Insurance coverage and diabetes quality indicators among patients in NHANES

Individuals with diabetes have improved care when insured, but outcomes for type of insurance are mixed, and key quality measures have been limited to self-report in most nationally representative studies. This study aims to assess the association between the quality of diabetes care and type of health insurance.

This is a cross-sectional, secondary analysis of the 2009-2010 and 2011-2012 National Health and Nutrition Examination Survey (NHANES) of adults aged 18 to 64 years with self-reported diabetes and either no insurance, Medicaid, or private insurance (n = 642).

Regression analysis was performed before and after adjusting for sociodemographics, chronicity, and severity of disease.

Adjusted analysis indicates that participants with private insurance had 2.73 times (95% CI, 1.24-6.03) the odds of controlled blood pressure compared with the uninsured. Participants with Medicaid were more likely to have had a foot exam and an eye exam in the last year (foot exam: odds ratio (OR), 2.81; 95% CI, 1.28-6.14; eye exam: OR, 4.79; 95% CI, 2.89-7.95), as were patients with private insurance (foot exam: OR, 2.59; 95% CI, 1.71-3.93; eye exam: OR, 2.96; 95% CI, 1.77-4.96) compared with the uninsured. No other statistically significant relationships were observed.

Overall, patients with insurance were more likely to meet 3 of 5 quality indicators for diabetes care compared with those without insurance. Glycated hemoglobin was not different among insurance groups. Results support the conclusion that access to health insurance is associated with improved diabetes management. There was no evidence for differences in diabetes quality measures between the privately and publicly insured. Additional research is needed to determine optimal coverage to maximize care quality.