Brown Derek S, McBride Timothy D
Brown School, Campus Box 1196, 1 Brookings Dr, Washington University in St. Louis, St. Louis, MO 63130. Email:
Brown School, Washington University in St. Louis, St. Louis, Missouri.
Prev Chronic Dis. 2015 May 7;12:E64. doi: 10.5888/pcd12.140431.
Lack of health insurance is a barrier to medical care, which may increase the risk of diabetes complications and costs. The objective of this study was to assess the potential of the Affordable Care Act (ACA) of 2010 to improve diabetes care through increased health care access by comparing health care and health outcomes of insured and uninsured people with diabetes.
We examined demographics, access to care, health care use, and health care expenditures of adults aged 19 to 64 years with diabetes by using the 2011 and 2012 Medical Expenditure Panel Survey. Bivariate descriptive statistics comparing insured and uninsured persons were evaluated separately by income above and below 138% of the federal poverty level (FPL), (a threshold for expanded Medicaid eligibility in select states under the ACA) using the t test and proportion and median tests.
Uninsured adults reported poorer access to care than insured adults, such as having a usual source of health care (69.0% vs 89.5% [≤138% FPL], 77.1% vs 94.6% [>138% FPL], both P < .001) and having lower rates of 6 key diabetes preventive care services (P ≤ .05). Insured adults with diabetes had significantly higher health care expenditures than uninsured adults ($13,706 vs $4,367, $10,838 vs $4,419, respectively, both P < .001).
Uninsured adults with diabetes had less access to health care and lower levels of preventive care, health care use, and expenditures than insured adults. To the extent that the ACA increases access and coverage, uninsured people with diabetes are likely to significantly increase their health care use, which may lead to reduced incidence of diabetes complications and improved health.
缺乏医疗保险是获得医疗服务的障碍，这可能会增加糖尿病并发症的风险和成本。本研究的目的是通过比较有保险和无保险的糖尿病患者的医疗服务和健康结果，评估2010年《平价医疗法案》（ACA）通过增加医疗服务可及性来改善糖尿病护理的潜力。
我们使用2011年和2012年医疗支出小组调查，研究了19至64岁患有糖尿病的成年人的人口统计学特征、医疗服务可及性、医疗服务使用情况和医疗支出。使用t检验、比例检验和中位数检验，分别按收入高于和低于联邦贫困水平（FPL）的138%（ACA规定的部分州扩大医疗补助资格的阈值），对有保险和无保险的人群进行双变量描述性统计比较。
无保险的成年人报告的医疗服务可及性比有保险的成年人差，例如有常规医疗服务来源的比例（[≤138% FPL]时为69.0%对89.5%，[>138% FPL]时为77.1%对94.6%，P均<.001）以及6项关键糖尿病预防护理服务的使用率较低（P≤.05）。患有糖尿病的有保险成年人的医疗支出显著高于无保险成年人（分别为13,706美元对4,367美元，10,838美元对4,419美元，P均<.001）。
与有保险的成年人相比，无保险的糖尿病成年人获得医疗服务的机会更少，预防护理水平、医疗服务使用情况和支出更低。在ACA增加可及性和覆盖范围的程度上，无保险的糖尿病患者可能会显著增加其医疗服务使用，这可能会导致糖尿病并发症发病率降低和健康状况改善。
