Monday, May 20, 2013

O-Aren't-You-Glad Part 2: Even Gladder

(Previously: I visited a Chinese medicine lab and Oregon had Medicaid lottery...)

(Traveler Tip: Have One of These on Hand)
Wandering down the streets of Taipei one morning, Ashley, Baby Syd, and I popped into a random traditional medicine practice so Nurse Practitioner Ashley could check out what Chinese medicine was all about. In my travels, I'd observed that though Taiwanese people were friendly to begin with, having an adorable white baby on hand guaranteed premier service everywhere.  Except there.  The doctor seemed bored by our presence.  Given Ashley's father's collection of Australian aboriginal remedies for snake bites, we asked what he'd prescribe for snake bites.  It was then that his attitude turned from curmudgeon to contempt, as if we asked if his medicine was magic.  "If a snake bites you, go to a hospital.  Why would you ask for for traditional medicine then?" He replied (quite sensibly).  "You'd want to remove the venom.  Call 119 and go to a hospital for that."

Two weeks ago, I left you in suspense with the outcome of the Oregon Medicaid study.  Here goes: About two years after eligible adults were randomly chosen to enroll in Medicaid or not, the people with Medicaid coverage went to their doctors more (and in turn, had more tests done) than people without.  They also spent less money on healthcare and were less likely to be bankrupt by illness.  Medicaid bought peace of mind.  Enrollees reported higher quality of life and were less likely to have depression.  They were also more likely to take their diabetes medications.  Read here for one enrollee’s experience.  Those were the good bits. 

However, when it came to health outcomes, the Medicaid group wasn’t significantly different from those without.  What are we to make of this?  Is Medicaid any good?

One way to look at this is to say that people without insurance, like their Medicaid counterparts, know to go to the hospital for snake bites.  When it comes to the big illnesses, people find a way of getting medical care.  Doing so comes at a greater financial and emotional cost without Medicaid.  Another perspective is to question the effectiveness of our healthcare system, and the quality of doctors that Medicaid patients (and indeed, all patients) see.  The enrollees are going to the doctors but the doctors aren't delivering.   A third perspective is to say that maybe two years aren’t long enough to observe health differences, perhaps we’ll see an effect in a few more years.  I think all three are at work.

The Oregon study reiterates the importance of having health insurance.  Saving people from depression and bankruptcy are not small feats.  Yet it also remind us of the work cut out for Public Health.  It doesn't stop at policies that enable healthcare access.  Improving healthcare quality, and in turn the population's health, is much trickier.  Good thing I’ve chosen to explore it for my doctoral thesis.  

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