This week: Oregon Medicaid Expansion and a systematic review of anti-influenza medications.
Janice and Amol want you to:
1. Understand the effect of health care coverage expansion on health care utilization.
2. Understand the utility of randomized control trials in the formulation of causal inferences.
3. Recognize that anti-influenza antiviral medications appear to cause only a minor reduction in the duration of symptoms
4. Understand how access to clinical study reports might enhance transparency in clinical trials and improve health policy decisions
Continuing Medical Education
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The papers
Sarah L. Taubman et al. Medicaid Increases Emergency-Department Use: Evidence from Oregon’s Health Insurance Experiment. Science. 17 January 2014: Vol. 343 no. 6168 pp. 263-26. (PubMed).
Good stuff
Janice – Urban HEART @Toronto. Toronto Community Health Profiles.
Amol (thanks to Andreas Laupacis for the tip) – Sunshine List 2014: Ontario’s list drives salaries up, not down. Kazi Stastna. CBC News. April 1, 2014.
Very interesting episode. I think the medicaid expansion findings are indeed interesting – they’re very much in line with the experiences of my colleagues in family medicine who have taken patients from Ontario’s Health Care Connect program – often these patients haven’t had primary care in decades, so they arrive at their new family doctor’s office with multiple medical issues, often involving multiple chronic conditions. As a result, my colleagues frequently need to see these patients weekly, and their medical complexity means that it can take years before meaningful improvements in measurable outcomes can be obtained. They also note that since these patients are often of lower socioeconomic status, the social determinants of health continue to exert their influence, further impeding improvement in measurable health status.
Thanks for your thoughtful comments, Jeremy. It will be interesting to follow this cohort over time to see if, and if so, how their health outcomes change over time. The jury appears to be out still on this fascinating question of substantial policy gravitas.