8 observations on how the Medicaid expansion impacted healthcare delivery in Kentucky

Last year marked the first year some of Kentucky's poorest and most underserved population gained access to health insurance, and a year of collecting data yielded some interesting observations published in the New England Journal of Medicine.

Here are eight observations from Michael D. Stillman, MD, who authored the article:

1. Several of his lowest income patients sought non-urgent medical attention for the first time and Dr. Stillman could offer them colonoscopies without the patients covering the entire bill.

2. There is improved residency education in the state. The residents Dr. Stillman taught were able to provide better care and newer procedures to patients who didn't have to worry about financial considerations that would have prevented them from undergoing treatment in the past.

3. Healthcare professionals can recommend laboratory tests without fearing non-payment. More time is spent examining patients and less time trying to figure out how to get the patients public assistance to pay for treatment.

4. There is an increased competition for patients. Uninsured patients were not pursued in the past, but now with many of those patients gaining Medicaid coverage or new commercial plans, they are pursued by several providers and can choose their site of care.

5. The increased competition for patients is pushing clinicians to provide a better patient experience and consider patient satisfaction more deeply than before.

6. There is still a concern about high medical debt because many people who are insured have low-premium, high deductible plans.

7. Dr. Stillman challenges his colleagues to challenge elected officials to meet the needs of their constituents, who are patients. He is now comfortable discussing politics with patients whereas before it was an uncomfortable discussion. He routinely asks them whether they are registered to vote and reminds them about legislation that benefits them.

8. Cost-effectiveness is now addressed by individual physicians.

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