Relationship between insurance and access and cost of care in patients with diabetes before and after the affordable care act
International Journal of Health Governance
ISSN: 2059-4631
Article publication date: 16 December 2020
Issue publication date: 24 February 2021
Abstract
Purpose
The purpose of this paper is to examine the influence of insurance coverage changes over time for patients with diabetes on expenditures and access to care before and after the Affordable Care Act (ACA).
Design/methodology/approach
The Medical Expenditure Panel Survey (MEPS) from 2002–2017 was used. Access included having a usual source of care, having delay in care or having delay in obtaining prescription medicine. Expenditures included inpatient, outpatient, office-based, prescription and emergency costs. Panels were broken into four time categories: 2002–2005 (pre-ACA), 2006–2009 (pre-ACA), 2010–2013 (post-ACA) and 2014–2017 (post-ACA). Logistic models for access and two-part regression models for cost were used to understand differences by insurance type over time.
Findings
Type of insurance changed significantly over time, with an increase for public insurance from 30.7% in 2002–2005 to 36.5% in 2014–2017 and a decrease in private insurance from 62.4% in 2002–2005 to 58.2% in 2014–2017. Compared to those with private insurance, those who were uninsured had lower inpatient ($2,147 less), outpatient ($431 less), office-based ($1,555 less), prescription ($1,869 less) and emergency cost ($92 less). Uninsured were also more likely to have delay in getting medical care (OR = 2.22; 95% CI 1.86, 3.06) and prescription medicine (OR = 1.85; 95% CI 1.53, 2.24) compared with privately insured groups.
Originality/value
Though insurance coverage among patients with diabetes did not increase significantly, the type of insurance changed overtime and fewer individuals reported having a usual source of care. Uninsured individuals spent less across all cost types and were more likely to report delay in care despite the passage of the ACA.
Keywords
Acknowledgements
Funding: This study was supported by Grant no. 5T3DK007431 and K24DK093699 from the National Institute of Diabetes and Digestive and Kidney Disease (PI: Leonard Egede).DeclarationsEthics approval and consent to participate: Not Applicable.Consent for publication: Not applicable.Availability of data and material: The data sets analyzed during the current study are available in the MEPS repository, https://meps.ahrq.gov/data_stats/download_data_files.jspDisclaimer: This article represents the views of the authors and not those of the NIH, VHA, or HSR&D.Author Contributions: LEE obtained funding for the study. AV, KGB, RJW, JSW, and LEE designed the study, KGB and SN analyzed the data, KGB, SN, RJW and LEE interpreted the results, AV and KGB, drafted the article, and RJW, JSW, and LEE critically revised the manuscript for important intellectual content. All authors approved the final manuscript.Conflicts of Interest: No financial, consultant, institutional or other conflicts of interest.
Citation
Varadarajan, A., Walker, R.J., Williams, J.S., Bishu, K., Nagavally, S. and Egede, L.E. (2021), "Relationship between insurance and access and cost of care in patients with diabetes before and after the affordable care act", International Journal of Health Governance, Vol. 26 No. 1, pp. 73-83. https://doi.org/10.1108/IJHG-02-2020-0014
Publisher
:Emerald Publishing Limited
Copyright © 2020, Emerald Publishing Limited