Usual Source of Care as a Health Insurance Substitute for U.S. Adults With Diabetes?
- Jennifer E. DeVoe, MD, DPHIL1,
- Carrie J. Tillotson, MPH2 and
- Lorraine S. Wallace, PHD3
- 1Department of Family Medicine, Oregon Health and Science University, Portland, Oregon;
- 2Oregon Clinical and Translational Research Institute and the Oregon Health and Science University, Portland, Oregon;
- 3University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, Tennessee.
- Corresponding author: Jennifer E. DeVoe, devoej{at}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 ≥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.
Footnotes
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The funding agencies had no involvement in the design and conduct of the study; analysis and interpretation of the data; and preparation, review, or approval of the manuscript. The Agency for Healthcare Research and Quality collects and manages the Medical Expenditure Panel Survey.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received January 7, 2009.
- Accepted February 22, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
