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Diabetes Care. 2009 Jun;32(6):983-9. doi: 10.2337/dc09-0025. Epub 2009 Feb 27.

Usual source of care as a health insurance substitute for U.S. adults with diabetes?

Author information

  • 1Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA. devoej@ohsu.edu

Abstract

OBJECTIVE:

The purpose of this study was to examine the effects of health insurance and/or a usual source of care (USC) on receipt of diabetic-specific services and health care barriers for U.S. adults with diabetes.

RESEARCH DESIGN AND METHODS:

Secondary analyses of data from 6,562 diabetic individuals aged >or=18 years from the nationally representative Medical Expenditure Panel Survey from 2002 to 2005 were performed. Outcome measures included receipt of seven diabetic services plus five barriers to care.

RESULTS:

More than 84% of diabetic individuals in the U.S. had full-year coverage and a USC; 2.3% had neither one. In multivariate analyses, the uninsured with no USC had one-fifth the odds of receiving A1C screening (odds ratio 0.23 [95% CI 0.14-0.38]) and one-tenth the odds of a blood pressure check (0.08 [0.05-0.15]), compared with insured diabetic individuals with a USC. Similarly, being uninsured without a USC was associated with 5.5 times the likelihood of unmet medical needs (5.51 [3.49-8.70]) and three times more delayed urgent care (3.13 [1.53-6.38]) compared with being insured with a USC. Among the two groups with either insurance or a USC, diabetic individuals with only a USC had rates of diabetes-specific care more similar to those of insured individuals with a USC. In contrast, those with only insurance were closer to the reference group with fewer barriers to care.

CONCLUSIONS:

Insured diabetic individuals with a USC were better off than those with only a USC, only insurance, or neither one. Policy reforms must target both the financing and the delivery systems to achieve increased receipt of diabetes services and decreased barriers to care.

PMID:
19252167
[PubMed - indexed for MEDLINE]
PMCID:
PMC2681031
Free PMC Article
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