a Professor, Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA.
J Aging Soc Policy. 2015;27(1):63-86. doi: 10.1080/08959420.2015.969114.
Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states.
糖尿病是一个严重的全球公共卫生挑战。过去 5 年来，用于糖尿病护理的医疗服务成本增加了 41%。尽管医疗支出不断增加，但美国的糖尿病发病率仍高于许多其他发达国家。美国不仅需要进行医疗保健改革以降低医疗成本，还需要改善预防性保健的质量。本研究提出了一种多层次模型的检验，以研究个体和州层面的变量，从而更好地了解可以为 50 岁以上的 2 型糖尿病患者提供所需的预防性高质量护理的最重要的背景途径。该模型使用三级重复横断面设计和来自各种现有数据源的数据进行了测试，使用了一个全国性的 181,870 名 50 岁及以上成年人的样本。结果表明，州级医疗保健系统的差异导致了获得服务的不平等。具体而言，在一个 65 岁及以上成年人比例较高且医疗保健专业人员短缺的州，获得推荐的预防性高质量护理的可能性降低。此外，在诊断出糖尿病患者比例较高但人均医疗保健支出低于平均水平的州，接受高质量预防性护理的老年患者情况更糟。最后，在拥有较高比例未参保人口的富裕州，获得高质量预防性护理的老年患者可能性最低。建议进行医疗保健改革，类似于当前 2010 年《患者保护与平价医疗法案》所倡导的改革，以改善所有州所有医疗保健系统的绩效。
