Changes in diabetes prescription patterns following Affordable Care Act Medicaid expansion

Gemelas, Jordan; Valenzuela, Steele; Schmidt, Teresa; Suchocki, Andrew; Huguet, Nathalie

doi:10.1136/bmjdrc-2021-002135

Cited by 3 publications

(1 citation statement)

References 25 publications

(11 reference statements)

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“…The current study sought to examine the association between Medicaid expansion and hospitalizations with DKA. While the literature has some studies exploring the impact of Medicaid expansion on diabetes and its management [12][13][14][15][16][17][18][19], none of them have looked specifically into DKA hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

The Association Between Medicaid Expansion and Diabetic Ketoacidosis Hospitalizations

Tekin¹,

Saygili²

2022

Cureus

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Background and objectiveDiabetic ketoacidosis (DKA) is a potentially fatal complication of uncontrolled diabetes and remains a significant source of morbidity and mortality even though it is considered preventable. Diabetes is a chronic illness that requires constant monitoring and regular check-ups. Delaying or foregoing necessary diabetes care due to a lack of health insurance can result in severe complications. The Affordable Care Act (ACA) Medicaid expansion is intended to increase access to healthcare and improve health outcomes. This study aimed to examine the relationship between the ACA Medicaid expansion and hospitalizations with DKA. MethodsThis retrospective cross-sectional study used discharge records from 2010 to 2017 for hospitals in Texarkana, located on the border of Texas and Arkansas. The study employed a difference-in-differences method. Patients from Arkansas, which expanded Medicaid in 2014, constituted the treatment group, while those from Texas, which did not adopt the expansion, were the control group. A triple difference methodology was used to compare the impact of the expansion on patients with different socioeconomic backgrounds. The main outcome measure was DKA per 1000 discharges. ResultsA total of 89,184 inpatient discharges from Texarkana hospitals were analyzed; 43,286 patients were from Arkansas (48.54%) and 45,898 (51.46%) were from Texas. Even though DKA cases increased from preexpansion (2010-2013) to post-expansion (2014-2017) period among patients from Arkansas (by a mean of 4.33) and Texas (by a mean of 8.28), the increase was milder among Arkansas patients with an adjusted decrease of 4.17 per 1000 discharges (95% CI: -5.04 to -3.31; p<0.001), implying a 42% lower risk of hospitalizations with DKA compared to the baseline averages. The triple difference analysis suggested that the decrease in incidences was more pronounced for patients from low-income areas with an adjusted decrease of 13.47 per 1000 discharges (95% CI: -22.45 to -4.49; p=0.003). ConclusionsBased on our findings, Medicaid expansion decreases hospitalizations with DKA, presumably due to better monitoring and care of diabetes made possible by increasing access to healthcare among individuals with low incomes.

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Section: Introductionmentioning

confidence: 99%

The Association Between Medicaid Expansion and Diabetic Ketoacidosis Hospitalizations

Tekin¹,

Saygili²

2022

Cureus

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Factors Associated With Blood Pressure Control Among Patients in Community Health Centers

Huguet¹,

Green²,

Voss³

et al. 2023

American Journal of Preventive Medicine

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Economic Costs of Diabetes in the U.S. in 2022

Parker,

Lin,

Mahoney

et al. 2023

Diabetes Care

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OBJECTIVE This study updates previous estimates of the economic burden of diagnosed diabetes, with calculation of the health resource use and indirect costs attributable to diabetes in 2022. RESEARCH DESIGN AND METHODS We combine the demographics of the U.S. population in 2022 with diabetes prevalence, from national survey data, epidemiological data, health care cost data, and economic data, into a Cost of Diabetes Economic Model to estimate the economic burden at the population and per capita levels. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, comorbid condition, and health service category. Data sources include national surveys (2015–2020 or most recent available), Medicare standard analytic files (2020), and administrative claims data from 2018 to 2021 for a large commercially insured population in the U.S. RESULTS The total estimated cost of diagnosed diabetes in the U.S. in 2022 is $412.9 billion, including $306.6 billion in direct medical costs and $106.3 billion in indirect costs attributable to diabetes. For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes. On average people with diabetes incur annual medical expenditures of $19,736, of which approximately $12,022 is attributable to diabetes. People diagnosed with diabetes, on average, have medical expenditures 2.6 times higher than what would be expected without diabetes. Glucose-lowering medications and diabetes supplies account for ∼17% of the total direct medical costs attributable to diabetes. Major contributors to indirect costs are reduced employment due to disability ($28.3 billion), presenteeism ($35.8 billion), and lost productivity due to 338,526 premature deaths ($32.4 billion). CONCLUSIONS The inflation-adjusted direct medical costs of diabetes are estimated to rise 7% from 2017 and 35% from 2012 calculations (stated in 2022 dollars). Following decades of steadily increasing prevalence of diabetes, the overall estimated prevalence in 2022 remains relatively stable in comparison to 2017. However, the absolute number of people with diabetes has grown and contributes to increased health care expenditures, particularly per capita spending on inpatient hospital stays and prescription medications. The enormous economic toll of diabetes continues to burden society through direct medical and indirect costs.

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Changes in diabetes prescription patterns following Affordable Care Act Medicaid expansion

Cited by 3 publications

References 25 publications

The Association Between Medicaid Expansion and Diabetic Ketoacidosis Hospitalizations

The Association Between Medicaid Expansion and Diabetic Ketoacidosis Hospitalizations

Factors Associated With Blood Pressure Control Among Patients in Community Health Centers

Economic Costs of Diabetes in the U.S. in 2022

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