Medicaid on the main stage
Studies fail to address long-term viability: NAPH
Two new Medicaid studies examined spending variations across states and the benefits of coverage as state and federal lawmakers evaluate ways to reduce spending in the program. But neither study addressed whether Medicaid payments to providers are sufficient to keep them operating and meeting the needs of beneficiaries.
That was the message last week from the National Association of Public Hospitals and Health Systems, which represents the nation’s safety net hospitals—where half of all care is provided to Medicaid and uninsured patients and for which Medicaid accounts for 35% of total net revenue.
A study published in the July issue of Health Affairs found significant variation in the volume of services and prices for Medicaid spending across states. Understanding those differences, the study authors noted, could help improve the quality and efficiency of care.
Analysts studied Medicaid cash assis- tance data from 2001 to 2005 for inpatient hospital services, outpatient services and prescription drugs. They also concluded that the supply of primary-care physicians in certain areas was associated with reduced rates of admission for diabetes, lung disease and adult asthma—suggesting that increased access to primary care could improve the management of chronic disease for Medicaid beneficiaries.
Xiaoyi Huang, assistant vice president for policy at NAPH, said the association agrees with the Health Affairs study’s conclusion that better access to primary-care services results in less frequent hospital visits.
The study authors found that the average number of outpatient visits and the price per visit were associated with reduced admissions, suggesting that better access to primary care may result in reduced admissions. They noted that provisions of the Patient Protection and Affordable Care Act that focus on primary care—such as those aimed at increasing the size of the primary-care workforce, expanding coverage for preventive services and temporarily increasing physician payment rates under Medicaid—may result in fewer hospitalizations.
Primary-care access was also highlighted in a second Medicaid-related study last week. The National Bureau of Economic Research released a report that showed Medicaid enrollment could lead to better self-reported physical and mental health and lower medical debt. In 2008, the state of Oregon opened a
A doctor speaks to a Medicaid patient in Atlanta. Georgia, like many other states, struggles to cut spending.