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Feb 25, 2008
Once they see a doctor, patients get the same treatment, regardless of insurance status according to a RAND study. But do the uninsured delay seeing doctors when they need attention? Apparently, according to an American Cancer Institute study (full study is gated). Unfortunately, rationing by waiting and other obstacles, makes Medicaid enrollment almost as bad.
One Response to “Medicaid is only Marginally Better than Being Uninsured”
February 27th, 2008 at 3:32 pm
Hmmmmm, last week I had a local newspaper reporter give the American Cancer Institute (ACS) study as a reference to support her claim that all kids need to be covered because uninsured children use the ER more, don't get immunizations, and are absent more days at school.
The ACS study is so new that PubMed, the online database of medical journal articles, hasn't even linked to the full article yet; it only lists the abstract. It is unusual for something so recently published in the specialist literature to already be cited as a reference by a local reporter.
The PubMed abstract waffles on the results. The findings are that the privately insured get treatment at an earlier state of cancer, boosting the chances of cure. Specifically, it says, "Although many factors other than insurance status also affect the quality of care received, adequate insurance is a crucial factor for receiving appropriate cancer screening and timely access to medical care." It's a pretty big step from "many factors" to "adequate insurance is crucial."
And the results suggest that Medicaid is not adequate. Patients on Medicaid apparently do worse than those who are privately insured. For advanced-stage melanoma, you may be better off being uninsured. The odds ratio of having advanced-state disease at diagnosis for uninsured patients was 2.3 compared to the insured. For those with Medicaid the odds ratio comparison to the insured was 3.3. So much for putting all the uninsured kids on Medicaid.
Better off uninsured than on Medicaid? Probably not. There likely are a lot of SES factors that explain differences in when people seek and receive treatment. We know that the Medicaid, privately insured, and uninsured populations differ in important respects. It will be interesting to see which of those are taken into account in this study.