So much for Medicaid or government insurance.

[EMEDPA]

There has to be some limits to stop abuse. In NC, there is a $3 copay for adults (children are still free) and a limit of 22 visits to a doctor's office per year....

they should limit inappropriate er visits first. around here the pcp who accepts medicaid(yup, there is only 1 in the county) requires a 40 dollar copay. guess what? this defeats the purpose and no one goes to their pcp, they all come to the er because it is "free". some folks who actually just need a very reasonable rx refill for atenolol will still come to the er because they honestly can't afford the 40 dollar copay to see their pcp , as much as they would like to.

[EMEDPA]

There has to be some limits to stop abuse. In NC, there is a $3 copay for adults (children are still free) and a limit of 22 visits to a doctor's office per year....

they should limit inappropriate er visits first. around here the pcp who accepts medicaid(yup, there is only 1 in the county) requires a 40 dollar copay. guess what? this defeats the purpose and no one goes to their pcp, they all come to the er because it is "free". some folks who actually just need a very reasonable rx refill for atenolol will still come to the er because they honestly can't afford the 40 dollar copay to see their pcp , as much as they would like to.

[Teasip]

It is never a good sign when a Medicaid pt. comes into the ED for a HA and you don't even have to see the pt., but only hear them, to know who they are and why they are there. Why such frequent visitation? Because they don't pay a blanking thing for their visit and they have nothing else better to do (no sign of distress and fully functional BTW) regardless of how much time you spend trying to educate them.

 

I still like the idea behind a high deductible, major medical policy for the majority of us which would then allow us to shop for the best bang for the dollar for lesser illnesses. Keep deposited funds contributions each year for routine care tax deductible. Having such a plan would cut out a lot of the medical resources abuse because using the example above, they wouldn't be able to afford regular ED visits. Exceptions could be made for chronic medical conditions where we KNOW that treatment of complications will significantly worsen the overall cost of treatment, i.e.-DM, HTN. As I get back on my high horse, most of what we treat doesn't need treatment, and certainly not expensive treatment, and in fact will resolve just fine on its' own. Also, allow the states/Feds to negotiate with pharmaceutical companies to lower prescription costs even though in most cases there are plenty of cheaper, equally effective medications available which would treat whatever just fine.

[Teasip]

It is never a good sign when a Medicaid pt. comes into the ED for a HA and you don't even have to see the pt., but only hear them, to know who they are and why they are there. Why such frequent visitation? Because they don't pay a blanking thing for their visit and they have nothing else better to do (no sign of distress and fully functional BTW) regardless of how much time you spend trying to educate them.

 

I still like the idea behind a high deductible, major medical policy for the majority of us which would then allow us to shop for the best bang for the dollar for lesser illnesses. Keep deposited funds contributions each year for routine care tax deductible. Having such a plan would cut out a lot of the medical resources abuse because using the example above, they wouldn't be able to afford regular ED visits. Exceptions could be made for chronic medical conditions where we KNOW that treatment of complications will significantly worsen the overall cost of treatment, i.e.-DM, HTN. As I get back on my high horse, most of what we treat doesn't need treatment, and certainly not expensive treatment, and in fact will resolve just fine on its' own. Also, allow the states/Feds to negotiate with pharmaceutical companies to lower prescription costs even though in most cases there are plenty of cheaper, equally effective medications available which would treat whatever just fine.

[Teasip]

It is never a good sign when a Medicaid pt. comes into the ED for a HA and you don't even have to see the pt., but only hear them, to know who they are and why they are there. Why such frequent visitation? Because they don't pay a blanking thing for their visit and they have nothing else better to do (no sign of distress and fully functional BTW) regardless of how much time you spend trying to educate them.

 

I still like the idea behind a high deductible, major medical policy for the majority of us which would then allow us to shop for the best bang for the dollar for lesser illnesses. Keep deposited funds contributions each year for routine care tax deductible. Having such a plan would cut out a lot of the medical resources abuse because using the example above, they wouldn't be able to afford regular ED visits. Exceptions could be made for chronic medical conditions where we KNOW that treatment of complications will significantly worsen the overall cost of treatment, i.e.-DM, HTN. As I get back on my high horse, most of what we treat doesn't need treatment, and certainly not expensive treatment, and in fact will resolve just fine on its' own. Also, allow the states/Feds to negotiate with pharmaceutical companies to lower prescription costs even though in most cases there are plenty of cheaper, equally effective medications available which would treat whatever just fine.

