Medicaid-Covered Men with Hemophilia Spend Less on Healthcare Than Employer-Insured Peers

Magdalena Kegel avatar

by Magdalena Kegel |

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Men with hemophilia who have a Medicaid health plan spend less on healthcare than those with employer-sponsored health insurance, due to lower reimbursement. However, Medicaid spends more on extensive healthcare users than employer-sponsored plans, according to a new study from the Centers for Disease Control and Prevention (CDC).

The study, “Accounting for differences in healthcare utilization and expenditures among US males with haemophilia by type of health insurance,” was published in the journal Haemophilia.

To examine how a hemophilia patient’s health insurance plan affects healthcare spending, researchers at the Division of Blood Disorders at the CDC examined claims data for 419 men with Medicaid and an equal number with an employer-sponsored insurance. Researchers did not have access to data showing the severity of hemophilia among the participants.

Analyses showed that expenses per emergency room visit (that did not lead to hospitalization), as well as hospital admissions, were threefold to sixfold lower among men with Medicaid insurance than with employer-sponsored insurance.

Medicaid users also were less likely to receive a clotting factor replacement infusion at home by a healthcare provider. Among Medicaid users who did get infusions at home, the average cost per infusion was 35% lower.

Medicaid can be granted to people according to either poverty or disability criteria. When looking separately at the two groups, researchers noted that poverty-qualified Medicaid users had lower total healthcare costs than people with employer-sponsored insurance. In contrast, those with disability-qualified insurance had higher total expenses.

Researchers underscored these differences likely can be explained by the fact that there probably are more patients with severe hemophilia in the disability-qualified group.

Medicaid users also were more likely to get their factor replacement through pharmacies. But among all men who had pharmacy expenses, those with Medicaid had lower factor expenses.

Extensive healthcare users with Medicaid had more frequent outpatient visits than extensive users with employer-sponsored insurance, but there was no difference in the frequency of outpatient visits among less-extensive users. In total, Medicaid spent more on extensive users than the employer-based insurance plans.

Poverty-qualified Medicaid users were more likely to have sought care in emergency rooms compared to employer-insured men, but all Medicaid users were overrepresented among those seeking emergency care. Earlier research has shown that newly-insured patients with Medicaid tend to seek care in emergency rooms more often.

Disability-qualified patients with Medicaid stayed longer when admitted to the hospital than patients insured through the employer. The research team also noted that other healthcare concerns significantly contributed to costs.