Friday, April 20, 2007

More Medicaid Musings

So having had a chance to read the methodology of the Public Citizen study on Medicaid, and take a closer look at the rankings, I have this to say:

The good news is that Oregon missed top 10 by a tiny amount. There was a small cluster at 8-12 that was separated by something like 10 points (out of a 1000 point scale). Hawai'i and Oregon are 11th and 12th by a hair's breadth.

The bad news is that, even if we had made the top 10 - indeed, even if we had ended up first - the top 10 is an accolade only to the extent that it indicates that those states are markedly less broken than the states in the rest of the rankings. No one reached 700 out of 1000 points. 30 states ended up in the bottom 10 in one of the statistical categories (Oregon did not - it was 31st in one, but that's as low as it went). Generally speaking, the states are not doing the job.

Across the board, the hands-down biggest problem for most states is quality of care. Actually, no one knows if that's the problem because very few people are actually attempting to measure it. Problem number one. Problem number two can be found in the lack of standards within state Medicaid programs for quality of care. In short, no one pays any attention to the problem, and even if they did, they would not currently know what to do with the data. Surely there are benchmarks for this sort of thing? Maybe the gummit is on the case? (Not exactly - it's much more about communication to served populations, but it's a start.) Actually, the AHRQ has quite the clearinghouse for information on quality standards. Oregon specifically is falling down pretty hard here, so a bit of light reading might be in order.

It's not apparent that states care much at the moment about improving their measurements of quality, let alone actually improving quality of care. But they'd better start, because the boomers are entering Medicare and Medicaid years. And ignoring the strain on the system, our elders deserve better.

PS - If you're old, impoverished, pregnant, or some combination of same, and you live in Mississippi, move.

No comments: