by jerry on September 12, 2021
Kaiser Health News published a longer piece on California's plans to spend nearly $6 billion on more comprehensive care for low-income patients. On some level, this plan makes sense in that a low-income patient's health might be determined by more than just access to health care; for example, lack of access to stable housing and nutritious food could undermine the effectiveness of free health care. Apparently, more than 25 regional experiments have shown a more holistic approach to be effective. Critics of the idea appear skeptical that this approach will work on a scale as large as California as a whole, and might be inclined to believe the state's apparent lack of success in providing basic services might preclude their success in more intensive efforts. The chief medical officer of a participating health plan expressed concerns about the readiness of the existing infrastructure to support the initiative.
Both sides have good points, and testing it out at the next level would be an appropriate next step. The article gives the impression, though, that goals and metrics are not well-defined (e.g. "State officials do not have a savings estimate for the program, nor a projection of how many people will be enrolled."). For example, officials should probably be able to articulate what would happen if they spent this money on the status quo. Without a clear idea of goals and metrics (or with too many conflicting goals), it is possible that the state will go through this exercise and not learn enough through the experience to shape future behavior.