Thursday, Mar 22, 2018
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Money and health

A direct link between income and health should promote a greater focus on preventive care

Given the direct link between income and general health, it’s no surprise that Medicaid patients arrive at hospitals sicker than patients with private plans, who are either well off or at least gainfully employed. Previous medical care, nutrition, eating habits, smoking rates, and other conditions generally correlate with how much a patient earns.

Researchers at the University of Michigan, in a study published this month in the journal JAMA Surgery, found that Medicaid-covered surgical patients were in worse health, endured more complications, stayed in the hospital longer, and were more likely to come back. They also were twice as likely to smoke.

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For all those reasons, Medicaid patients cost more to treat. The study found that these patients had more emergency operations and used 50 percent more resources than patients with other kinds of insurance. Considering that the Medicaid patients were younger, the findings were even more stark.

The UM study underscores not only the importance of the Affordable Care Act in expanding coverage, but also the need for changes in how hospitals deliver care. It should also concern the federal government, which aids hospitals that serve large numbers of Medicaid patients and promotes preventive health measures.

Hospitals usually don’t recover the total cost of patient care from Medicaid. As millions of uninsured people become eligible to enroll in Medicaid programs that 26 states, including Ohio and Michigan, have expanded under the Affordable Care Act, hospitals that treat large numbers of Medicaid patients will face rising costs and financial pressures.

Americans spend nearly $3 trillion a year on health care — 17 percent of the U.S. economy — and overall costs will continue to rise. Some of those increases are natural, even healthy, as newly covered patients get treated for conditions that went untreated when they had no insurance. The Affordable Care Act aims to cover 30 million uninsured Americans.

It’s important that hospitals treating most of the nation’s Medicaid patients, many of them in urban areas such as Toledo, remain financially stable. In the UM study, more than 61 percent of all Medicaid-funded operations were done at just 20 of the 52 hospitals surveyed.

Such hospitals now get payments from the federal government under the Disproportionate Share Hospital program — payments that are scheduled to decline. At a minimum, the Obama Administration must monitor the finances of hospitals with high numbers of Medicaid patients to determine whether added support is warranted.

But hospitals can help themselves as well. They can, as UM researchers point out, more aggressively treat problems and conditions, including smoking and high blood-sugar levels, before surgical operations. Doing so would help to avoid later complications, such as infections and pneumonia.

U.S. medical care is by far the costliest in the world, but Americans are not the healthiest people: The United States is the only developed country with rising maternal mortality rates. The UM report underscores the importance of preventive care and healthy living in holding down health-care costs and alleviating disorders such as lung disease, diabetes, and blood-vessel blockages.

Smoking rates now correlate with income. They don’t need to, if hospitals and governments made more of an effort to target anti-smoking messages and education at poor and working-class people.

With better medical care and healthier habits, the troubling gap between the health of low-income and affluent Americans can narrow, and overall medical costs can go down.

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