Thursday, May 09, 2013

Government health insurance does not make you healthier

The surprising results of the study below suggest immediately  some methodological flaw -- a confounding with social class, for instance.  But the study is in fact high quality.  The random assignment into the two groups from a large general population body wipes out such doubts pretty thoroughly.  The results are therefore highly generalizable, unlike most medical research
The Oregon Experiment — Effects of Medicaid on Clinical Outcomes

Katherine Baicker et al.


Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects.


Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage.


We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.


This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

N Engl J Med 2013; 368:1713-1722.

Megan McArdle has a LONG commentary on the study here

How back pain can be beaten with antibiotics: Breakthrough could cure 40% of sufferers

This sounds comparable to the discovery of Helicobacter Pylori

Hundreds of thousands of people living with crippling back pain could be cured  - by a simple and inexpensive course of antibiotics.

In a breakthrough described as being worthy of a Nobel prize, scientists have shown that many cases of severe, long-term back ache are caused by bacteria  –  and the bugs can be zapped by a three-month course of pills costing just £114.

Patients who were in so much pain that they had to give up work have thanked the researchers for giving them their life back.

Hanne Albert, the Danish scientist who made the discovery, said almost half of those with chronic lower back pain could benefit.  This works out at more than half a million Britons, including many who are in the prime of life.

Dr Albert said: ‘These are mums and dads in the middle of an active working life. ‘These are pillars of society, they care for their parents and for their children.   ‘They will be able to play with their children, instead of just sitting and watching them play.’

An estimated four in five Britons suffer back problems and some point in their life and the condition is behind more GP visits each year than any condition, other than the common cold.

The NHS spends more than £1billion a year on treating it, including around £500million on surgery, while sick days and long-term disability cost the economy at least £3.5billion annually in lost productivity.

Many hard-to-treat cases are caused by slipped discs – where wear and tear, a car crash, heavy lifting or other problem causes a piece of the spongy tissue that cushions the bones of the spine to spill out, causing pain in the back and  legs.

Most people quickly recover but, in some, the pain persists and even major surgery is not completely effective.

Dr Albert, working with colleagues from Birmingham, believes that often this persistent pain is caused not by damaged disc by rogue bacteria that have infiltrated it.

The researcher began by examining tissue taken from discs of people whose back pain was so bad they had had spinal surgery.

Around half tested positive for bacteria, with a bug that normally causes acne predominant.

The researchers then allocated 162 men and women who were in ‘relentless’ back pain to a 100-day course of the antibiotic Bioclavid or a placebo.

In contrast to the placebo, the antibiotic greatly cut pain and disability.

For instance, a year on, those who had taken the drug said they’d experienced 64 hours of pain in the previous month. Those on placebo had racked up 200 hours of pain.

And those who had taken drug took just 19 sick days – compared with 45 by those on placebo, the European Spine Journal reports.

Dr Albert, of the University of Southern Denmark, described the improvement as ‘amazing’ and said the patients were effectively cured.  She added: ‘I can’t tell you how many people have given me hugs and told me I have given them their life back.’

It is thought that in these people, the slipped disc gradually had healed itself. However, they remained in pain due to the Propionibacterium acnes bug. It normally causes acne but is also found in the mouth and pushed into the circulation by tooth brushing.

In those who have slipped a disc, it worms its way into the damaged disc, where it produces acid which corrodes the spine, causing fresh and often excruciating pain.

Peter Hamlyn, the University College Hospital London surgeon who has successfully given the antibiotic to patients here, said doctors must now rethink their understanding of lower back pain.

He added: ‘More work needs to be done but make no mistake, this is a turning  point, a point where we will have to re-write the textbooks.  ‘It is the stuff of Nobel prizes.’

Dr Albert is now educating GPs, doctors and physiotherapists on how to spot those whose pain is caused by the bacteria.  She said: ‘I don’t want surgery for these people. I don’t want them to eat  morphine. I want them to be cured.’

However, the treatment is only for those in severe pain.

And with antibiotics only helping around 40 per cent of those whose with chronic lower back pain, she stresses that people mustn’t self-medicate.

Professor  Laura Piddock, a University of Birmingham microbiologist, agreed that accurate diagnosis is essential.  Otherwise, patients would be needlessly taking drugs that could increase rates of antibiotic resistance.


1 comment:

John A said...

Government health insurance does not make you healthier.

Thank goodness. If it was supposed to even try that, one of the first things would be to put us on the diet of, with the goal of reaching the BMI of, 1945 Auschwitz prisoners.

No "health insurance" makes you healthier. It is supposed to help pay for exams, medicines, and procedures - which may "make" you healthier if you have a problem, yes, but in general a lot of what you pay into insurance goes to not YOUR bills but to help payments for people who need more than the average help. Too many people do not understand how this ends up helping everybody, and want to get their "money's worth" - i.e. get every penny back in payouts to themselves. Alas, politicians go with this fallacy while knowing the reality.