The Quality of Diabetes Care by Insurance Status in Community Health Centers
- Presenter:
Chair: Dean Lillard; Discussant: James Marton Wed June 7, 2006 8:00-9:30 Room 121
Rationale: Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all persons in the United States. Community health centers (CHCs) provide critical primary health care to 12 million Americans with or without health insurance in medically underserved areas. Over forty percent of CHC patients are uninsured and over one-third are on Medicaid; therefore, understanding how insurance status relates to care at CHCs is important for improving medical care for vulnerable CHC patients.
Objective: The objective of this study is to compare the quality of care for diabetes patients by insurance status at 27 CHCs, including patients without health insurance and Medicaid/Medicare Dual Eligibles (DEs).
Methodology: We sampled 27 CHCs in 17 West Central and Midwest states in the year 2002. A total of 2,052 diabetes patients were enrolled in the study. We developed an algorithm to expand the insurance groupings commonly reported in the literature and categorized our diabetes patients into six mutually exclusive groups that included a Medicare/Medicaid dual eligible (DE) group, as well as groups for no insurance, Medicare without Medicaid, Medicaid without Medicare, private insurance, and other. We used a set of six quality of care indicators developed by National Committee for Quality Assurance (NCQA) to assess the quality of care. We applied multivariate regression analysis technique to analyze the association between the insurance coverage and quality of care, adjusting for age, gender, race, one dummy variable for urban location of services, seven dummy variables for medical comorbidity/complications, and CHC site fixed-effects. The quality of care in those CHCs were further compared to that in commercial managed care plans located in these states.
Results: This study reveals that in CHCs there are differences in quality of diabetes care by insurance status. Patients without insurance, and younger patients with Medicaid fared the worst in six comprehensive diabetes care quality indicators. In contrast, Medicaid/Medicare dual eligibles received better quality of care despite being more frail and vulnerable both medically and economically. Patients with private insurance did significantly better in four of the six quality indicators.
Conclusion: Our findings support the initiative to create and expand CHCs in communities to improve access to care for the poor and vulnerable, such as the Federal Health Center Growth Initiative supported by the current administration. Our study also argues for coupling expanding CHC service locations with increasing insurance coverage to achieve the best health outcomes for the hundreds of thousands indigent diabetes patients who rely on safety-net providers for their primary care.