[MedicinePower]

the study Davis is talking about examined MEDICAID, not MEDICARE, which are very different systems and insure very different populations.

I know. I was mentioning the "other" governmental insurance plan that people tend to forget about.

MEDICAID is abused. no doubt about it. I see it every day. folks who come to the er for a pregnancy test because going to the dollar store for one would cost a dollar but the govt ends up footing a 250 dollar bill for the test.

I can't comment one way or another without seeing studies, but I trust your reporting of the abuse.

 

I agree a minimal copay for medicaid(like 5 dollars) would stop the majority of the frivolous er visits. we have a lady on medicaid who comes into the dept EVERY DAY. if she had to decide between an er visit or her pack of smokes every day we would be seeing her less.

Goodness....oy vey.

 

MEDICARE is a program to mostly insure the elderly. much less abuse in this system.

Elderly and disabled who have been on SSDI for 2 years. Like I said above, I doubt that this sort of abuse happens in Medicare as there are co-pays, co-insurances, deductibles, and premiums. Plus that population is generally concerned with staying healthy.

 

I agree that walmart/target/etc 4 and 5 dollar lists are wonderful. most of us now only prescribe off these lists except for the rare pt with actual real insurance with prescription coverage.

Good to know they are that useful (for when I enter practice).

[MedicinePower]

the study Davis is talking about examined MEDICAID, not MEDICARE, which are very different systems and insure very different populations.

I know. I was mentioning the "other" governmental insurance plan that people tend to forget about.

MEDICAID is abused. no doubt about it. I see it every day. folks who come to the er for a pregnancy test because going to the dollar store for one would cost a dollar but the govt ends up footing a 250 dollar bill for the test.

I can't comment one way or another without seeing studies, but I trust your reporting of the abuse.

 

I agree a minimal copay for medicaid(like 5 dollars) would stop the majority of the frivolous er visits. we have a lady on medicaid who comes into the dept EVERY DAY. if she had to decide between an er visit or her pack of smokes every day we would be seeing her less.

Goodness....oy vey.

 

MEDICARE is a program to mostly insure the elderly. much less abuse in this system.

Elderly and disabled who have been on SSDI for 2 years. Like I said above, I doubt that this sort of abuse happens in Medicare as there are co-pays, co-insurances, deductibles, and premiums. Plus that population is generally concerned with staying healthy.

 

I agree that walmart/target/etc 4 and 5 dollar lists are wonderful. most of us now only prescribe off these lists except for the rare pt with actual real insurance with prescription coverage.

Good to know they are that useful (for when I enter practice).

[MedicinePower]

the study Davis is talking about examined MEDICAID, not MEDICARE, which are very different systems and insure very different populations.

I know. I was mentioning the "other" governmental insurance plan that people tend to forget about.

MEDICAID is abused. no doubt about it. I see it every day. folks who come to the er for a pregnancy test because going to the dollar store for one would cost a dollar but the govt ends up footing a 250 dollar bill for the test.

I can't comment one way or another without seeing studies, but I trust your reporting of the abuse.

 

I agree a minimal copay for medicaid(like 5 dollars) would stop the majority of the frivolous er visits. we have a lady on medicaid who comes into the dept EVERY DAY. if she had to decide between an er visit or her pack of smokes every day we would be seeing her less.

Goodness....oy vey.

 

MEDICARE is a program to mostly insure the elderly. much less abuse in this system.

Elderly and disabled who have been on SSDI for 2 years. Like I said above, I doubt that this sort of abuse happens in Medicare as there are co-pays, co-insurances, deductibles, and premiums. Plus that population is generally concerned with staying healthy.

 

I agree that walmart/target/etc 4 and 5 dollar lists are wonderful. most of us now only prescribe off these lists except for the rare pt with actual real insurance with prescription coverage.

Good to know they are that useful (for when I enter practice).

[zepoPA]

I can't comment one way or another without seeing studies, but I trust your reporting of the abuse.

.

 

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well. Week after week, same patient, same story. Overindulging over the weekend AGAIN, then "stopping by" for GERD Sx. Entire GI tests are negative, AGAIN (gone to different providers to get checked AGAIN). Tell me what you eat, drink and smoke 3days straight (fri-sat-sun) and I can give some people a diagnosis.

