Effect of Cost Controls on Arthritis Patients … Article Review
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¶ … formulary restrictions that are involved when it comes to Medicaid and the prescriptions that are dispensed as part of that program. Specifically, there will be a focus on the limitations of the study in question. When the author of this report says "limitations," this of course references problems with the study as it pertains to things like data sampling error, data sampling problems, validity issues, bias of some sort, ineptitude on the part of the researchers when using the research instruments in question and so forth. For each limitation that the author of this report points to, there will be a linkage to and citing of scholarly articles that buttress and support the assertions being made by the author of this article review and reaction. As with most research, the biggest goal could and should be to improve and perfect the science and methodology behind the study so as to improve and increase future progress on the subject at hand. When dealing with things that involve politics, society, culture and medicine, the variables are many and complex. With that in mind, any study and review of the subject reviewed in the primary article should be done with more precision and attention to detail than was exhibited by the authors as it is currently written.
As noted in the abstract, the article that will be the foundation of the rest of this report focuses on the formulary and cost restrictions that are involved when it comes to Medicaid patients and the treatment of arthritis patients that participate in the program. Specifically, there is heavy use of non-steroidal anti-inflammatory drugs (NSAID's) when it comes to the treatment of the disorder and there is the question of what drugs and formulations are preferred when it comes to Medicaid enrollees that have arthritis. In reviewing the article, it is clear that there are some major implications and there are also some pronounced barriers (Johnson & Stahl-Moncada, 1998). Beyond that, increased hospitalizations related to constricted spending in Medicaid is not remotely limited to arthritis. The homeless and their health problems are just one example (Lin, Bharel, Zhang, O'Connell & Clark, 2015). Even with the overall problem being well identified by Johnson and Stahl-Moncada, they made some major procedural missteps and this leads to incomplete or under-informed conclusions on their part.
One limitation that studies like this would have would include the fact that the threshold of pain and discomfort that different patients have is going to very a bit from person to person. To explain, many healthcare professionals ask their patients to use a one to ten sliding scale (or something similar) when it comes to getting feedback about the pain level of the patient. However, one person's "5" on that pain scale may be another person's "7." Additionally, some people go to the emergency room at the first sign of any illness or flare-up of a disorder (e.g. arthritis). Lastly, there is sometimes a lack of patient education when it comes to perspective, proportionality and so forth and this is by no means limited to arthritis (Brown, Clark, Dalal, Welch & Taylor, 2012). Given just those few small examples being what they are, making conclusions about a group of Medicaid patients in a study like the one under review would require a good and vast sample so as to smooth out the outliers and exceptions. With that being said, there are a few problems with the sample described in the reviewed study. First, the overall size of the sample is not really well-described and the details that are given are a bit concerning for one or more reasons. Basically, the sample used for the reviewed study was people over eighteen in one of twelve acute healthcare plans or long-term care plans. The overall number of people in the pool is not given. Further, all of the people involved are in one state ... Arizona. Given that Medicaid is a federal program, the inclusion of people from other states might have been very informative as compared to what was actually done. One other thing that this study did not control for with their sample, although it is something that cannot really be properly dealt with, are the people that do not get healthcare in a timely fashion due to lack of money or transportation. Indeed, Medicaid is for the poor but the healthcare of the people not showing up for Medicaid-funded care need to be counted as well if possible. However, the first point given above is the primary fault the author of this response is pointing to. Given the above, there should also be a mention in the reviewed study's limitations of people that do not use services due to lack of funds and/or shame in using government resources and money. However, the limitations named are very narrow and do not even touch on demographics, economics or other things of that nature. (Nguyen, Makam & Halm, 2016).
Another limitation that should be looked deeper than it was by the reviewed study is race or ethnicity of the people involved. This limitation dovetails, yet is notably more precise, with the sample identification problems mentioned earlier. While there is a mention of the fact that race was part of what was noted as part of the study, it is not really covered beyond that. This is a potential liability for this study given that healthcare outcomes and healthcare disparities are amplified for minorities (African-Americans in particular) for one or more reasons. Whether it be lack of easy access to Medicaid, lack of money or something else, there are some fairly significant issues that exist when it comes to minorities getting access to healthcare. This is amplified for Blacks and Hispanics in particular as they are much more likely to be among the poorest of Americans (Collins & Rocco, 2014). This obviously explains a lot of the reason they are experiencing healthcare outcome disparities but many argue it is not the only reason. As for ways to improve this, it would have been useful for this study to break out the results based on race. They easily could have done so and it is extremely likely that the hospitalization and ambulatory rates would have been starkly different between the races had those numbers been parsed out. To strengthen the legitimacy and applicability of the study, they really should have done that (Janicke, Gray, Mathews, Simon, Lim, Dumont-Driscoll & Silverstein, 2011); Chan, McGovern, Brown, Sheehy, Zacharia & Mikell, 2014). Even women face shortfalls in healthcare as compared to men (Ramondetta, Meyer, Schmeler, Daheri, Gallegos & Scheurer, 2015)
The final limitation of the Johnson study, although certainly not the last limitation that could be identified, is specifically mentioned by the study itself. There is mention of the fact that the market for NSAID's is artificially expensive due to the presence of drugs that are more expensive than ones that have been on the market prior but have since been yanked. The article mentions Vioxx as an example. Indeed, there should indeed be a focus on keeping drugs safe and effective. However, the lawyers and other parties that assail drug companies at every turn do not seem to understand that all of this pressure is indeed at least of the reasons that drug prices continue to go up. This could and should absolutely be correlated to the restrictiveness of the formularies as discussed in the discussion portion of the reviewed study. The study comes very close to getting to the full and proper conclusion as they admit that prescription costs are much higher for those that are on restricted drug lists but the budget limitations and cost cutting of Medicaid itself is not mentioned and that is almost certainly a factor. Beyond that, a study done in 2015 has established that using the full litany of drugs available actually drives costs down. Even better, this does include Medicaid environments (Roebuck, Dougherty, Kaestner & Miller, 2015). The data reviewed and conclusions drawn when considering this vein of thought were not "wrong" per se. However, they were most certainly incomplete and the reason for this is unclear. It is clear that data collection was incomplete and that the overall data sampling was either incomplete or some very important factors were dismissed or ignored in error. The author of this report and other authors would assert that the government budgetary side of things is indeed the main catalyst for the cost-cutting moves being made and those moves are actually exacerbating the problem rather than helping it.
In general, there are going to be trials and tribulations when it comes to the drug market and government programs. The main reason and impetus for this is that there is a finite amount of taxpayer money allocated to government programs like Medicaid and those dollars have to be allocated properly. The primary and reviewed article in this report makes clear that there are shortfalls due to money constraints and a bit… [END OF PREVIEW]
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