Analysis of the Louisiana Medicaid program: a microcosm of the U.S. health cost crisis
Ellis, M.S.
Journal of the Louisiana State Medical Society Official Organ of the Louisiana State Medical Society 146(1): 25-31
1994
ISSN/ISBN: 0024-6921 PMID: 8169493 Document Number: 438407
While the "health care crisis" is a major topic of discussion, it is apparent that to properly evaluate and manage the "ailment," we must first establish a proper diagnosis. To that end, we have provided actual statistics for the Medicaid program in Louisiana. As is the case in many states today, Medicaid has become a major component of the overall governmental health cost figures, involving over one-half of actual government expenditures, and consuming $140 billion of the total $800 billion national figure. In the debate over the cost of health care, we face an issue of trying to compare apples to oranges. Health care costs in the United States are not being portrayed accurately, especially in comparisons to other nations. In the United States, in part because of programs such as Medicaid, categories such as transportation, substance abuse, care of the mentally retarded, insurance administrative costs, long term institutional or custodial care of the elderly, capital equipment costs, and medical education and research are all counted as "health care" costs. In 1991, nursing home care alone cost over $60 billion with $32.3 billion being paid by Medicaid. In other nations, however, many of these categories are classified as social, educational, or welfare programs. If health care spending decisions are to be made on the basis of statistical comparisons to other countries, then it is critical that we develop a standardized international classification system, and similarly effective methods for the collection of data. In lieu of this approach, at the very least, we should be factoring in these tremendous differences in classification of costs into the comparisons.