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Diabetes Care. 2014 Jun;37(6):1629-35. doi: 10.2337/dc13-1997. Epub 2014 Mar 25.

Changes over time in high out-of-pocket health care burden in U.S. adults with diabetes, 2001-2011.

Author information

  • 1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA eok8@cdc.gov.
  • 2Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
  • 3David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.



High out-of-pocket (OOP) costs can be an obstacle to health care access and treatment compliance. This study investigated trends in high OOP health care burden in people with diabetes.


Using Medical Expenditure Panel Survey 2001-2011 data, we examined trends in the proportion of people aged 18-64 years with diabetes facing a high OOP burden. We also examined whether the trend differed by insurance status (private insurance, public insurance, or no insurance) or by income level (poor and near poor, low income, middle income, or high income).


In 2011, 23% of people with diabetes faced high OOP burden. Between 2001-2002 and 2011, the proportion of people facing high OOP burden fell by 5 percentage points (P < 0.01). The proportion of those who were publicly insured decreased by 22 percentage points (P < 0.001) and of those who were uninsured by 12 percentage points (P = 0.01). Among people with diabetes who were poor and near poor and those with low income, the proportion facing high OOP burden decreased by 21 (P < 0.001) and 13 (P = 0.01) percentage points, respectively; no significant change occurred in the proportion with private insurance or middle and high incomes between 2001-2002 and 2011.


The past decade has seen a narrowing of insurance coverage and income-related disparities in high OOP burden in people with diabetes; yet, almost one-fourth of all people with diabetes still face a high OOP burden.

© 2014 by the American Diabetes Association.

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