• Deathly Medicaid?

    Never draw broad policy conclusions from one study. It could hurt your brain. Well it hurts mine, anyway.

    Avik Roy writes,

    Medicaid so severely underpays doctors—reimbursing them at 72 percent of already-stingy Medicare rates—that many physicians refuse to see Medicaid patients. Medicaid patients, in turn, fill up emergency rooms, where they delay the care of the seriously injured.

    Now comes word, via a large study by the University of Virginia (h/t Joseph Colletti), that surgical patients on Medicaid are 13% more likely to die than those with no insurance at all, and 97% more likely to die than those with private insurance.

    The policy implication is that we should make Medicaid as close as possible to private insurance, thereby making Medicaid surgical patients 97% less likely to die. Or, if that is too costly, we should instead make Medicaid more like no insurance at all and boost survival by 13%. Talk about bang for the buck!

    One way this could make sense is if very little health care (such as that the uninsured might receive) is bad for you, a little bit of, perhaps low quality, health care (such as that Medicaid patients might receive) is very bad for your health, and a lot of perhaps higher quality health care (that the privately insured enjoy so much) is very very good for you.

    Or maybe there’s a problem with the study.

    • They also chose procedures which would be heavily tilted towards academic centers. The Medicaid cases would be more heavily managed by residents.Would also like to see how they controlled for functional status.


    • It also doesn’t look like they controlled for prior health status, a pretty important factor to ignore. My not-so-wild guess is that Medicaid recipients are generally in worse health than those with private insurance.

    • “It also doesn’t look like they controlled for prior health status, a pretty important factor to ignore. ”

      They did control for prior health status:

      “Unadjusted mortality for Medicare (4.4%, OR= 3.51), Medicaid (3.7%, OR: 2.86) and Uninsured (3.2%, OR: 2.51) patient groups were higher compared to Private Insurance groups (1.3%, p<0.001). Moreover, mortality was lowest for Private Insurance patients independent of operation. Importantly, after controlling for age, gender, income, geographic region, operation, and 30 comorbid conditions, "