title: The Oregon experiment--effects of Medicaid on clinical outcomes.
abstract: BACKGROUND
  Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects.
  
  
  METHODS
  Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage.
  
  
  RESULTS
  We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (-9.15 percentage points; 95% confidence interval, -16.70 to -1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.
  
  
  CONCLUSIONS
  This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.
authors: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA. kbaicker@hsph.harvard.edu
authors: Katherine
authors: K
authors: Baicker
authors: Sarah L
authors: SL
authors: Taubman
authors: Heidi L
authors: HL
authors: Allen
authors: Mira
authors: M
authors: Bernstein
authors: Jonathan H
authors: JH
authors: Gruber
authors: Joseph P
authors: JP
authors: Newhouse
authors: Eric C
authors: EC
authors: Schneider
authors: Bill J
authors: BJ
authors: Wright
authors: Alan M
authors: AM
authors: Zaslavsky
authors: Amy N
authors: AN
authors: Finkelstein
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D019458:Insurance Coverage / Q000191:economics; D008484:Medicaid / Q000191:economics; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D015995:Prevalence; D014481:United States; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin
references: Circulation. 2008 Feb 12;117(6):743-53
references: 18212285
references: Q J Econ. 2012 Aug;127(3):1057-1106
references: 23293397
references: N Engl J Med. 2012 Sep 13;367(11):1025-34
references: 22830435
references: N Engl J Med. 1984 Aug 16;311(7):480-4
references: 6379458
references: JAMA. 2002 Dec 18;288(23):2981-97
references: 12479763
references: Cochrane Database Syst Rev. 2011 Jan 19;(1):CD004816
references: 21249663
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD007954
references: 19588448
references: N Engl J Med. 1986 May 8;314(19):1266-8
references: 3517642
references: JAMA. 2000 Oct 25;284(16):2100-7
references: 11042759
references: Demography. 2007 Nov;44(4):899-925
references: 18232218
references: J Affect Disord. 2009 Apr;114(1-3):163-73
references: 18752852
references: Ann Intern Med. 2007 Sep 18;147(6):386-99
references: 17638715