The Effect Of Medicaid On Medication Use Among Poor Adults: Evidence From Oregon.
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ABSTRACT:
SUBMITTER: Baicker K
PROVIDER: S-EPMC5739033 | biostudies-literature | 2017 Dec
REPOSITORIES: biostudies-literature
Publications
The Effect Of Medicaid On Medication Use Among Poor Adults: Evidence From Oregon.
Baicker Katherine K Allen Heidi L HL Wright Bill J BJ Finkelstein Amy N AN
Health affairs (Project Hope) 20171201 12
Oregon's 2008 Medicaid expansion significantly increased the use of prescription medications in 2009-10. ...[more]
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Project description:ObjectiveTo evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations.Data sourcesPrimary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery.Study designWe used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care.Data collectionData were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N = 24,646).Principal findingsMedicaid coverage significantly reduced the share of respondents who reported needing dental care (-9.8 percentage points, p < .001) or having unmet dental care needs (-13.5 percentage points, p < 0.001). Medicaid doubled the share visiting the ED for dental care (+2.6 percentage points, p = .003) and the use of anti-infective medications often prescribed for dental care, but it had no detectable effect on uncovered dental care or out-of-pocket spending.ConclusionsExpansion of Medicaid covering emergency dental care substantially reduced unmet need for dental care, increasing ED dental visits and medication use, while not changing patient use of uncovered dental services.
| S-EPMC6052006 | biostudies-literature
Project description:In Oregon, more than 4 in 5 pregnant women who smoke are covered by Medicaid. Although birth certificate data for smoking during pregnancy are not accessible in a timely manner, Medicaid claims data are available monthly and provide person-level data. This study utilized an individually linked database of Medicaid claims and birth certificate data to compare the prevalence of tobacco use diagnosis codes in Medicaid claims data to self-reported smoking during pregnancy reported on birth certificates. We computed the sensitivity and specificity of Medicaid claims data to ascertain tobacco use during pregnancy compared to self-report on linked birth certificates. Using logistic regression models, we also examined demographic, prenatal care, and behavioral health factors that predicted agreement between claims and birth certificates. From 2008 to 2013, 17.9% of women with Medicaid births reported smoking during pregnancy on birth certificates compared to 3.8% of non-Medicaid births. Tobacco-related claims during pregnancy were present for 12.6% of Medicaid births. Overall agreement between claims and birth certificates rose from 87.0% in 2008 to 90.2% in 2013; sensitivity rose from 43.0% to 62.2%. Sensitivity was lowest for Hispanic women and highest for White women, and declined as maternal education increased. Sensitivity was 33.9 percentage points higher for women with any mental illness diagnosis and 27.3 percentage points higher for women with any substance use disorder diagnosis. Specificity was greater than 95% in all years. Medicaid claims data may help in surveillance of maternal smoking rates and assessment of smoking cessation programs for female Medicaid beneficiaries of reproductive age.
| S-EPMC7229484 | biostudies-literature
Project description:In 2008, a group of uninsured low-income adults in Oregon was selected by lottery for the chance to apply for Medicaid. Using this randomized design and state administrative data on voter behavior, we analyze how a Medicaid expansion affected voter turnout and registration. We find that Medicaid increased voter turnout in the November 2008 Presidential election by about 7 percent overall, with the effects concentrated in men (18 percent increase) and in residents of Democratic counties (10 percent increase); there is suggestive evidence that the increase in voting reflected new voter registrations, rather than increased turnout among pre-existing registrants. There is no evidence of an increase in voter turnout in subsequent elections, up to and including the November 2010 midterm election.
