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Medicaid study links insurance to reduced depression and financial strain, but no increase in health

An analysis of 2 years of data from the Oregon Health Insurance Experiment showed that Medicaid coverage reduced rates of depression and overall financial strain on participating individuals, but did not yield improvements in overall health status. Results of the study, funded in part by NIA, appear in the March 2, 2012, issue of The New England Journal of Medicine.

In 2008, Oregon expanded its Medicaid program through a statewide lottery of low-income adults. Selected persons were given the opportunity to apply for Medicaid coverage. This provided a unique opportunity to examine the effects of insurance coverage using a randomized study design, comparing various health and financial outcomes among those who were selected versus a control group. About 2 years after the lottery, the researchers conducted in-person interviews and health examinations with 6,387 adults receiving Medicaid and 5,842 who were not selected for the program.

The investigators found that Medicaid enrollees had reduced rates of depression and better self-reported mental health. Enrollment in Medicaid had no significant effect on the diagnosis or treatment of high blood pressure or high cholesterol, but did increase the probability of being diagnosed with and treated for diabetes. Medicaid enrollment did not affect the measures of diabetic blood sugar control, however, even after diagnosis and treatment.

Medicaid almost completely eliminated out-of-pocket catastrophic medical expenditures and reduced other measures of financial hardship, including borrowing money to pay medical bills or skipping payments on bills. Health care use, including physician visits, preventive care, and prescription drugs, increased. Medicaid also increased the number of people who said that their health was the same or better than it was a year previously.

The researchers noted that the results highlight the financial protections that Medicaid provides, as well as the improvements in mental health, but does not provide evidence that Medicaid coverage translates to measurable improvements in physical health in the first 2 years.

Reference: Baicker K, et al. The Oregon experiment—effects of Medicaid on clinical outcomes. N Engl J Med, 2013 May 2;368(18):1713-22. doi:10.1056/NEJMsa1212321.