Recently I came across a magazine insert advertising real estate services. It listed all sorts of benefits of home ownership, including things like the fact that children of homeowners were more likely to graduate from high school – and less likely to become teen parents – than the children of renters. It struck me as funny, given how obvious it was that those “benefits” were simply correlations, with no clear cause-and-effect. I came across an article at The Incidental Economist that does a great job of reminding readers to not confuse correlation with causation. Austen Frakt digs into several studies regarding health outcomes for Medicaid patients. Although it’s widely known that Medicaid patients have generally worse outcomes than people with private health insurance or Medicare, Frakt notes that none of the studies cite Medicaid coverage itself as a cause of the poor outcomes. Rather, being a Medicaid patient is associated with worse outcomes, but the actual factors driving those outcomes are not completely understood.
Coincidentally, another article written by Avik Roy, addresses a specific aspect of Medicaid coverage that may help to explain part of why Medicaid patients tend to have worse health outcomes than people with Medicare or private health insurance. Roy has created a graph showing how much harder it is to find a doctor who will see you if you’re on Medicaid. A couple years ago, I mentioned that our son’s doctor was able to fit him in the day after I called to schedule a well-child check. But when I called back and asked about an appointment for a new patient on Medicaid, I was told that the doctor only takes a limited number of Medicaid patients, and that they would have to get back to me. Roy’s article makes it clear that this is not uncommon: finding a doctor who will see you isn’t nearly as easy if you’re on Medicaid. It’s understandable that doctor’s aren’t clamoring to take on new Medicaid patients, given how little Medicaid pays when compared with other insurers. But the shortage of doctors who will accept new Medicaid patients could definitely be seen as a significant obstacle to receiving care for people who rely on Medicaid to cover their healthcare costs. It’s likely that there is a long list of reasons why people on Medicaid have poorer health outcomes (and we have to be careful to not mistake correlation with causation). But it’s reasonable to assume that the difficulty Medicaid patients experience in finding a doctor isn’t doing anything to improve their health outcomes.