| S-EPMC8021132 | biostudies-literature
Project description:Importance:Reducing unintended pregnancy is a national public health priority. Incentive metrics are increasingly used by health systems to improve health outcomes and reduce costs, but limited data exist on the association of incentive metrics with contraceptive use. Objective:To evaluate whether an association exists between implementing an incentive metric and effective contraceptive use within the Oregon Medicaid program. Design, Setting, and Participants:In this state-level, claims-based cohort study, a comparative interrupted time series design was used to evaluate whether the implementation of an effective contraceptive use incentive metric on January 1, 2015, was associated with changes in contraceptive use among Oregon Medicaid adult enrollees when compared with commercially insured women. The participants were adult women at risk of pregnancy (18-50 years of age) living in Oregon from January 1, 2012, through December 31, 2017, and enrolled in Medicaid (532?337 person-years) or in commercial health insurance (1?131?738 person-years). Exposure:Implementation of an effective contraceptive use incentive metric as defined using the 2019 Oregon Health Authority specifications. Main Outcomes and Measures:International Classification of Diseases, Ninth Revision codes; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes; and Current Procedural Terminology codes were used to identify contraceptive use. Annual rates of effective contraceptive use were measured through health insurance claims. Results:The final analyses included 532?337 Medicaid person-years and 1?131?738 privately insured person-years. Women enrolled in Medicaid were younger than those with private insurance (47.5% vs 33.2% of women in 2013 younger than 30 years), and approximately 40% of Medicaid enrollees (vs fewer than 10% of women with private insurance) resided in rural locations. Demographic characteristics within each group remained similar before and after the incentive metric was implemented. In the comparative interrupted time series model, relative to the commercially insured comparison group, effective contraceptive use among Medicaid enrollees for all ages combined increased 3.6% (95% CI, 3.1%-4.1%) 1 year after the start of the incentive metric, 7.5% (95% CI, 6.8%-8.2%) at the end of 2 years, and 11.5% (95% CI, 10.5%-12.4%) at the end of 3 years. Prior to the introduction of the incentive, contraceptive use rates among the youngest cohort of Medicaid enrollees (18-24 years of age) were decreasing; following the introduction of the incentive, contraceptive use increased steadily among all enrollees. Among women aged 18 to 24 years, the effective contraceptive use rate increased 16.5 percentage points (95% CI, 14.4-18.6 percentage points) after 3 years. The largest initial increase in contraceptive use was among women enrolled in Medicaid who were 30 to 34 years of age (4.9%; 95% CI, 3.4%-6.3%). Conclusions and Relevance:Implementation of the effective contraceptive use incentive metric was associated with a significant increase in contraceptive use among Medicaid enrollees relative to a commercially insured comparison group. This finding is relevant given national efforts aimed at adopting a similar metric for widespread use.
| S-EPMC7407076 | biostudies-literature
Project description:BackgroundThe study examined the association of the Affordable Care Act's 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients.MethodsLogistic regression analysis examined utilization of care before (January 1, 2010-December 31, 2013) and after Medicaid expansion in Oregon (January 1, 2014-December 31, 2016).ResultsAdult membership in the Oregon Health Plan (Medicaid) increased 180% following Medicaid expansion (2013 = 172,539; 2014 = 482,081) and the number with a diagnosis of OUD nearly doubled (2013 = 6808; 2014 = 13,418). More individuals received psychosocial services (2013 = 4714; 2014 = 8781) and medications (2013 = 3464; 2014 = 6093) for opioid use disorder. The percent of patients receiving psychosocial services (69% to 65%) and the percent of individuals receiving pharmacotherapy (57% to 45%) declined primarily because of a decline in the proportion receiving care in an opioid treatment program (2013 = 41%; 2014 = 33%). Odds of accessing any psychosocial service increased by 8% per year from 2010 to 2013 (AOR = 1.08; 95% CI 1.06-1.11) with an 18% immediate decline associated with Medicaid expansion in 2014 (AOR = 0.82; 95% CI 0.76-0.87). Following Medicaid expansion, the odds of accessing psychosocial services increased 8% per year (2014 through 2016) (AOR = 1.08; 95% CI 1.06-1.11). Use of medications for opioid use disorder found no change in the odds of use in the years prior to Medicaid expansion, an immediate 36% (AOR = 0.64; 95% CI 0.60-0.68) decline in 2014, and a 13% increase per year in 2015 and 2016 (AOR = 1.13; 95% CI 1.09-1.16).ConclusionThe number of Medicaid recipients with an opioid use disorder who received psychosocial and pharmacological services increased substantially following Oregon's Medicaid expansion in 2014. There was a decline, however, in the proportion of individuals with an opioid use disorder receiving care in opioid treatment programs.
| S-EPMC6694675 | biostudies-literature
Project description:Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for context. We examine health care access and use, personal finances, and self-reported health. While urban and rural populations have unique demographic profiles, rural populations appear to have benefited from Medicaid as much as urban. Qualitative interviews revealed the distinctive challenges still facing low-income uninsured and newly insured rural populations.
| S-EPMC5726939 | biostudies-other
Project description: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.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.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.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.
