I do know the difference between Medicare and Medicaid and in my younger days was very familiar with Medicare. Medicaid is just a big unknown to me
Like I said, I’ve only had one personal experience. We had a niece living with us while she was in HS. Tough family background, Mom was mentally disabled. The niece was eligible for Medicaid. We never had issues with doctors.
Of course, we took her to the same doctors we had used for our kids. But, we also had a couple specialists who were new.
But, that’s a sample of one.
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I think this is the typical experience. Thankfully, we still have a fair number of community health clinics and federally qualified health centers that exist largely to provide care to the underserved. They are often under-staffed and work on shoestring budgets (Medicaid reimbursement rates are low), so to @Cooke’s question still a bit two-tiered, they aren’t getting concierge service.
In many areas it seems, anecdotally, to depend on how many doctors and how many patients are there. If you have one doctor in a small town they’ll treat anyone and everyone. In large cities you’ll have the whole variety, from clinics who will treat Medicaid benes to the practices that charge you $100/mo to be able to walk in their doors. And everything in between, if a doctor can keep a full schedule and not have to settle for Medicaid rates, many will do so. You know, healthcare is local.
My company has been working to get CHCs and FQHCs into value-based care, where they can earn shared savings to help bolster their budgets a bit. I think for 2022 we averaged about $125k or maybe closer to $150k per clinic, and these are generally pretty small clinics.
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I don’t believe that has changed recently, so it’s irrelevant to the trends.
“Can’t abort a dead or doomed fetus” is a new thing, though, and might have caused an uptick in US infant mortality.
The number I’m really worried about is maternal mortality. We already have crappy maternal mortality, and things just got a lot worse.
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This is a greater concern to me as well. The US maternal mortality rate is about double Canada’s but Canada in turn compares poorly against most Western Europe countries.
Do we have more drug use in the US? I’m sure we have more obesity, which is surely a factor, but I’m less certain about drug use.
If I had more drugs I wouldn’t be so fat
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I think the opioid crisis is roughly equal as a problem in our two countries. It would be the number one medical issue in Canada.
However general prescription drug use is higher in the US than Canada.
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Is Canada’s as variable? It’s not too bad in California, but go to Arkansas or Mississippi and I think it’s like ~5x as high. Mississippi has terrible health outcomes in… I think pretty much every part of healthcare.
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I expect the mortality rate is a bit higher in rural areas than urban ones. We would not have a provincial extreme equivalent to Mississippi as far as I know.
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And the mortality rate for Black mothers in the US is 2.6x that of white mothers.
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It also varies by income and geography.
And i bet it’s increased in the states with new abortion restrictions. But so far, that’s just anecdotal. I don’t think we’ll have actual data for a while yet.
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The Women’s Center I go to for my annual PAP has stopped seeing pregnancies. It used to be 90% visibly pregnant women in the waiting room. I’d heard the nearest place to them accepting new patients was 30 minutes away.
(I live in an area with ~1m people, not rural)
Yikes. Yeah, stuff like that increases maternal mortality.
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In the other countries we operate in we noticed a spike in the years 2020 and 2021. It is associated with COVID-19 making it harder to safely access prenatal medical facilities as well as it being a hard economic period. 2022 was broadly a better year.
early last year, i was at a conference talk where those in the medmal space and those who ran groups of ob/gyn docs were listing states they knew docs would avoid bc they’d have to unlearn a lot of training to legally do the job they were used to doing. i doubt it happens all at once, but we are setting up for a lot of care deserts.
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It is not all about “care deserts”. It’s also about quality doctors choosing other specializations due to the exorbitant malpractice premium OBs pay in the US. And OBs leaving the profession, or only performing the GYN duties for the same reason.
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Who cares what the voters think? Just because they voted 57-43 to keep abortion legal doesn’t mean that it should be. And definitely don’t let those pesky judges address what laws say.
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The obvious reasons why US infant mortality is on the upswing… no national health care system, insane costs, and a simply abysmal food supply. When ROE trumps health, it’s not a mystery why results are poor. The net income is robust, if that’s any consolation.
The political side is nuanced. The private equity arena(as well as the consolidation via public companies, looking at you UHC and others) are rapidly withdrawing from unprofitable markets. Those are often in rural areas. No hospitals or doctors will naturally result in poorer health outcomes. Then toss in the closing of Ob-Gyn facilities cuz, few doctors are interested in having staff attorneys with the proliferation of state level abortion regs…and viola…bye bye pre natal care.
It’s not rocket surgery. Limit or eliminate care, feed the mothers toxic but highly profitable food, and don’t be surprised at the poor results.
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Jaspess says that part of the reason for this is the proliferation of dollar stores. The idea being, no need for proper grocery stores since they technically sell food (or is it sell technically food?) so dollar stores are part of the reason that food deserts are a thing. I won’t shop at a dollar store for that reason (among other reasons).
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