Stanley Feld M.D.,FACP,MACE
As the recession deepens and more people are unemployed, the Medicaid roles are increasing. President Obama has promised the states that he will increase federal subsides to the states to cover this increase in participants.
I refer you back to Moises’ story and his inability to qualify for Medicaid because he earns more than $900 per month ($2200 per month). Texas’ poverty level is defined as earnings of $900 per month
Medicaid is supposed to provide coverage to the poor. The Medicaid program is probably better than being uninsured in case of an emergency.
The poor have a very high incidence of chronic disease. Prevention of chronic diseases and its complications are the biggest burden to the healthcare system. Eighty percent of the healthcare dollars are spent on the complications of chronic diseases.
Providing Medicaid for more people is not going to solve our healthcare problems. Preventing chronic diseases and its complications will. Unfortunately the Medicaid system presents barriers to appropriate and timely medical care.
Here are some of the barriers;
1. Reimbursement rates are very low.
2. Billing Medicaid is complicated.
3. Access to specialized care is difficult.
4. Permission for timely interventions is difficult to obtain.
5. Medicaid is replete with paperwork for both patients and physicians.
6. Regulations, rules and rejections are common.
7. Qualifying for Medicaid is difficult.
President Obama’s economic stimulus package is going to supplement Medicaid with about 100 billion dollars to the states. The states are not under any obligation to do anything to improve delivery of care or remove the barriers to care.
There are many reports of poor medical outcomes for chronic diseases by Medicaid recipients. The poor medical outcomes are a function of both the severity of the chronic diseases, patients’ compliance and the difficulty in accessing medical care in the Medicaid program.
Chronic diseases need early diagnosis, treatment, patient education and appropriate follow-up to avoid complications. The patients need to be taught to be the “professor of their chronic disease” so they can avoid the complications of their chronic disease.
It is my belief that most patients who are afflicted with a chronic disease would love to understand their disease process. They would love to know how they can avoid complications no matter what their socioeconomic group. The treatment of Diabetes Mellitus has taught us that lesson.
Do patients on Medicaid have better or worse medical outcomes than patients on Medicare or private insurance?
“One study published in the Journal of the American College of Cardiology (2005) found that Medicaid patients were almost 50% more likely to die after coronary artery bypass surgery than patients with private coverage or Medicare. The authors suggest this may be a result of poorer long-term, follow-up care.”
“Another study in the journal Ethnicity and Disease (2006) showed that elderly Medicaid patients with unstable angina had worse care, partly because they were less likely to get timely interventions or be treated at higher quality hospitals.”
“Three other recent studies showed that Medicaid patients presenting with heart attacks or unstable angina received cardiac catheterization less often than Medicare or private paying patients.”
Coronary stents to open blocked coronary arteries has become the standard of care. There is a large body of evidence proving improved outcomes. Coronary stents have come under attack lately. The argument against stents is they are overused. This could be true but under use of coronary stents would certainly result in poorer medical outcomes.
“A study of adults with cancer published in the journal Cancer (2005) found that patients on Medicaid were two to three times more likely to die from the disease even after researchers corrected for differences in the location of the tumor and its stage when diagnosed.”
President Obama’s notion that expanding Medicaid will improve medical care for the uninsured is faulty. Increasing the quality of care is the key. The incentives in the healthcare system for all stakeholders must be changed. This can only be accomplished by patients’ ownership of their healthcare dollar as well as responsibility for their care and not expanding defective government plans such as Medicaid.