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Field Before After
Last Published March 27, 2014 01:46 PM April 30, 2014 04:24 PM
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Papers
Field Before After

Paper Abstract

In 2008, Oregon initiated a limited expansion of a Medicaid program for uninsured, low-income adults, drawing names from a waiting list by lottery. This lottery created a rare opportunity to study the effects of Medicaid coverage using a randomized controlled design. Using the randomization provided by the lottery and emergency department records from Portland-area hospitals, we study the emergency department use of about 25,000 lottery participants over approximately 18 months after the lottery. We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.

Paper URL

http://www.sciencemag.org/content/343/6168/263.full.pdf?keytype=ref&siteid=sci&ijkey=GoMYHyTTSQ4.Q
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Field Before After

Paper Abstract

In 2008, a group of uninsured low-income adults in Oregon was selected by lottery for the chance to apply for Medicaid. We use this randomized design and 2009 administrative data to evaluate the effect of Medicaid on labor market outcomes and participation in other social safety net programs. We find no significant effect of Medicaid on employment or earnings: our 95 percent confidence intervals allow us to reject that Medicaid causes a decline in employment of more than 4.4 percentage points, or an increase of more than 1.2 percentage points. We find that Medicaid increases receipt of food stamps, but has little, if any, impact on receipt of other government benefits, including SSDI.

Paper URL

http://www.nber.org/oregon/files/oregon_hie_LF_WP.pdf
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Field Before After

Paper Abstract

Despite imminent expansion of Medicaid to low-income adults, the effects of expanding coverage are unclear. Oregon’s 2008 Medicaid expansion using lottery drawings from a waiting list provides an opportunity to evaluate the effects of Medicaid using random assignment. Approximately two years after the lottery, we collected data from 6,387 adults randomly selected to be able to apply for Medicaid coverage and 5,842 not selected. Measures included blood pressure, cholesterol and glycosylated hemoglobin; a depression screen; medication catalogs; and self-reported diagnoses, health, health care utilization and out-of-pocket spending. We use the lottery’s random assignment to calculate the effect of Medicaid coverage.We found no statistically significant effect of Medicaid on the prevalence, diagnosis, or medication of hypertension or high cholesterol. Medicaid coverage significantly increased the diagnosis of diabetes and use of diabetes medication, but we observed no significant effect on average glycosylated hemoglobin levels nor on the percent with levels >6.5%. Medicaid coverage decreased the probability of screening positive for depression (-9.15 percentage points; 95% CI: -16.70 to -1.60; P=0.018), increased use of preventive services, and almost eliminated catastrophic out-of-pocket medical expenditures. Thus, evidence using a randomized controlled design showed that Medicaid coverage generated no statistically significant improvements in measured physical health outcomes in the first two years, but did generate increased health care use, higher rates of diabetes detection and management, lower rates of depression, and lower financial strain.

Paper URL

http://www.nejm.org/doi/full/10.1056/NEJMsa1212321
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Field Before After

Paper Abstract

In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

Paper URL

http://qje.oxfordjournals.org/content/127/3/1057
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Analysis Plans
Field Before After
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Field Before After
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Field Before After

Document

ARCHIVED_Criminal_Charges_Analysis_Plan_2014_04_30.pdf
MD5: 61c7fae83e12b51595126749e42c242f
SHA1: 93167c501ed289fae6d43df05218803168b2bf89
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