Healthcare Costs for Diabetes Associated with Health Disparities in Puerto Rico

This study compared the healthcare utilization of and costs for adults (18-64 years) with diabetes mellitus (DM) by plan type in Puerto Rico in 2013. This study is important because understanding disparities in healthcare access and expenditures can inform public health policy decisions aimed at improving diabetes care in Puerto Rico.

Puerto Rico public and private medical insurance paid claims and enrollment data from 2013 were used to calculate the diabetes prevalence and medical care expenditures associated with this disease for total enrollers and by type of health insurance. This cross-sectional analytic study analyzed healthcare claims from 96% of the insured population in Puerto Rico, providing a comprehensive assessment of diabetes-related healthcare costs.

The total expenditure for patients with DM for 2013 was $388,536,735, with 58.0% attributed to the private sector. In the public sector, the largest expenditure was for hospital services (53.8%), while in the private sector, the highest spending occurred in outpatient services (54.6%). After adjusting for sex, age, Charlson comorbidity index, and percent of copayment, public insurance beneficiaries were more likely to use hospital services (PR=3.23, 95% CI: 3.13-3.33, p<0.001) and emergency services (PR=1.61, 95% CI: 1.56-1.64, p<0.001), while private insurance beneficiaries used more ambulatory services (PR=0.91, 95% CI: 0.89-0.93, p<0.001).

The findings of this study suggest disparities in access to primary health services for people with DM between public and private insureds, and that there is no continuity of care, leading to high costs for such services.