Insurance and Uninsured
People who reported their health status as "fair" or "poor" and had individual health insurance policies were less likely than their counterparts with small-group policies to become uninsured, according to a study published online by Health Affairs.
In addition, among workers in the poorest health who lost their jobs, those with small-group coverage were significantly more likely than those with individual coverage to become uninsured, the study found. However, overall, people with individual insurance were more likely than those with small- or large-group policies to lose coverage, according to the study. Uninsurance among people in average health was most likely if they had individual policies, less likely if they had small-group policies and least likely if they had large-group policies.
Researchers concluded that individual and group insurance each have advantages and disadvantages and that neither is absolutely preferable. In the short term, "leveling the tax playing field" between the individual and group markets could reduce retention problems for high-risk individuals, according to the study (Pauly/Lieberthal, Health Affairs, 5/6).
Although Medicaid beneficiaries use ED services more than other demographics, ED expenses represent a relatively small percentage of total Medicaid spending in Oregon's Medicaid program, according to a study in the Annals of Emergency Medicine.
Researchers found that monthly ED-associated expenditures averaged $12.63 per Medicaid beneficiary, representing 6.8% of total medical spending, and that ancillary services, such as laboratory tests and diagnostic imaging, made up 35% of ED costs. However, 50% of all ED utilization and spending was attributed to 3% of beneficiaries, approximately 16,000 people.
According to the study, cutting ED expenditures by 25% would lower total Medicaid spending by less than 2% annually. The authors concluded that the most effective way to lower ED spending might be through targeting beneficiaries with the highest utilization at the primary care level rather than measures that aim to reduce ED use among Medicaid beneficiaries (Handel et al., Annals of Emergency Medicine, May 2008).