May 8, 2013

Does Access Improve Outcome?

One of the reasons frequently given for starting an on-site clinic these days is access.  Employees complain that they just can’t find adequate primary care services.   And, it’s true, there does seem to be a shortage of family and internal medicine physicians these days (to say nothing of peds and ob/gyns).  If not a shortage, then certainly a problem with distribution.

Now, we have the Affordable Care Act expanding coverage to all of us; this should, hopefully, improve outcomes – right?  Since more people will have insurance?  Well, think again.  A study was done in Oregon (the perfect place,   home of rationing medical care) and published in the New England Journal of Medicine, regarding the change in status of those who had been put on Medicaid during 2008 (through a lottery system) and those who weren’t covered.

I’m thinking, great, there should be significant differences in outcome because now these people who couldn’t see a physician due to cost barriers can now do so.  Well, not so fast, Charlie!

The study report demonstrated that there was no real difference in the incidence of diagnosed conditions between the lottery winners and the “losers.”  Not at all what we expected.  The coverage, however, “. . . almost completely eliminated catastrophic out-of-pocket medical expenditures.”  So, costs to the patient went down, but increased detection of illness remained unchanged.  The conclusion was that access alone (free of significant financial barriers), doesn’t improve care or outcomes; that requires a much more comprehensive system in place.  To quote, ” Better results will likely require more aggressive community outreach, disease management and coordination of care by hospitals and doctors.”  OR-the very things that on-site clinics do and have done, best.

Sorry to burst any bubbles out there.  For those of us who thought expansion of coverage would make a huge difference and drive down costs, it may not be the panacea we want because it lacks the “legs” required and available in an onsite to achieve that success.

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Filed Under: General, Opinion

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