Definition of the Behavior:

  • The behavior examined in this text is the acquisition of insurance coverage and whether or not having insurance specifically Medicaid.
    • Medicaid: a health insurance issued by the US government targeting disadvantaged population started in 1965. (Medicaid. gov)
    • Managed care: one of the systems for delivering Medicaid benefit aiming to disseminate home and community based medical services to strengthen the community and to enhance the quality and efficacy.

Prevalence and Group At-risk

  • National Medicaid enrollment rate among eligible is 62%.
  • Those who are particularly at risk for committing the behavior of not having Medicaid coverage are those whose incomes currently exclude them from Medicaid eligibility because they are too high, but those incomes are also still too low to allow purchase of health insurance on the individual market.

Relationship between Behavior and Disease

  • Un-enrolled:
    • This population is generally un-healthy since typically they do not have an access to go to see a medical professional for preventive care.
    • The uninsured Medicaid population suffers from mental health issues, alcoholism, heart disease, obesity, and other chronic conditions, but at a lower reported rate than the currently enrolled Medicaid population. This discrepancy is likely due to the fact that that the uninsured population has less opportunity to report their conditions.
  • Enrolled:
    • Oregon Health Study reported that because of Medicaid enrollment, probability of being diagnosed with diabetes, use of physician services, prescription drugs, and hospitalization all increased. Medicaid coverage reduced observed rates of depression and out-of-pocket catastrophic expenditures.

Predictor for the behavior

  • First strongest predictor is category of eligibility; disabled adults are more likely to enroll than others.
  • Second strongest predictor is state of residence; liberal states have higher enrollment rates presumably due to richer benefit offerings and simplified enrollment processes.

Background information about the behavior

  • The behavior of not having insurance coverage is notoriously difficult to change as it is not always a choice of will for individuals.
  • Even some individuals who do qualify for Medicaid have chosen not to enroll because of the social stigma that has typically accompanied Medicaid.
  • Even with Medicaid expansion there are still groups of people who are prohibited either by mental illness, language barriers, illiteracy, or healthcare illiteracy that will likely not find their way into the Medicaid system.
  • Some States are opposing Medicaid expansion on political grounds but most, if not all, are concerned with the long-term cost of the Medicaid program.
  • The federal government is currently offering to pay the majority of the cost for this program, but this subsidy will taper off and leave more burdens on State budgets in coming years.

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