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Varadarajan A, Walker RJ, Williams JS, Bishu K, Nagavally S, Egede LE. 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 2020. [DOI: 10.1108/ijhg-02-2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe 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/approachThe 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.FindingsType 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/valueThough 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.
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Konchak JN, Moran MR, O'Brien MJ, Kandula NR, Ackermann RT. The State of Diabetes Prevention Policy in the USA Following the Affordable Care Act. Curr Diab Rep 2016; 16:55. [PMID: 27145778 PMCID: PMC5210175 DOI: 10.1007/s11892-016-0742-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Type 2 diabetes is a major public health problem in the USA, affecting over 12 % of American adults and imposing considerable health and economic burden on individuals and society. There is a strong evidence base demonstrating that lifestyle behavioral changes and some medications can prevent or delay the onset of type 2 diabetes in high risk adults, and several policy and healthcare system changes motivated by the Patient Protection and Affordable Care Act (ACA) have the potential to accelerate diabetes prevention. In this narrative review, we (1) offer a conceptual framework for organizing how the ACA may influence diabetes prevention efforts at the level of individuals, healthcare providers, and health systems; (2) highlight ACA provisions at each of these levels that could accelerate type 2 diabetes prevention nationwide; and (3) explore possible policy gaps and opportunity areas for future research and action.
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Affiliation(s)
- Juleigh Nowinski Konchak
- Preventive Medicine Residency, Cook County Health and Hospitals System, 1900 W Polk Street, Room 901, Chicago, IL, 60612, USA
| | - Margaret R Moran
- Department of Medicine, Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Matthew J O'Brien
- Department of Medicine, Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Namratha R Kandula
- Department of Medicine, Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
- American Medical Association, Improving Health Outcomes, 330 N Wabash, Chicago, IL, 60611, USA
| | - Ronald T Ackermann
- Department of Medicine, Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA.
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Powers AC, Wexler JA, Lash RW, Dyer MC, Becker MN, Vigersky RA. Affordable Care Act Implementation: Challenges and Opportunities to Impact Patients With Diabetes. J Clin Endocrinol Metab 2016; 101:1315-7. [PMID: 27007692 PMCID: PMC5399518 DOI: 10.1210/jc.2016-1047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alvin C Powers
- Departments of Medicine and Molecular Physiology and Biophysics (A.C.P.), Vanderbilt University Medical Center, Nashville, Tennessee 37232; Medtronic Diabetes (R.A.V.), Minneapolis, Minnesota 55432; Walter Reed National Military Medical Center (R.A.V.), Bethesda, Maryland 20814; MedStar Washington Hospital Center (J.A.W.), Washington, DC 20010; University of Michigan Health System (R.W.L.), Ann Arbor, Michigan 48108; and the Endocrine Society (M.C.D., M.N.B.), Washington, DC 20036
| | - Jason A Wexler
- Departments of Medicine and Molecular Physiology and Biophysics (A.C.P.), Vanderbilt University Medical Center, Nashville, Tennessee 37232; Medtronic Diabetes (R.A.V.), Minneapolis, Minnesota 55432; Walter Reed National Military Medical Center (R.A.V.), Bethesda, Maryland 20814; MedStar Washington Hospital Center (J.A.W.), Washington, DC 20010; University of Michigan Health System (R.W.L.), Ann Arbor, Michigan 48108; and the Endocrine Society (M.C.D., M.N.B.), Washington, DC 20036
| | - Robert W Lash
- Departments of Medicine and Molecular Physiology and Biophysics (A.C.P.), Vanderbilt University Medical Center, Nashville, Tennessee 37232; Medtronic Diabetes (R.A.V.), Minneapolis, Minnesota 55432; Walter Reed National Military Medical Center (R.A.V.), Bethesda, Maryland 20814; MedStar Washington Hospital Center (J.A.W.), Washington, DC 20010; University of Michigan Health System (R.W.L.), Ann Arbor, Michigan 48108; and the Endocrine Society (M.C.D., M.N.B.), Washington, DC 20036
| | - Meredith C Dyer
- Departments of Medicine and Molecular Physiology and Biophysics (A.C.P.), Vanderbilt University Medical Center, Nashville, Tennessee 37232; Medtronic Diabetes (R.A.V.), Minneapolis, Minnesota 55432; Walter Reed National Military Medical Center (R.A.V.), Bethesda, Maryland 20814; MedStar Washington Hospital Center (J.A.W.), Washington, DC 20010; University of Michigan Health System (R.W.L.), Ann Arbor, Michigan 48108; and the Endocrine Society (M.C.D., M.N.B.), Washington, DC 20036
| | - Mila N Becker
- Departments of Medicine and Molecular Physiology and Biophysics (A.C.P.), Vanderbilt University Medical Center, Nashville, Tennessee 37232; Medtronic Diabetes (R.A.V.), Minneapolis, Minnesota 55432; Walter Reed National Military Medical Center (R.A.V.), Bethesda, Maryland 20814; MedStar Washington Hospital Center (J.A.W.), Washington, DC 20010; University of Michigan Health System (R.W.L.), Ann Arbor, Michigan 48108; and the Endocrine Society (M.C.D., M.N.B.), Washington, DC 20036
| | - Robert A Vigersky
- Departments of Medicine and Molecular Physiology and Biophysics (A.C.P.), Vanderbilt University Medical Center, Nashville, Tennessee 37232; Medtronic Diabetes (R.A.V.), Minneapolis, Minnesota 55432; Walter Reed National Military Medical Center (R.A.V.), Bethesda, Maryland 20814; MedStar Washington Hospital Center (J.A.W.), Washington, DC 20010; University of Michigan Health System (R.W.L.), Ann Arbor, Michigan 48108; and the Endocrine Society (M.C.D., M.N.B.), Washington, DC 20036
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