Impact of Expanded Medicaid Eligibility on the Diabetes Continuum of Care Among Low-Income Adults: A Difference-in-Differences Analysis

Yan, Lily; Ali, Mohammed K.; Strombotne, Kiersten L.

doi:10.1016/j.amepre.2020.08.013

Cited by 10 publications

(5 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous data have also shown an association between type of insurance coverage and quality of care [ 16 ]. While lack of insurance would be expected to be associated with inadequate clinical care, expansion of Medicaid coverage was not associated with much of a change in diabetes related outcomes [ 17 ]. Thus, neighborhood may be a more important factor in receiving adequate diabetes care.…”

Section: Discussionmentioning

confidence: 99%

Predictors of lack of glycemic control in persons with type 2 diabetes

Louie,

Shiffman,

Rowland

et al. 2024

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

Background Professional guidelines recommend an HbA1c < 7% for most people with diabetes and < 8.5% for those with relaxed glycemic goals. However, many people with type 2 diabetes mellitus (T2DM) are unable to achieve the desired HbA1c goal. This study evaluated factors associated with lack of improvement in HbA1c over 3 years. Methods All patients with T2DM treated within a major academic healthcare system during 2015–2020, who had at least one HbA1c value > 8.5% within 3 years from their last HbA1c were included in analysis. Patients were grouped as improved glycemic control (last HbA1c ≤ 8.5%) or lack of improvement (last HbA1c > 8.5%). Multivariate logistic regression analysis was performed to assess independent predictors of lack of improvement in glycemic control. Results Out of 2,232 patients who met the inclusion criteria, 1,383 had an improvement in HbA1c while 849 did not. In the fully adjusted model, independent predictors of lack of improvement included: younger age (odds ratio, 0.89 per 1-SD [12 years]; 95% CI, 0.79–1.00), female gender (1.30, 1.08–1.56), presence of hypertension (1.29, 1.08–1.55), belonging to Black race (1.32, 1.04–1.68, White as reference), living in low income area (1.86,1.28–2.68, high income area as reference), and insurance coverage other than Medicare (1.32, 1.05–1.66). Presence of current smoking was associated with a paradoxical improvement in HbA1c (0.69, 0.47—0.99). In a subgroup analysis, comparing those with all subsequent HbA1c values > 8.5% (N = 444) to those with all subsequent HbA1c values < 8.5% (N = 341), similar factors were associated with lack of improvement, but smoking was no longer significant. Conclusion We conclude that socioeconomic factors like race, type of insurance coverage and living in low-income areas are associated with lack of improvement in HbA1c over a period of 3-years in people with T2DM. Intervention strategies focused on low-income neighborhoods need to be designed to improve diabetes management.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of lack of glycemic control in persons with type 2 diabetes

Louie,

Shiffman,

Rowland

et al. 2024

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

show abstract

“…However, in reality, outcomes change over time after the policy introduction ( 27 ). When panel data are obtained through sampling and analysis, observations are made for a long period after treatment to increase statistical power; thus, difference-in-differences estimates using TWFE regression are not appropriate ( 28 ). In the present study, we avoided these problems by constructing a cohort of patients with TB based on the National Health Information Database.…”

Section: Discussionmentioning

confidence: 99%

Beyond reducing direct medical cost: examining health outcomes in tuberculosis through a difference-in-differences analysis of South Korea’s out-of-pocket payment exception policy

Yu,

Moon,

Jeong

et al. 2024

Front. Public Health

View full text Add to dashboard Cite

BackgroundUniversal health coverage and social protection are major global goals for tuberculosis. This study aimed to investigate the effects of an expanded policy to guarantee out-of-pocket costs on the treatment outcomes of patients with tuberculosis.MethodsBy linking the national tuberculosis report and health insurance data and performing covariate-adjusted propensity-score matching, we constructed data on health insurance beneficiaries (treatment group) who benefited from the out-of-pocket payment exemption policy and medical aid beneficiaries as the control group. Using difference-in-differences analysis, we analyzed tuberculosis treatment completion rates and mortality in the treatment and control groups.ResultsA total of 41,219 persons (10,305 and 30,914 medical aid and health insurance beneficiaries, respectively) were included in the final analysis (men 59.6%, women 40.4%). Following the implementation of out-of-pocket payment exemption policy, treatment completion rates increased in both the treatment and control groups; however, there was no significant difference between the groups (coefficient, −0.01; standard error, 0.01). After the policy change, the difference in mortality between the groups increased, with mortality decreasing by approximately 3% more in the treatment group compared with in the control group (coefficient: −0.03, standard error, 0.01).ConclusionThere are limitations to improving treatment outcomes for tuberculosis with an out-of-pocket payment exemption policy alone. To improve treatment outcomes for tuberculosis and protect patients from financial distress due to the loss of income during treatment, it is essential to proactively implement complementary social protection policies.

show abstract

“…[6][7][8] Using Behavioral Risk Factor Surveillance System data (2008-2018) and a Difference-In-Differences study design Yan et al found that Medicaid expansion was not associated with any changes in treatment or self-management among newly Medicaid-eligible patients with diabetes, residing in expansion states, relative to those residing in non-expansion states. 9 Using all state hospital discharge records in Pennsylvania, Fisher and Ma found that the numbers of emergent/urgent diabetes-related hospital admissions among patients with diabetes and Medicaid coverage and with diabetes without insurance were not statistically different. 10 The literature is replete with examples of pharmacist-led interventions improving outcomes among patients with diabetes in the general population.…”

Section: Introductionmentioning

confidence: 99%

An Effectiveness Study of a Primary Care-embedded Clinical Pharmacist-Led Intervention Among Patients With Diabetes and Medicaid Coverage

Narain

Tseng

Bell

et al. 2022

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Objective Examine the impact of a primary care-embedded clinical pharmacist-led intervention (UCMyRx) on hemoglobin A1C and blood pressure control, relative to usual care, among patients with Type 2 diabetes (TD2) and Medicaid, in a large healthcare system. Methods We used data extracted from the Electronic Health Records system and a Difference-In-Differences study design with a 2:1 propensity-matched comparison group to evaluate the impact of UCMyRx on HbA1c and systolic blood pressure among patients with TD2 and Medicaid, relative to usual care. Results Having at least one UCMyRx clinical pharmacist visit was associated with a significant reduction in HbA1c; (−.27%, P-value= .03) but no impact on SBP. We do not find differential UCMyRx effects on HbA1c or SBP among the subpopulations with baseline HbA1C ≥9% or SBP ≥150 mmHg, respectively. In Charlson Comorbidity Index (CCI)-stratified analyses we found stronger UCMyRx effects on HbA1C (−.47%, P-value< .02) among the CCI tercile with the lowest comorbidity score (CC1 ≤ 5). Significant UCMyRx effects are only observed among the subpopulation of Medicaid beneficiaries without Medicare (−.35%, P-value= .02). Conclusions The UCMyRx intervention is a useful strategy for improving HbA1c control among patients with TD2 and Medicaid.

show abstract

Impact of Expanded Medicaid Eligibility on the Diabetes Continuum of Care Among Low-Income Adults: A Difference-in-Differences Analysis

Cited by 10 publications

References 44 publications

Predictors of lack of glycemic control in persons with type 2 diabetes

Predictors of lack of glycemic control in persons with type 2 diabetes

Beyond reducing direct medical cost: examining health outcomes in tuberculosis through a difference-in-differences analysis of South Korea’s out-of-pocket payment exception policy

An Effectiveness Study of a Primary Care-embedded Clinical Pharmacist-Led Intervention Among Patients With Diabetes and Medicaid Coverage

Contact Info

Product

Resources

About