Understanding Medicaid’s Effects on New Enrollees: A Qualitative Approach

In recent years, health policy practitioners have become increasingly reliant upon quantitative data, such as financial metrics and aggregated wellness data, to solve complex problems facing healthcare systems in the United States. However, quantitative healthcare research often lacks contextualized information that can help researchers form a more comprehensive understanding of why certain trends occur.

In a 2014 article, Heidi Allen, Bill Wright, and Katherine Baicker utilize an alternative methodological approach—one that emphasizes qualitative research—in order to better understand how newly insured individuals interact with the healthcare system. The study, consisting of new Medicaid enrollees in Oregon, finds that many participants used healthcare “infrequently” due to problems accessing and understanding the healthcare system. For participants using the healthcare system more frequently, researchers found that the most significant healthcare gains resulted from extended interactions with providers.

The 2011 study was conducted in Oregon, a state that expanded its Medicaid program in 2008. Researchers selected a random sample of 173 newly covered individuals, of whom 120 agreed to participate in the study. They then created a timeline of each patient’s healthcare history since acquiring Medicaid, encouraging interviewees to openly share their experiences and healthcare decisions.

The authors classified the results from the study into two distinct groups of newly insured individuals—those that “infrequently” utilized the healthcare system (40 percent) and those that use the healthcare system on a regular basis (60 percent). Individuals infrequently utilizing the healthcare system cited four general reasons for not visiting a provider: perception of good health (34 percent), confusion about coverage (30 percent), dissatisfaction with care (21 percent), and experiencing access barriers (15 percent). Crucially, the authors provide examples of respondents from each category to help draw out idiosyncrasies in healthcare usage.

For example, Jason, a 40-year-old man with chronic knee pain, chose not to see a provider about his problem because he was confused about the details of his coverage. He had previously read that his new healthcare insurance would cover only dental emergencies, not dental check-ups, and assumed that the same policy applied towards his knee injury when it did not.

For the 60 percent of newly insured participants who frequently used healthcare coverage, their responses indicated a variety of outcomes. About 10 percent of these individuals experienced an immediate improvement in health outcomes, often having delayed costly procedures until health insurance coverage could help mitigate the financial burden. For example, a 43-year-old woman named Gloria struggled with severe depression because of her sleep apnea. Using Medicaid, Gloria was able to receive treatment, making a positive impact on her quality of life, and stated that she “would have died” without health insurance.

44 percent of frequent users reported “mixed success” in terms of health outcomes. These individuals often cited an inability to construct a strong relationship with the healthcare provider or medical conditions that continued to deteriorate even with medical care.

Perhaps most importantly, the authors note that 39 percent of the frequent healthcare users reported “successful” experiences with the healthcare system, although it took an extended period of time. Respondents articulated the benefits of seeing the same physician on a regular basis in order to help enact more meaningful lifestyle changes to improve patient health. Markedly, of the respondents indicating successful experiences with the healthcare system after receiving Medicaid, 83 percent reported continuous coverage. In contrast, only 30 percent of the respondents reporting “mixed success” indicated stable insurance coverage, highlighting the importance of continuity of care to patients’ reported health outcomes.

Although policymakers must account for discrepancies in state-run Medicaid programs, this study presents a number of ideas that can be used to improve the effectiveness of healthcare programs such as Medicaid. The results indicate that individuals qualifying for Medicaid are likely to benefit from improved communication regarding the types of medical care that the insurance covers. Additionally, they suggest that incentivizing continuous relationships between new Medicaid patients and physicians can result in substantial improvements in health outcomes. This study also demonstrates how a more holistic understanding of patient interactions with the healthcare system, gained through the qualitative data approach, can enable policymakers to more accurately address problems and effectively improve health outcomes.

Article Source: Heidi Allen, Bill J. Wright, and Katherine Baicker, “New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges,” Health Affairs 33, No. 2 (Feb 2014): 292-99.

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