When it comes to improving health care spending and efficiency, or to improving patients’ health and well-being, what does health insurance actually do? This question is harder to answer than you might think, says Katherine Baicker, Chair of the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.
If you want to know how effective Medicaid is, for example, simply comparing mortality rates for those on Medicaid versus those who are uninsured won’t provide enough evidence. Randomized controlled trials are better for answering public policy questions like this one, as demonstrated by the rare opportunity Oregon had to conduct one. In this trial, patients on a waiting list for public health insurance received Medicaid via lottery. The results: those who received Medicaid used more health care — a cost, from an economist standpoint — but they benefited from the financial protection and security that insurance is meant to bring.
What happens to people’s health when you expand health insurance? In the Oregon trial, self-reported health improved substantially, and depression was reduced by 30%. But clinical measures were much more nuanced: there were no detectable improvements in blood pressure or cholesterol, for example. This kind of evidence leaves policymakers with a much more difficult decision. Medicaid has enormous benefits to the people enrolled, but it’s an expensive program.
“I don’t think anybody wants health care,” says Baicker. “People want health outcomes. They want to have better health, and health care’s the resource you use to get that better health. If we could deliver the same health outcomes or better health outcomes using fewer health care resources, that would be a great thing.”
From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.