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Am J Public Health. 2016 Jan;106(1):63-9. doi: 10.2105/AJPH.2015.302925. Epub 2015 Nov 12.

Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured.

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Andrea S. Christopher, Danny McCormick, Steffie Woolhandler, David U. Himmelstein, and David H. Bor are with the Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA. S. Woolhandler and D. U. Himmelstein are also with the City University of New York School of Public Health at Hunter College, New York, NY. Andrew P. Wilper is with the Department of Medicine, Boise Veterans Affairs Medical Center, Boise, ID.



We sought to determine the association between Medicaid coverage and the receipt of appropriate clinical care.


Using the 1999 to 2012 National Health and Nutritional Examination Surveys, we identified adults aged 18 to 64 years with incomes below the federal poverty level, and compared outpatient visit frequency, awareness, and control of chronic diseases between the uninsured (n = 2975) and those who had Medicaid (n = 1485).


Respondents with Medicaid were more likely than the uninsured to have at least 1 outpatient physician visit annually, after we controlled for patient characteristics (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 3.8, 6.6). Among poor persons with evidence of hypertension, Medicaid coverage was associated with greater awareness (OR = 1.83; 95% CI = 1.26, 2.66) and control (OR = 1.69; 95% CI = 1.32, 2.27) of their condition. Medicaid coverage was also associated with awareness of being overweight (OR = 1.30; 95% CI = 1.02, 1.67), but not with awareness or control of diabetes or hypercholesterolemia.


Among poor adults nationally, Medicaid coverage appears to facilitate outpatient physician care and to improve blood pressure control.

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