I bet if there was a copay, some would think twice about just "stopping by" for certain treatments.

I can give you hundreds of examples.

 

And please do not tell me to "educate" the patient about proper eating habits. Fortunately, I consider myself successful at educating a multitude of patients. The proactive ones.

[zepoPA]

I can't comment one way or another without seeing studies, but I trust your reporting of the abuse.

.

 

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well. Week after week, same patient, same story. Overindulging over the weekend AGAIN, then "stopping by" for GERD Sx. Entire GI tests are negative, AGAIN (gone to different providers to get checked AGAIN). Tell me what you eat, drink and smoke 3days straight (fri-sat-sun) and I can give some people a diagnosis.

I bet if there was a copay, some would think twice about just "stopping by" for certain treatments.

I can give you hundreds of examples.

 

And please do not tell me to "educate" the patient about proper eating habits. Fortunately, I consider myself successful at educating a multitude of patients. The proactive ones.

[zepoPA]

I can't comment one way or another without seeing studies, but I trust your reporting of the abuse.

.

 

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well. Week after week, same patient, same story. Overindulging over the weekend AGAIN, then "stopping by" for GERD Sx. Entire GI tests are negative, AGAIN (gone to different providers to get checked AGAIN). Tell me what you eat, drink and smoke 3days straight (fri-sat-sun) and I can give some people a diagnosis.

I bet if there was a copay, some would think twice about just "stopping by" for certain treatments.

I can give you hundreds of examples.

 

And please do not tell me to "educate" the patient about proper eating habits. Fortunately, I consider myself successful at educating a multitude of patients. The proactive ones.

[rcdavis]

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well. Week after week, same patient, same story. Overindulging over the weekend AGAIN, then "stopping by" for GERD Sx. Entire GI tests are negative, AGAIN (gone to different providers to get checked AGAIN). Tell me what you eat, drink and smoke 3days straight (fri-sat-sun) and I can give some people a diagnosis.

I bet if there was a copay, some would think twice about just "stopping by" for certain treatments.

I can give you hundreds of examples.

 

And please do not tell me to "educate" the patient about proper eating habits. Fortunately, I consider myself successful at educating a multitude of patients. The proactive ones.

 

You, and most of the seasoned PAs above are making salient points about the well recognized abuse of the program. What the study shows is, even with the abuse of almost unfettered access, HAVING MEDICAID LEADS TO NO IMPROVEMENT in medical outcomes ( with some minor exceptions).

 

This correlates to our clinical impressions.

 

Hence my suggestion that we drop it. Stop it, stop funding it. If it ain't improving or fixing anything, why pay for it?

 

All it seems to be doing is enforcing the entitlement class, and continuing the absolution of any sense of personal accountability or responsibility in health care.

 

Where oh where is physassist and the policy makers on this seeming refutation that free health care improves health?

[rcdavis]

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well. Week after week, same patient, same story. Overindulging over the weekend AGAIN, then "stopping by" for GERD Sx. Entire GI tests are negative, AGAIN (gone to different providers to get checked AGAIN). Tell me what you eat, drink and smoke 3days straight (fri-sat-sun) and I can give some people a diagnosis.

I bet if there was a copay, some would think twice about just "stopping by" for certain treatments.

I can give you hundreds of examples.

 

And please do not tell me to "educate" the patient about proper eating habits. Fortunately, I consider myself successful at educating a multitude of patients. The proactive ones.

 

You, and most of the seasoned PAs above are making salient points about the well recognized abuse of the program. What the study shows is, even with the abuse of almost unfettered access, HAVING MEDICAID LEADS TO NO IMPROVEMENT in medical outcomes ( with some minor exceptions).

 

This correlates to our clinical impressions.

 

Hence my suggestion that we drop it. Stop it, stop funding it. If it ain't improving or fixing anything, why pay for it?

 

All it seems to be doing is enforcing the entitlement class, and continuing the absolution of any sense of personal accountability or responsibility in health care.

 

Where oh where is physassist and the policy makers on this seeming refutation that free health care improves health?

[rcdavis]

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well. Week after week, same patient, same story. Overindulging over the weekend AGAIN, then "stopping by" for GERD Sx. Entire GI tests are negative, AGAIN (gone to different providers to get checked AGAIN). Tell me what you eat, drink and smoke 3days straight (fri-sat-sun) and I can give some people a diagnosis.

