Gaps in insurance coverage linked to less receipt of preventive services by patients with diabetes
Patients in safety-net clinic settings may receive care regardless of insurance status. However, continuity of insurance coverage can make a difference in whether optimal care is received. During coverage gaps, it is likely that patients delay getting preventive care until securing insurance coverage again. In fact, a new study reveals that patients with diabetes who have gaps in coverage, regardless of the duration of the gap, receive less diabetes preventive care than their continuously insured counterparts.
A team of researchers investigated whether the amount of time with insurance coverage had a dose-response relationship with the likelihood of receiving diabetes preventive care over a 3-year study period among patients treated at safety-net clinics. They found no evidence of a relationship with increasing duration of coverage, nor of a threshold amount of partial coverage, associated with better receipt of care. In almost all cases, those insured for 1 percent to 99 percent of the study period received services less often than the continuously insured, with no pattern of differences in receipt of care. Clinical preventive services included in the study were low-density lipoprotein screens, influenza vaccinations, HbA1c screens (a test for blood-glucose level), and microalbumin screens (to detect diabetes-related kidney damage). All of these tests are recommended to be done annually for patients with diabetes. The study group consisted of 3,384 adults with diabetes—711 were partially insured (covered for 1 to 99 percent of the 3-year study period), 909 had no coverage, and 1,764 were continuously insured.
The researchers concluded that persons in vulnerable populations need both access to primary care and continuous insurance coverage. This study was supported in part by the Agency for Healthcare Research and Quality (HS16181).
See "Receipt of diabetes preventive care among safety net patients associated with differing levels of insurance coverage" by Rachel Gold, PhD, Jennifer E. DeVoe, M.D., D.Phil., Patti J. McIntire, B.A., and others in the January-February 2012 Journal of the American Board of Family Medicine 25(1), pp. 40-49.
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