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Washington praised for how it cares for the poor and sick

Same as the South? Washington's health care spending for disabled Medicaid beneficiaries is among the lowest in the nation.
Todd Gilmer and Kronick
Health Affairs (journal)
Same as the South? Washington's health care spending for disabled Medicaid beneficiaries is among the lowest in the nation.

When it comes to caring for its poorest and sickest people, Washington state appears to be doing better than the rest of the country. At least, that’s the view from a new study that looks at Medicaid spending.

Public spending on health-care is a hot political topic these days, as states and the federal government try to balance their budgets. Researchers were wondering: How do the 50 states compare in their spending on Medicaid, which covers low-income people? Do some states spend more because they pay doctors higher fees?

The study, published in the July issue of Health Affairs, focuses on the cost of caring for people with serious disabilities, ranging from psychiatric problems to cerebral palsy to multiple sclerosis. Todd Gilmer, the lead author and a health economist at the University of California-San Diego, says Washington’s approach stands out:

"We were identifying Washington state as the best practice in terms of providing high quality care at a low cost to disabled Medicare beneficiaries."

Preventive care matters

Washington spends much less on treating people in hospitals than most other states do – while spending a little more on primary care visits and prescription drugs. That implies the poorest and sickest people in Washington are managing to stay out of the hospital, compared to people with similar conditions in other states – and the way they do that is by using a little more preventive care.

States such as New York and New Jersey spend more because apparently they perform a lot more procedures. In contrast, states in the south spend the least because they offer fewer services and they pay hospitals lower fees.

The Health Affairs journal has blogger named Chris Fleming, and he summarizes it this way:

"Washington State provided the best example of how states can lower spending by reducing hospital care and expanding access to primary care providers. Acute care spending there was 18 percent below the national average. Inpatient stays per beneficiary were 35 percent below the national average; in contrast, outpatient visits and prescription fills were each 15 percent above the national average."

Teaming up on the high risk

Washington also has worked on getting the criminal justice, mental health, and health care systems to work together when it comes to people considered high risks. Typically, Washington is grouped with Minnesota and Massachusetts as the most efficient states when it comes to health-care. But Gilmer says, in this case, Washington does better.

What may be disconcerting is seeing Washington grouped with southern states such as Alabama and Oklahoma – because those states typically have the worst overall health status in the country, and provide fewer health services to poor people. Washington gets in this group by being efficient, the study implies, not by restricting care.

On the other hand, some of the reduced spending may not be so innocent – as this spring the legislature cut how much it’s willing to pay hospitals for Medicaid patients by 10%


Keith Seinfeld is a former KNKX/KPLU reporter who covered health, science and the environment over his 17 years with the station. He also served as assistant news director. Prior to KLPU, he was a staff reporter at The Seattle Times and The News Tribune in Tacoma and a freelance writer-producer. His work has been honored by the American Association for the Advancement of Science (AAAS) and the Knight Science Journalism Fellowships at Massachusetts Institute of Technology.