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Objective: To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations.Data Sources: Primary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery.Study Design: We used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care.Data Collection: Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N = 24,646).Principal Findings: Medicaid coverage significantly reduced the share of respondents who reported needing dental care (-9.8 percentage points, p < .001) or having unmet dental care needs (-13.5 percentage points, p < 0.001). Medicaid doubled the share visiting the ED for dental care (+2.6 percentage points, p = .003) and the use of anti-infective medications often prescribed for dental care, but it had no detectable effect on uncovered dental care or out-of-pocket spending.Conclusions: Expansion of Medicaid covering emergency dental care substantially reduced unmet need for dental care, increasing ED dental visits and medication use, while not changing patient use of uncovered dental services. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the effects of the expanding Medicaid coverage for low-income adults in the U.S. using the 2008 Medicaid expansion in Oregon. Results revealed no significant effect of the coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for the conditions. It concludes that the coverage generated no significant improvements in measured physical health outcomes in its first two years of implementation.

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. [ABSTRACT FROM AUTHOR]

The article discusses how Medicaid coverage affects emergency department (ED) use based on the Oregon Health Insurance Experiment. Topics covered include the increased ED use as a result of the expansion of Medicaid coverage to more uninsured individuals, the expectation that primary care use will increase because of the expansion, and the impact of public health insurance on the relationship between visits to the physician's office and the ED.

The article looks at the evaluation of health care delivery systems. The authors express the view that randomized methods, which are standard in the evaluation of specific drugs and medical techniques, should also be used in evaluating aspects of the health care system such as health insurance and coordinated care programs. Topics include study design and the use of randomized studies in various social-science fields.