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What are the effects on health care of payment source?

PopulationInterventionComparisonOutcome & results
Massachusetts Health Care Reform Ann Int Med 2014
PMID: 24798521
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
Oregon Medicaid
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
JAMA, 1983
PMID: 6834620 and
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: Oct 23, 2018
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