I bet if there was a copay, some would think twice about just "stopping by" for certain treatments.

I can give you hundreds of examples.

 

And please do not tell me to "educate" the patient about proper eating habits. Fortunately, I consider myself successful at educating a multitude of patients. The proactive ones.

 

You, and most of the seasoned PAs above are making salient points about the well recognized abuse of the program. What the study shows is, even with the abuse of almost unfettered access, HAVING MEDICAID LEADS TO NO IMPROVEMENT in medical outcomes ( with some minor exceptions).

 

This correlates to our clinical impressions.

 

Hence my suggestion that we drop it. Stop it, stop funding it. If it ain't improving or fixing anything, why pay for it?

 

All it seems to be doing is enforcing the entitlement class, and continuing the absolution of any sense of personal accountability or responsibility in health care.

 

Where oh where is physassist and the policy makers on this seeming refutation that free health care improves health?

[Guest Paula]

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well.

I can give you hundreds of examples.

 

I agree. There is abuse in other programs too where patients of a certain group are deemed by the government to have free access to health care. The free care is abused and if patients were required to pay a co-pay for services and medication, there would be a whole lot more money to run the clinic I work at. Patients do not get better with the recurrent visits. What can a clinic do when a patient visits the ER every other day for abdominal pain and the government still pays for the tests and does not hold the patient responsible for payment? I have had the same thought as rcdavis about doing away with medicaid or at least institute a nationwide co-pay for tests, visits, drugs, etc

[Guest Paula]

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well.

I can give you hundreds of examples.

 

I agree. There is abuse in other programs too where patients of a certain group are deemed by the government to have free access to health care. The free care is abused and if patients were required to pay a co-pay for services and medication, there would be a whole lot more money to run the clinic I work at. Patients do not get better with the recurrent visits. What can a clinic do when a patient visits the ER every other day for abdominal pain and the government still pays for the tests and does not hold the patient responsible for payment? I have had the same thought as rcdavis about doing away with medicaid or at least institute a nationwide co-pay for tests, visits, drugs, etc

[Guest Paula]

It would take you 2 weeks of clinical practice to realize that you need no research studies to learn what truly happens in terms of abuse. In 19 years of practice I am yet to change my mind about this subject. There is abuse... Not only at ED level, but in primary care as well.

I can give you hundreds of examples.

 

I agree. There is abuse in other programs too where patients of a certain group are deemed by the government to have free access to health care. The free care is abused and if patients were required to pay a co-pay for services and medication, there would be a whole lot more money to run the clinic I work at. Patients do not get better with the recurrent visits. What can a clinic do when a patient visits the ER every other day for abdominal pain and the government still pays for the tests and does not hold the patient responsible for payment? I have had the same thought as rcdavis about doing away with medicaid or at least institute a nationwide co-pay for tests, visits, drugs, etc

[myironlung]

this is a little off topic but what is keystone mercy? is this medicaid? My real question is how much do patients who have keystone mercy as "insurance" actually pay out of their own pocket? is it completely free? I tried checking out their website but it doesn't get into specifics.

[myironlung]

this is a little off topic but what is keystone mercy? is this medicaid? My real question is how much do patients who have keystone mercy as "insurance" actually pay out of their own pocket? is it completely free? I tried checking out their website but it doesn't get into specifics.

[myironlung]

this is a little off topic but what is keystone mercy? is this medicaid? My real question is how much do patients who have keystone mercy as "insurance" actually pay out of their own pocket? is it completely free? I tried checking out their website but it doesn't get into specifics.

[physasst]

Let's see....here's the paper. Several thoughts come to mind. First, there was a reduction in positive screening tests for depression, which was noted to be the most prevalent of the 4 illnesses studied. Secondly, there was a reduction in financial strain. Finally, there was a greater probability of being diagnosed with diabetes and being treated with a medication for diabetes. All are positive indicators. Notwithstanding that these are good things in and of themselves, let's look at this study...

 

Also, when you actually look at individual level data within the cohort, there was significant improvement in some individuals, but not in the group as a whole. This study is rather limited and I think therefore that generalizability is somewhat hampered by that. The number of patients with these conditions was somewhat small within the study population and they limited data collection to the Portland, OR MSA. This is an important study, but it's hard to draw far reaching conclusions, unless you just wish to have confirmational bias.

