Insurance Status and Quality of Diabetes Care in Community Health Centers

Abstract

Objective To compare the quality of care by insurance type in federally-funded community health centers (HC). Method A total of 2,018 diabetes patients, randomly selected from 27 HCs in 17 states in the year 2002, were categorized into six mutually exclusive insurance groups. Quality of diabetes care, using six National Committee for Quality Assurance (NCQA) Health Plan Employer Data and Information Set (HEDIS) diabetes processes of care and outcome measures, were compared using multivariate logistic regression analyses. Results Thirty-three percent of patients had no health insurance, 24% had Medicare without Medicaid, 15% Medicaid without Medicare, 7% were Medicare-Medicaid dual eligibles, 14% had private insurance, and 7% had other type of insurance. Those without insurance were least likely to meet the HEDIS quality-of-care measures, and those with Medicaid had quality of care that was very similar to those with no insurance. Conclusion Research is needed to identify the major mediators of differences in quality of care by insurance status in safety-net providers such as HCs, for policy interventions at Medicaid benefit design, and incentive to improve quality of care.

Quality of Care Associated with Common Chronic Diseases in a 9-State Medicaid Population Utilizing Claims Data: An Evaluation of Medication and Health Care Use and Costs

“…1 Recent research suggests that these goals are not being met for many publicly insured Americans. [2][3][4][5][6] Medicaid coverage, compared with other insurance types such as commercial or self-pay insurance, has shown an association with poorer access to preventive, acute, and follow-up care. 2,3 The reasons for these discrepancies in care and outcomes based on insurance type are likely multifactorial and could include insufficient funding, sicker patients, and subpar health care providers and organizations.…”

“…4 For all the interest in improving quality of care in the Medicaid population, surprisingly little is known about the current baseline quality of care for common diseases for Medicaid-dependent individuals on a population health level. Studies of quality of care have generally been limited to single conditions or specific subsets of the Medicaid population.…”

“…For example, a study comparing insurance status and diabetes quality of care at community health centers revealed that Medicaid patients received low quality of care, similar to the uninsured. 4 In another study evaluating quality of care, Medicaid managed care was compared to commercial managed care and it was found that Medicaid patients received lower quality of care than the commercially insured. 5 Similarly, while previous studies have been conducted to evaluate differences in medication treatment and adherence by race, the majority have focused on specific conditions or subsets with varying end points and methodologies.…”

Novel methodology using publicly reported data to study percutaneous coronary stent utilization in the United States: Linking centres for medicare medicaid services provider analysis and review inpatient data with hospital and community characteristics

“…Socioeconomic and racial status and type of insurance has consistently been a predictor in the rendering of medical care [4][5][6]. The Provider Utilization and Payment Data Inpatient Public Use File database can be utilized to study disparities in care of patients with…”

Association Between Quality of Care and the Sociodemographic Composition of Physicians’ Patient Panels: A Repeat Cross-Sectional Analysis

“…This may reflect that Medicaid-eligible patients have been found to have lower quality of care in other studies; they are also more likely to report poor health, which may increase the number of problems providers must address at each appointment and make it less likely that routine preventive services can be administered. 17,18 However, it may also be related to some other aspect of the way Medicaid services are administered or reimbursed. In anticipation of possible expansions of Medicaid programs nationwide, the delivery of preventive care to Medicaid recipients may merit further study.…”