Receipt of diabetes preventive services differs by insurance status at visit

Abstract

Background: Lack of insurance is associated with suboptimal receipt of diabetes preventive care. One known reason for this is an access barrier to obtaining healthcare visits; however, little is known about whether insurance status is associated with differential rates of receipt of diabetes care during visits.

Purpose: To examine the association between health insurance and receipt of diabetes preventive care during an office visit.

Methods: This retrospective cohort study used electronic health record and Medicaid data from 38 Oregon community health centers. Logistic regression was used to test the association between insurance and receipt of four diabetes services during an office visit among patients who were continuously uninsured (n=1,117); continuously insured (n=1,466); and discontinuously insured (n=336) in 2006-2007. Generalized estimating equations were used to account for within-patient correlation. Data were analyzed in 2013.

Results: Overall, continuously uninsured patients had lower odds of receiving services at visits when due, compared to those who were continuously insured (AOR=0.73, 95% CI=0.66, 0.80). Among the discontinuously insured, being uninsured at a visit was associated with lower odds of receipt of services due at that visit (AOR=0.77, 95% CI=0.64, 0.92) than being insured at a visit.

Conclusions: Lack of insurance is associated with a lower probability of receiving recommended services that are due during a clinic visit. Thus, the association between being uninsured and receiving fewer preventive services may not be completely mediated by access to clinic visits.

Figure 1

Figure 1A. Odds of a patient receiving services due at the time of visit: Continuously uninsured patients vs. continuously insured patients (reference group); Figure 1B. Odds of a discontinuously insured patient receiving services due at the time of visit: uninsured visits vs. visits when insured (reference group). Source. 2006–2007 data from 38 Oregon clinics in the OCHIN network that had fully operational electronic health records by 2005. Medicaid insurance status verified and supplemented by 2006–2007 Oregon Medicaid enrollment data. Notes. Diamonds represent estimated odds ratios; vertical lines represent corresponding 95% CIs. Odds ratios are estimated using a single generalized estimating equation (GEE) logistic regression of receipt of services at visits in which a service was due adjusted for fixed effects of the type of service due, clinic, gender, Hispanic ethnicity, race, age, and income below 100% of the Federal Poverty Level (FPL) ratios. Odds ratios of specific services and an aggregate measure of any service received when due are reported. HbA1c= hemoglobin A1c; LDL=low-density lipoprotein; Microalbumin=urine microalbumin; Influenza vx=influenza vaccination.