Benjamin Franklin once said “an ounce of prevention is worth a pound of cure.” The original goal of this commonplace idiom was to encourage Philadelphians to remain vigilant about fire awareness and prevention. Coal, the common source of heating in homes during the time, was often carried “live” from room to room, up and down stairs. Of course, during the Covid pandemic, the metaphor, and the lingering advice, is painfully obvious. But what is our proverbial “ounce” worth, in terms of Medicaid dollars in Ohio?
If we know vaccinations prevent hospitalization, how much did Ohio Medicaid save through its vaccination efforts?
It’s a fairly straightforward equation. If we know vaccinations prevent hospitalization, how much did Ohio Medicaid save through its vaccination efforts? To arrive at an estimate, we need to know the average cost of hospitalizations in Medicaid, the number of individuals vaccinated and the rate of hospitalizations. In simplistic terms, how many avoided hospitalizations were there in Ohio Medicaid and how much was that worth?
Framing the equation: Medicaid hospitalization costs and reimbursements
Hospitalizations First, we know hospitalizations in Medicare cost $21,752. In Ohio, however, Medicaid often pays 63% the average reimbursement of Medicare, meaning the average hospitalization in Medicaid costs $13,703.76.
Vaccinations According to the Ohio Department of Medicaid in August, about 2.3 million of Ohio’s Medicaid population was eligible for a Covid vaccine and, as of that report, over 841 thousand enrollees had some level of vaccination.
In Ohio, however, Medicaid often pays 63% the average reimbursement of Medicare, meaning the average hospitalization in Medicaid costs $13,703.76.
Avoided hospitalizations Data from the CDC indicates Ohio’s cumulative incidence rate—the number of people infected with Covid—was 237.1 per 100,000 as of August 7, 2021, around the time of the state’s above report was released. So if you take that rate and apply it to the 841 thousand vaccinated, you get 1,995 avoided hospitalizations. However, evidence suggests that 15 percent of vaccinated individuals, particularly older adults and individuals with comorbidities, are hospitalized. Even though some estimates have this number closer to 2 percent, using the more conservative rate may provide a better estimate. When discounting that 15 percent, 1,696 hospitalizations were avoided by August 2021.
Solving the equation: vaccination-driven cost containment in Ohio Medicaid
Once you have the average cost ($13,703.76) and the number of avoided hospitalizations (1696), we estimate Ohio Medicaid saved $23,241,576.96.
MetroHealth patient data underscores how vaccination impacts hospitalization
An email from MetroHealth System President and CEO Dr. Akram Boutros this week offered recent patient-level impacts of vaccinations on hospitalizations. Unvaccinated or partially vaccinated individuals make up 90% of MetroHealth’s Covid admissions. Within this cohort, if admitted to the ICU, 1 in 3 of unvaccinated or partially vaccinated patients die. Fully vaccinated but not boosted patients account for 12% of Covid admissions.
Fully vaccinated but not boosted patients account for 12% of Covid admissions.
Boosted patients who are not immunocompromised account for only 1% of Covid admissions. Of these boosted and not-immunocompromised patients, ZERO have died from Covid.
Social determinants of health and privilege as protection
Mind you, this data is as of August of 2021. Many more individuals have been vaccinated and we have new dynamics in regards to spread and the omicron variant. Still, this is good news for Ohio taxpayers and validates Medicaid as a first responder in public health. However, it’s important to understand the deeper lessons the pandemic has taught us in regards to prevention as cost containment.
In thinking about prevention, what typically gets termed as the “social determinants” may be alternatively understood as insurance risk to Ohio’s Medicaid program. But unlike a shot in the arm performed by a clinician, many of the factors which influence morbidity and mortality for the Medicaid program have to do with the ways state and local policies can as vaccines for housing, food insecurity, transit and discrimination. Privilege is a form of protection from disease and until we recognize and remediate that reality through policy outside medical environments, Medicaid will continue to foot the bill.