A Usual Source of Care as a Health Insurance Substitute for Diabetics?

Abstract

Objective: To examine the effects of health insurance and/or a usual source of care (USC) on receipt of diabetic-specific services and healthcare barriers for US adults with diabetes.

Research design and methods: Secondary analyses of data from 6,562 diabetics ≥18 years from the nationally-representative Medical Expenditure Panel Survey from 2002-2005. Outcome measures included receipt of 7 diabetic services plus 5 barriers to care.

Results: Over 84% of US diabetics had full-year coverage and a USC; 2.3% had neither one. In multivariate analyses, the uninsured with no USC had 1/5 the odds of receiving HgAlc screening (OR 0.23; 95% CI 0.14-0.38); 1/10 the odds of a blood pressure check (OR 0.08; 95% CI 0.05-0.15), compared with insured diabetics with a USC. Similarly, being uninsured without a USC was associated with 5.5 times the likelihood of unmet medical needs (OR 5.51; 95% CI, 3.49-8.70) and 3 times more delayed urgent care (OR 3.13; 95% CI 1.53, 6.38), compared to being insured with a USC. Among the two groups with either insurance or a USC, diabetics with only a USC had rates of diabetic-specific care more similar to the insured with a USC. In contrast, those with only insurance were closer to the reference group with fewer barriers to care.

Conclusions: Insured diabetics 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.