Who Receives More Wasteful Care: Medicaid Enrollees or People with Private Insurance?

Some medical services are unnecessary. Is it your first day of uncomplicated lower back pain? You don’t need an x-ray.

But many patients continue to receive such services anyway, perhaps because they demand them or, perhaps, because their providers keep recommending them. But does the likelihood of unnecessary services depend on your insurance?

Specifically, do Medicaid enrollees receive fewer unnecessary services than people with private insurance, because of the relative stinginess of Medicaid reimbursement? Or do they receive more, because people on Medicaid have more need or greater demands?

The answer is–yes and yes. Medicaid enrollees receive more of some unnecessary services and fewer of some other unnecessary services. That, at least, was what Christina Charlesworth and colleagues found when they studied people in Oregon. They assessed the frequency with which Medicaid enrollees and privately insured patients received 13 unnecessary services, things like imaging tests for uncomplicated low back pain and arthroscopic surgery for wear-and-tear arthritis of the knee. Overall, the rate of unnecessary services didn’t differ by insurance, but did differ for specific services.

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