Insurance coverage and diabetes quality indicators among patients with diabetes in the US general population

• Published in: Primary care diabetes Vol. 11; no. 6; pp. 515 - 521
• Main Authors: Doucette, Emily D., Salas, Joanne, Wang, Jing, Scherrer, Jeffrey F.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2017
• Subjects: Adolescent; Adult; Chi-Square Distribution; Databases, Factual; Diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - economics; Diabetes Mellitus - epidemiology; Diabetes Mellitus - therapy; Endocrinology & Metabolism; Epidemiology; Female; Health Care Surveys; Health insurance; Healthcare Disparities - economics; Humans; Insurance Coverage - economics; Insurance, Health - economics; Internal Medicine; Logistic Models; Male; Medicaid; Medically Uninsured; Middle Aged; Multivariate Analysis; Odds Ratio; Private Sector; Quality Indicators, Health Care - economics; Quality of care; Risk Factors; United States - epidemiology; Young Adult; Health insurance; Diabetes; Epidemiology; Quality of care
• ISSN: 1751-9918; 1878-0210; 1878-0210
• DOI: 10.1016/j.pcd.2017.05.007

•Odds of meeting diabetes quality indicators differ by health insurance.•Private and government insurance associated with similar odds of meeting quality indicators.•Persons without health care insurance were significantly less likely to meet diabetes quality indicators. This study explores associations between health insurance and diabetes quality indicators. Data were obtained from 8305 patients with diabetes who reported no insurance, Medicaid or private insurance in the 2013 BRFSS in 26 states in the US. Six diabetes quality indicators were assessed: HgbA1c testing, foot exam, eye exam, influenza immunization, pneumococcal immunization and diabetes education. Logistic regression was performed comparing quality indicators by insurance group adjusting for covariates. Subjects with private insurance or Medicaid were more likely than the uninsured to have HgbA1c testing (OR=2.60, 95%CI: 2.02–3.35; OR=2.04, 95%CI: 1.55–2.69, respectively), a foot exam (OR=1.72, 95%CI: 1.32–2.25; OR=1.64, 95%CI: 1.23–2.18, respectively) and an eye exam (OR=2.01, 95%CI: 1.56–2.58; OR=2.50, 95%CI: 1.91–3.27, respectively). Those with private insurance were more likely than the uninsured to have influenza immunization (OR=1.75, 95%CI: 1.37–2.25) and diabetes education (OR=1.36, 95%CI: 1.06–1.74). Uninsured persons with diabetes are less likely to receive standard diabetes services compared to the insured, but most quality indicators were similar in publicly and privately insured groups.