27 Mar Study Finds Medicaid Improves Depression But Not Physical Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Muennig: The Oregon Health Insurance Experiment (OHIE) is one of just two experimental investigations of the health benefits of medical insurance. The first was the Rand Health Insurance Experiment, which was conducted over 3 decades ago. The OHIE randomly assigned participants to receive Medicaid or their usual care. It found that Medicaid protected families from financial ruin caused by medical illness, that it reduced depression, and that it increased preventive screening tests. However, it produced no medical benefits with respect to high blood pressure, diabetes, or high cholesterol. Medicaid opponents suggested that this meant that we should get rid of Medicaid because Medicaid does not improve physical health. But Medicaid proponents suggested that too few participants enrolled to detect a benefit, and, regardless of the study’s flaws, reduced depression, financial protections, and improved screening were reason enough to continue.
We found that the Medicaid opponents were right. Medicaid actually didn’t produce any meaningful benefits with respect to blood pressure, diabetes, or cholesterol. But we also found that the Medicaid proponents were right. It’s impacts on depression alone rendered it cost-effective even if one does not account for the benefits of financial protections or medical screening.
Medical Research: What should clinicians and patients take away from your report?
Dr. Muennig: All of the benefits of screening for blood pressure, diabetes, and high cholesterol have been very thoroughly documented in carefully managed experiments. But in the real world, many people might not actually take their medicines or listen to the advice of their doctor.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Muennig: We need to understand how to make preventive screening work better for low-income populations. We also need to know whether other kinds of screening (such as breast cancer screening) actually save lives. In this study, that question might have been answered if we had enough participants.
The most important take home message, though, is that we need more research on social policies. We are spending over a trillion dollars on social programs that have not been adequately studied. It is astounding that this study—which cost less than a tenth of a percent of the annual Medicaid budget—took so long to actually be conducted. Education, housing, and other social policies have potential, but we really don’t know whether they work. Only a very limited number of programs (such as welfare reform) have been tested rigorously in this way.
Considering Whether Medicaid Is Worth the Cost: Revisiting the Oregon Health Study
Peter A. Muennig, Ryan Quan, Codruta Chiuzan, and Sherry Glied. (2015). Considering Whether Medicaid Is Worth the Cost: Revisiting the Oregon Health Study. American Journal of Public Health. e-View Ahead of Print.
MedicalResearch.com Interview with: Peter Muennig, MD, MPH (2015). Study Finds Medicaid Improves Depression But Not Physical Health