 

I would also add a note about their findings. Statistically, there were not significant differences, but its important to remember that that DOES NOT mean that there were not differences. In fact, in reviewing the data, the patients on Medicaid all exhibited a trend towards improvement over the uninsured group. For example, there was a reduction in elevated blood pressure of -1.33% in the Medicaid group when compared to the control, but the difference wasn't statistically significant. Also, there was an increase in the diagnosis of HTN of 1.76% when compared to control, a reduction in high total level of cholesterol of -2.43%, a reduction in glycated hgb of >/= to 6.5 of 0.93%, and an increase in medication for depression of 5.49%.

 

While these weren't statistically significant, they did show a trend towards better diagnosis and disease control. Another limitation of this study was the limited time frame. One year. There are funding constraints I understand, but this study doesn't definitively "prove" anything, it's more exploratory in nature.

 

It's important, and it's needed data, but we need a larger, longer term study using multiple MSAs and it likely needs to have 3 arms. 1. New Medicaid enrollees 2. Uninsured 3. New enrollees to commercial insurance. And, if we can't do that, than at the very least, this study needs to be validated by replicating the study in a different MSA.

 

http://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articleTop

 

It's also important to remember the patients that are generally enrolled in Medicaid. One of the studies presented this past week reminded us of how hard it was for many of these patients to even get rides to the doctor. Many of them missed appointments because they couldn't get rides. One lady was very poor, disabled, and on Medicaid. She would call to get a transport van to pick her up for her physician appointments. She would call the night before. She would wait for hours, and they were usually late. She would get to the doctors, and they would tell her she had to reschedule because she missed her appointment 30 minutes ago. She would wait for another 2 hours to get a ride home. She would be unable to fill her diabetic meds and would end up in the ED. I used to think of many of these people as "abusers"....and some are, no doubt about it, but many are not. Many cannot even get a primary care, and those that can often have limited appointments and access. We ration care in the US..those that have money and good insurance get good access (not really good care, but that's a whole nother discussion), but if you are uninsured, on Medicaid, and/or don't have money.....good luck. There are a number of other issues here...but that's some late thoughts.....(IOW, I've been working on a grant all day and my mind is mush).....

[physasst]

Let's see....here's the paper. Several thoughts come to mind. First, there was a reduction in positive screening tests for depression, which was noted to be the most prevalent of the 4 illnesses studied. Secondly, there was a reduction in financial strain. Finally, there was a greater probability of being diagnosed with diabetes and being treated with a medication for diabetes. All are positive indicators. Notwithstanding that these are good things in and of themselves, let's look at this study...

 

Also, when you actually look at individual level data within the cohort, there was significant improvement in some individuals, but not in the group as a whole. This study is rather limited and I think therefore that generalizability is somewhat hampered by that. The number of patients with these conditions was somewhat small within the study population and they limited data collection to the Portland, OR MSA. This is an important study, but it's hard to draw far reaching conclusions, unless you just wish to have confirmational bias.

 

I would also add a note about their findings. Statistically, there were not significant differences, but its important to remember that that DOES NOT mean that there were not differences. In fact, in reviewing the data, the patients on Medicaid all exhibited a trend towards improvement over the uninsured group. For example, there was a reduction in elevated blood pressure of -1.33% in the Medicaid group when compared to the control, but the difference wasn't statistically significant. Also, there was an increase in the diagnosis of HTN of 1.76% when compared to control, a reduction in high total level of cholesterol of -2.43%, a reduction in glycated hgb of >/= to 6.5 of 0.93%, and an increase in medication for depression of 5.49%.

 

While these weren't statistically significant, they did show a trend towards better diagnosis and disease control. Another limitation of this study was the limited time frame. One year. There are funding constraints I understand, but this study doesn't definitively "prove" anything, it's more exploratory in nature.

 

It's important, and it's needed data, but we need a larger, longer term study using multiple MSAs and it likely needs to have 3 arms. 1. New Medicaid enrollees 2. Uninsured 3. New enrollees to commercial insurance. And, if we can't do that, than at the very least, this study needs to be validated by replicating the study in a different MSA.

