 完全免费就会滥用，必须有copay
【在 M****a 的大作中提到】
: 这文章挺无聊的，把很明显的事情用randomized trial包装一下，就成了香饽饽，跟
: CNS里面大量的灌水文章没区别。
: Wait a minute，靠，原来就是一篇CNS的文章也！
: Anyway，我的two cents
: 1. 没有医疗保险的人群，现在有了医疗保险，干吗不用啊？普罗大众有多少对
: healthcare cost有概念（除了知道看病贵，医生收入高之外）？不是每个低收入的病
: 人都是瘾君子，我见过不少没医疗保险的人连急诊都不敢去，怕付不起账单。文章自己
: 也说了，有了Medicaid之后，primary/preventive medicine也提高了，这不是好事么
: ？要是中国也有Medicaid，全国医疗开支恐怕要涨几个数量级。
: 2. 不知道怎么回事，这个版老是对其他有色人种耿耿于怀，好像自己交点税，全落到
| a**e
发帖数: 5094 | 30 我以前从来不知道social science也能做randomized trial
更惊奇的是这也能发CNS
文章重点不是在前面，重点是在要funding
中国人农耕文明搞得太久了，比较看中多劳多得，可以理解
【在 M****a 的大作中提到】
: 这文章挺无聊的，把很明显的事情用randomized trial包装一下，就成了香饽饽，跟
: CNS里面大量的灌水文章没区别。
: Wait a minute，靠，原来就是一篇CNS的文章也！
: Anyway，我的two cents
: 1. 没有医疗保险的人群，现在有了医疗保险，干吗不用啊？普罗大众有多少对
: healthcare cost有概念（除了知道看病贵，医生收入高之外）？不是每个低收入的病
: 人都是瘾君子，我见过不少没医疗保险的人连急诊都不敢去，怕付不起账单。文章自己
: 也说了，有了Medicaid之后，primary/preventive medicine也提高了，这不是好事么
: ？要是中国也有Medicaid，全国医疗开支恐怕要涨几个数量级。
: 2. 不知道怎么回事，这个版老是对其他有色人种耿耿于怀，好像自己交点税，全落到
| | | l*****9
发帖数: 9501 | 31 医疗保险比较特殊，多用不一定是好事
【在 a**e 的大作中提到】
: 我以前从来不知道social science也能做randomized trial
: 更惊奇的是这也能发CNS
: 文章重点不是在前面，重点是在要funding
: 中国人农耕文明搞得太久了，比较看中多劳多得，可以理解
|
|
