The Oregon Experiment — Effects of Medicaid on Clinical Outcomes
Open accessAbstract
BACKGROUND: Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects. METHODS: Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage. RESULTS: We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (-9.15 percentage points; 95% confidence interval, -16.70 to -1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures. CONCLUSIONS: This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.
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- Authors
- Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., Schneider, E. C., Wright, B. J., Zaslavsky, A. M., & Finkelstein, A. N.
- Affiliations
- National Bureau of Economic Research (US)
- Columbia University (US)
- RAND Corporation (US)
- Providence Portland Medical Center (US)
- Harvard University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2013-05-02
- Volume
- 368
- Issue
- 18
- Pages
- 1713-1722
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3701298
- OpenAlex
- W2102905683
- Cited by
- 1,150
- References
- 14
- Citations by year
- 2026: 49 · 2025: 53 · 2024: 68 · 2023: 55 · 2022: 80 · 2021: 70 · 2020: 112 · 2019: 97 · 2018: 103 · 2017: 115 · 2016: 108 · 2015: 100 · 2014: 91 · 2013: 43 · 2012: 3
- FWCI
- 267.61
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- DSpace@MIT (Massachusetts Institute of Technology) (submittedVersion, cc-by-nc-sa)
- Radboud Repository (Radboud University) (submittedVersion)
- PMC
- Funders
- National Institutes of Health (RC2AGO36631)
- National Institute on Aging (RC2AG036631, R01AG0345151, R01AG034151, P30AG012810)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- Medicaid expansion, Medicaid coverage, health outcomes, diabetes diagnosis, HbA1c, hypertension, cholesterol, depression screening, preventive medicine, out-of-pocket medical expenditure, health care utilization, low-income adults, health insurance
- MeSH terms
- Adult, Depressive Disorder, Diabetes Mellitus, Health Services, Health Status, Glycated Hemoglobin, Humans, Hypercholesterolemia, Hypertension, Medicaid, Middle Aged, Oregon, United States, Prevalence, Health Care Costs, Insurance Coverage, Young Adult
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