 

http://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articleTop

 

It's also important to remember the patients that are generally enrolled in Medicaid. One of the studies presented this past week reminded us of how hard it was for many of these patients to even get rides to the doctor. Many of them missed appointments because they couldn't get rides. One lady was very poor, disabled, and on Medicaid. She would call to get a transport van to pick her up for her physician appointments. She would call the night before. She would wait for hours, and they were usually late. She would get to the doctors, and they would tell her she had to reschedule because she missed her appointment 30 minutes ago. She would wait for another 2 hours to get a ride home. She would be unable to fill her diabetic meds and would end up in the ED. I used to think of many of these people as "abusers"....and some are, no doubt about it, but many are not. Many cannot even get a primary care, and those that can often have limited appointments and access. We ration care in the US..those that have money and good insurance get good access (not really good care, but that's a whole nother discussion), but if you are uninsured, on Medicaid, and/or don't have money.....good luck. There are a number of other issues here...but that's some late thoughts.....(IOW, I've been working on a grant all day and my mind is mush).....

[physasst]

Let's see....here's the paper. Several thoughts come to mind. First, there was a reduction in positive screening tests for depression, which was noted to be the most prevalent of the 4 illnesses studied. Secondly, there was a reduction in financial strain. Finally, there was a greater probability of being diagnosed with diabetes and being treated with a medication for diabetes. All are positive indicators. Notwithstanding that these are good things in and of themselves, let's look at this study...

 

Also, when you actually look at individual level data within the cohort, there was significant improvement in some individuals, but not in the group as a whole. This study is rather limited and I think therefore that generalizability is somewhat hampered by that. The number of patients with these conditions was somewhat small within the study population and they limited data collection to the Portland, OR MSA. This is an important study, but it's hard to draw far reaching conclusions, unless you just wish to have confirmational bias.

 

I would also add a note about their findings. Statistically, there were not significant differences, but its important to remember that that DOES NOT mean that there were not differences. In fact, in reviewing the data, the patients on Medicaid all exhibited a trend towards improvement over the uninsured group. For example, there was a reduction in elevated blood pressure of -1.33% in the Medicaid group when compared to the control, but the difference wasn't statistically significant. Also, there was an increase in the diagnosis of HTN of 1.76% when compared to control, a reduction in high total level of cholesterol of -2.43%, a reduction in glycated hgb of >/= to 6.5 of 0.93%, and an increase in medication for depression of 5.49%.

 

While these weren't statistically significant, they did show a trend towards better diagnosis and disease control. Another limitation of this study was the limited time frame. One year. There are funding constraints I understand, but this study doesn't definitively "prove" anything, it's more exploratory in nature.

 

It's important, and it's needed data, but we need a larger, longer term study using multiple MSAs and it likely needs to have 3 arms. 1. New Medicaid enrollees 2. Uninsured 3. New enrollees to commercial insurance. And, if we can't do that, than at the very least, this study needs to be validated by replicating the study in a different MSA.

 

http://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articleTop

 

It's also important to remember the patients that are generally enrolled in Medicaid. One of the studies presented this past week reminded us of how hard it was for many of these patients to even get rides to the doctor. Many of them missed appointments because they couldn't get rides. One lady was very poor, disabled, and on Medicaid. She would call to get a transport van to pick her up for her physician appointments. She would call the night before. She would wait for hours, and they were usually late. She would get to the doctors, and they would tell her she had to reschedule because she missed her appointment 30 minutes ago. She would wait for another 2 hours to get a ride home. She would be unable to fill her diabetic meds and would end up in the ED. I used to think of many of these people as "abusers"....and some are, no doubt about it, but many are not. Many cannot even get a primary care, and those that can often have limited appointments and access. We ration care in the US..those that have money and good insurance get good access (not really good care, but that's a whole nother discussion), but if you are uninsured, on Medicaid, and/or don't have money.....good luck. There are a number of other issues here...but that's some late thoughts.....(IOW, I've been working on a grant all day and my mind is mush).....

[EMEDPA]

there is also the issue of setting priorities and personal responsibility...if you smoke 2 packs/day and have an ipad4 don't tell me you don't have a dollar for a pregnancy test or 4 dollars for 1 month of atenolol.

[EMEDPA]

there is also the issue of setting priorities and personal responsibility...if you smoke 2 packs/day and have an ipad4 don't tell me you don't have a dollar for a pregnancy test or 4 dollars for 1 month of atenolol.