Addressing Issues

Aligning Payment Policies with Quality Improvement: Affordable insurance coverage

Affordable insurance of diabetes-specific services, prescription drugs, equipment and related medical supplies is essential to diabetes management. The level of health care insurance coverage can affect health outcomes. For example, poor health insurance coverage appears to contribute to increased microvascular complications (nephropathy and retinopathy) in Mexican Americans with type 2 diabetes. Of 255 people surveyed, 26 percent lacked any type of health insurance, and 28 percent relied on county- or federal-funded clinics rather than private doctors as their primary source of care. Microvascular complications were more common among those who received their health care from a clinic versus a private doctor, and among those who lacked health insurance coverage for outpatient doctor visits and medications.7

A study of factors that prevented patients with newly diagnosed diabetes from seeking medical care found that of seven variables examined, only lack of health insurance correctly predicted those patients who failed to seek medical care for their diabetes.8  Further, health care utilization appears to decrease as out-of-pocket patient costs such as co-pays increase. Benefit packages that require out-of-pocket payments may result in suboptimal use of diabetes preventive care services and contribute to poorer clinical outcomes.9  The economic burden on families can be substantial. Researchers examined the health insurance experience and out-of-pocket health care costs of families with a child with type 1 diabetes. They found that most families with a child with type 1 diabetes had health insurance, but incurred out-of-pocket health care costs that were 56 percent higher than those in the control families without diabetes.10

The cost of prescription drugs may be a barrier to patient participation in comprehensive diabetes management. Often polypharmacy is needed in adult patients for the management of glucose, lipid, and blood pressure as well as for microvascular and macrovascular complications of diabetes.11-15  It has been shown that acquisition of Medicare coverage is associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.16  In addition, the costs of expanding health insurance coverage for uninsured adults before they reach the age of 65 may be partially offset by subsequent reductions in health care use and spending for these adults after the age of 65, particularly if they have cardiovascular disease or diabetes before the age of 65.17

For a summary of Medicare coverage for people with diabetes click here

-Return to the Top-
-Return Home-

Continue to Issues: Aligning Payment Policies: Fixing the Quality Care Problem