Annals of Family Medicine -- Comments for Carlson et al., 4 (5) 391-398

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Original Research:
Matthew J. Carlson, Jennifer DeVoe, and Bill J. Wright
Short-Term Impacts of Coverage Loss in a Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan
Ann Fam Med 2006; 4: 391-398 [Abstract] [Full text] [PDF]

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Electronic letters published:

Access to Health care: Mustafa Z. Younis, William Cissell (1 October 2006)

Access to Health care 1 October 2006

Mustafa Z. Younis,
Miami, Florida
ASSOCIATE PROFESSOR AND CHAIR , Stemple School of Public Health, Florida International University,
William Cissell
Send response to journal:
Re: Access to Health care

Comments on Short-Term Impacts of Coverage Loss in a Medicaid Population: Early Results From a Prospective Cohort Study of the Oregon Health Plan," by Carlson et al. for the Annals of Family Medicine.
The article provided an insight on the effect of the changes in Medicaid reimbursement on the poor and underserved. Their article provides a good example of the effect of the cuts in state and federal spending on health care services. However the problem of access to quality of health care goes much further beyond the Medicaid beneficiary. The United States is almost the only country among the industrial countries that ties health insurance to employment. Many of the insured face higher out of pocket expenses to meet their health care needs, as well.
Since the late nineties, employers have shifted the cost of health care to their employees in the form of higher premiums, deductibles and co-payments. This shift reduced the cost for employers, however many families on limited income are postponing their health services due to higher deductibles and co-payments. A routine visit to family practice frequently costs over $100 for co-payment and 2 or 3 prescribed drugs. Younis & Cissell (2006) found that hospital type, based on ownership, teaching affiliation, and location by region (urban versus rural), are factors that limit the access to health care of Medicaid patients.
See Younis, M and Cissell, W. "Impact of the Balance Budget Act on Access to Rural Hospital Health Services for Medicaid Patients"
J Health Care Finance, forthcoming (Summer 2006)
Competing interests: None declared