Nelson KM (VA Puget Sound)
Chapko M (VA Puget Sound)
Reiber G (VA Puget Sound)
Boyko E (VA Puget Sound)
To describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States.
DATA SOURCE: The 2000 Behavioral Risk Factor Surveillance System (BRFSS). STUDY DESIGN: Our study cohort included individuals who reported a diagnosis of diabetes (n=11,647). We performed bivariate and multivariate logistic regression analyses by age greater or less than 65 years to examine the association of health insurance coverage with diabetes-specific quality of care measures, controlling for the effects of race/ethnicity, annual income, gender, education and insulin use.
Most individuals with diabetes are covered by private insurance (39%) or Medicare (44%). Among persons under the age of 65, 11% were uninsured. The uninsured were more likely to be African American or Hispanic and report low incomes. The uninsured were less likely to report annual dilated eye exams, foot examinations or hemoglobin A1c (HbA1c) tests and less likely to perform daily blood glucose monitoring than those with private health insurance. We found few differences in quality indicators between Medicare, Medicaid, or the Department of Veterans Affairs (VA) as compared to private insurance coverage. Persons who received care through the VA were more likely to report taking a diabetes education class and HbA1c testing than those covered by private insurance.
Uninsured adults with diabetes are predominantly minority and low-income and receive fewer preventive services than individuals with health insurance. Among the insured, different types of health insurance coverage appear to provide similar level of care, except for higher rates of diabetes education and HbA1c testing at the VA.
The VA provides similar or better level of care to individuals with diabetes compared to those covered by Medicare, Medicaid or private insurance.