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

Abstract

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

Methods: 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).

Results: 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.

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

FIGURE 1—

Frequency of Outpatient Visits Among Nonelderly Adults Living Below the Federal Poverty Line (Unadjusted n = 4461): 1999–2012 US National Health and Nutritional Examination Surveys

FIGURE 2—

Chronic Disease Measures for Medicaid vs Uninsured: 1999–2012 US National Health and Nutritional Examination Surveys Note. CI = confidence interval. A separate model was generated for each predictor. Each model adjusted for gender, age, race/ethnicity, disability, and year of survey.