The association between health insurance coverage and diabetes care; Data from the 2000 Behavioral Risk Factor Surveillance System
The association between health insurance coverage and diabetes care; Data from the 2000 Behavioral Risk Factor Surveillance System
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DOI：
10.1111/j.1475-6773.2005.0d362.x
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Boyko, EJ
中科院分区：
文献类型：
--
作者：
Nelson, KM;Chapko, MK;Boyko, EJ
描述美国糖尿病患者的健康保险类型和护理质量之间的关系。2000年行为风险因素监测系统。我们的研究队列包括报告糖尿病诊断的个体（n= 11，647）。我们对年龄大于或小于65岁的患者进行了双变量和多变量logistic回归分析，以检查健康保险覆盖范围与糖尿病特定护理质量指标的相关性，控制种族/民族，年收入，性别，教育和胰岛素使用的影响。大多数糖尿病患者都有私人保险（39%）或医疗保险（44%）。在65岁以下的人中，11%没有保险。没有保险的人更有可能是非洲裔美国人或西班牙裔，收入较低。没有保险的人不太可能报告年度散瞳眼科检查，足部检查或血红蛋白A1 c（HbA 1c）测试，并且不太可能进行每日血糖监测。我们发现医疗保险，医疗补助，或退伍军人事务部（VA）与私人保险覆盖范围相比，质量指标几乎没有差异。通过VA接受护理的人更有可能报告参加糖尿病教育课程和HbA 1c测试比那些由私人保险覆盖的人。未投保的糖尿病成年人主要是少数民族和低收入，并且比有健康保险的人接受更少的预防服务。在被保险人中，不同类型的健康保险似乎提供了类似的护理水平，除了在VA的糖尿病教育和HbA 1c检测率较高。
To describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States.The 2000 Behavioral Risk Factor Surveillance System.Our study cohort included individuals who reported a diagnosis of diabetes (n=11,647). We performed bivariate and multivariate logistic regression analyses by age greater or less than 65 years to examine the association of health insurance coverage with diabetes-specific quality of care measures, controlling for the effects of race/ethnicity, annual income, gender, education, and insulin use.Most individuals with diabetes are covered by private insurance (39 percent) or Medicare (44 percent). Among persons under the age of 65 years, 11 percent were uninsured. The uninsured were more likely to be African American or Hispanic and report low incomes. The uninsured were less likely to report annual dilated eye exams, foot examinations, or hemoglobin A1c (HbA1c) tests and less likely to perform daily blood glucose monitoring than those with private health insurance. We found few differences in quality indicators between Medicare, Medicaid, or the Department of Veterans Affairs (VA) as compared with private insurance coverage. Persons who received care through the VA were more likely to report taking a diabetes education class and HbA1c testing than those covered by private insurance.Uninsured adults with diabetes are predominantly minority and low income and receive fewer preventive services than individuals with health insurance. Among the insured, different types of health insurance coverage appear to provide similar levels of care, except for higher rates of diabetes education and HbA1c testing at the VA.