Every Illinoisan wants, or ought to want to curb unneeded increases in Medicaid spending. Purging the rolls will help a little, but the real problem is something else.

According to Harold Pollack, writing in the Washington Post, the average annual expenditures on the bottom 72 percent of Illinois Medicaid recipients is only about $564. That accounts for only 10 percent of total program spending. The top 3.2 percent of recipients, astonishingly, account for half of total Medicaid spending, with average expenditures exceeding $30,000 annually.

Pollack explains. “Many of these men and women face life-ending or life-threatening illnesses, as well as cognitive or psychiatric limitations….If we want to provide more cost-effective care to poor people, we should proceed in the same way that we should proceed in other parts of the medical economy. We must do the hard work of improving the quality and economy of care provided to the concentrated group of extremely costly patients. There is no short cut. Under any financing system, this requires the hard work of clinical-care coordination, quality improvement and social services to address life circumstances that undermine health.”

He concludes, “It’s unrealistic and unwise to expect that financial pressures on or incentives for patients will play a large part in this work.”

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