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The Oregon health insurance experiment was a research study looking at the effects of the 2008 Medicaid expansion in the U.S. state of Oregon, which occurred based on lottery drawings from a waiting list and thus offered an opportunity to conduct a randomized experiment by comparing a control group of lottery losers to a treatment group of winners who were eligible to apply for enrollment in the Medicaid expansion program after previously being uninsured.〔Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, Katherine Baicker, and the Oregon Health Study Group, "The Oregon Health Insurance Experiment: Evidence from the First Year", ''The Quarterly Journal of Economics'', 2012 Aug; 127(3): 1057-1106.〕 The study's results have been published in the academic journals ''The Quarterly Journal of Economics'', ''Science'', ''The New England Journal of Medicine'', and the ''The American Economic Review''. In the first year after the lottery, Medicaid coverage was associated with higher rates of health care use, a lower probability of having medical debts sent to a collection agency, and higher self-reported mental and physical health.〔 In the eighteen months following the lottery, researchers found that Medicaid increased emergency department visits.〔Sarah Taubman, Heidi Allen, Bill Wright, Katherine Baicker, Amy Finkelstein, and the Oregon Health Study Group, "Medicaid Increases Emergency Department Use: Evidence from Oregon's Health Insurance Experiment", ''Science'', 2014 Jan 17; 343(6168): 263-268.〕 Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, though "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."〔〔 Commentators in publications such as ''Forbes'' and ''RealClearPolitics'' cited the study as evidence that the Medicaid program doesn't fulfill its central cause of assisting the American poor,〔〔 while other commentators in publications such as ''The New Republic'' and the ''Daily Kos'' stated that the evidence of improved financial security and mental health provided a significant social benefit.〔〔 ==Background== In 2008, Oregon began an expansion of its Medicaid program for low-income adults. Because officials could not afford coverage for all those who wanted to enroll, they decided on the novel approach of allocating the limited number of available slots by lottery.〔Katherine Baicker, Sarah Taubman, Heidi Allen, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Eric Schneider, Bill Wright, Alan Zaslavsky, Amy Finkelstein, and the Oregon Health Study Group, "The Oregon Experiment – Effects of Medicaid on Clinical Outcomes", ''The New England Journal of Medicine'', 2013 May; 368(18): 1713-1722.〕 Thus, a situation allowing for a randomized experiment occurred, with a control group of individuals not selected by the lottery and a treatment group of individuals selected by the lottery and thus eligible to apply for Medicaid.〔 A total of 29,835 Oregonians were given the opportunity to apply for the state's Medicaid program, out of almost 90,000 people on the waitlist. 〔 About 30% of those who were selected from the waitlist both chose to apply for Medicaid and met the eligibility criteria. Researchers collected data from both existing administrative data sources and new primary sources. Administrative data included hospital discharge, emergency department, credit report, and mortality records and records on receipt of state and federal benefits.〔〔Baicker, Katherine, Amy Finkelstein, Jae Song, and Sarah Taubman, "The Impact of Medicaid on Labor Market Activity and Program Participation: Evidence from the Oregon Health Insurance Experiment", ''The American Economic Review: Papers and Proceedings'', 2014 May; 104(5): 322-328.〕 The researchers also conducted a mail survey approximately one year after the lottery and conducted in-person interviews and physical-health exams.〔 For logistical reasons, data on emergency-department visits was limited to twelve Portland-area hospitals and in-person data collection was limited to study participants in the Portland metropolitan area.〔〔 The control and study groups were statistically similar in many dimensions such as age and ethnicity. Because of the randomized controlled design, the study was able to isolate the effects of insurance from confounding factors such as the initial health status of participants. Principal investigators Katherine Baicker and Amy Finkelstein are well known as economists at Harvard University and the Massachusetts Institute of Technology (MIT), respectively. The rest of the authors are regarded as some of the top researchers in this field.〔〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Oregon Medicaid health experiment」の詳細全文を読む スポンサード リンク
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