Department of Preventive Medicine and Public Health
1010 N. Kansas
Wichita, KS 67214
What are the effects on health care of payment source?
|Population||Intervention||Comparison||Outcome & results|
|Massachusetts Health Care Reform Ann Int Med 2014
|Adults aged 20 to 64 years in Massachusetts and control group counties||Massachusetts health care reform of 2006: near-universal insurance coverage||Similar counties in nonreform states||• All-cause mortality drop (absolute decrease of 8.2 deaths per 100,000 adults P = 0.003). Benefit greater in poorer counties.
• NNT = ~ 830 adults to prevent 1 death/year
N Engl J Med 2013
|Low-income, uninsured, able-bodied adults who are not eligible for other public insurance (e.g. Medicare)||Randomized via lottery to 2008 Medicaid expansion||No Medicaid||Over two years follow-up:
• No improvement in measured health. • Less depression
• Increased use of health care services
• Less financial strain
PMID: 6834620 and http://www.rand.org/pubs/research_briefs/RB9174.html
|Dayton families with incomes < $25,000 (1973 dollars) and not eligible for other public insurance (e.g. Medicare)||Random assignment to insurance||No insurance||• Less spent on care if patients had to pay.
• Improved care of HTN, vision, dental, serious symptoms.
• Less worry about health
• Fewer restricted activity days (including time spent seeking medical care)
Last modified: Sep 17, 2018