| S-EPMC3701298 | biostudies-literature
Project description:In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance. Oregon's randomized Medicaid expansion for adults, known as the Oregon Experiment, created a rare opportunity to assess causality between parent and child coverage.To estimate the effect on a child's health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage.Oregon Experiment randomized natural experiment assessing the results of Oregon's 2008 Medicaid expansion. We used generalized estimating equation models to examine the longitudinal effect of a parent randomly selected to apply for Medicaid on their child's Medicaid or Children's Health Insurance Program (CHIP) coverage (intent-to-treat analyses). We used per-protocol analyses to understand the impact on children's coverage when a parent was randomly selected to apply for and obtained Medicaid. Participants included 14409 children aged 2 to 18 years whose parents participated in the Oregon Experiment.For intent-to-treat analyses, the date a parent was selected to apply for Medicaid was considered the date the child was exposed to the intervention. In per-protocol analyses, exposure was defined as whether a selected parent obtained Medicaid.Children's Medicaid or CHIP coverage, assessed monthly and in 6-month intervals relative to their parent's selection date.In the immediate period after selection, children whose parents were selected to apply significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a nonsignificant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent's selection compared with children whose parents were not selected (adjusted odds ratio [AOR]=1.18; 95% CI, 1.10-1.27). The effect remained significant during months 7 to 12 (AOR=1.11; 95% CI, 1.03-1.19); months 13 to 18 showed a positive but not significant effect (AOR=1.07; 95% CI, 0.99-1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage (AOR=2.37; 95% CI, 2.14-2.64).Children's odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents' access to Medicaid coverage and their children's coverage.
| S-EPMC4918752 | biostudies-other
Project description:Hypertensive disorders occur in approximately 6% to 8% of all pregnancies and are a significant source of maternal and fetal morbidity. Little is known about the range of agents routinely used in practice. We used Medicaid claims from 2000 to 2007 to identify completed pregnancies. We included women who were Medicaid beneficiaries from at least 3 months prior to last menstrual period to 1 month postdelivery, and were successfully linked to infant records. Maternal exposure to antihypertensive medications was derived from Medicaid pharmacy claim files, and duration of exposure was assigned based on the days' supply dispensed. We identified 1,106,757 Medicaid patients in our cohort, of whom 48,453 (4.4%) were exposed to antihypertensive medications during pregnancy. The prevalence of antihypertensive use increased from 3.5% to 4.9% during the study period. Antihypertensive medication users were older than nonusers, more likely to be white or black, and more likely to have comorbid diabetes mellitus and renal disease. Overall, 1.9% of pregnant women were exposed during the first trimester, 1.7% during the second trimester, and 3.2% during the third trimester. The range of antihypertensive medications to which patients were exposed was highly heterogeneous and frequently included agents other than methyldopa or labetalol. Angiotensin-converting enzyme inhibitor exposure, which is contraindicated in late pregnancy, occurred in 928 (4.9%) antihypertensive medication users in the second trimester and 383 (1.1%) in the third trimester. Antihypertensive use during pregnancy is relatively common and increasing. The wide range of agents used during pregnancy includes medications considered contraindicated during pregnancy.
| S-EPMC3501756 | biostudies-literature
Project description:We sought to measure population-level adherence to antihyperlipidemics, antihypertensives, and oral hypoglycemics, and to develop a model for early identification of subjects at high risk of long-term poor adherence.Prescription-filling data for 2 million subjects derived from a payor's insurance claims were used to evaluate adherence to three chronic drugs over 1 year. We relied on patterns of prescription fills, including the length of gaps in medication possession, to measure adherence among subjects and to build models for predicting poor long-term adherence.All prescription fills for a specific drug were sequenced chronologically into drug eras. 61.3% to 66.5% of the prescription patterns contained medication gaps >30 days during the first year of drug use. These interrupted drug eras include long-term discontinuations, where the subject never again filled a prescription for any drug in that category in the dataset, which represent 23.7% to 29.1% of all drug eras. Among the prescription-filling patterns without large medication gaps, 0.8% to 1.3% exhibited long-term poor adherence. Our models identified these subjects as early as 60 days after the first prescription fill, with an area under the curve (AUC) of 0.81. Model performance improved as the predictions were made at later time-points, with AUC values increasing to 0.93 at the 120-day time-point.Dispensed medication histories (widely available in real time) are useful for alerting providers about poorly adherent patients and those who will be non-adherent several months later. Efforts to use these data in point of care and decision support facilitating patient are warranted.
| S-EPMC3384104 | biostudies-literature