Experiences of People with Diabetes by Payer Type: An Analysis of the Roper Diabetes Data Set

Abstract

IntroductionThe study details the experiences of Medicare, Medicaid and privately insured patients with diabetes in the United States by focusing on how these distinct populations perceive their disease and manage their treatment.MethodsA national survey was fielded among a representative sample of 2,307 US adult diagnosed diabetes patients to investigate demographic, lifestyle, treatment, access to information, and socioeconomic status. This was achieved using a combination of telephone-based interviews and internet-based questionnaires administered via KnowledgePanel®, the only large-scale online panel based on a representative random sample of the US population.ResultsPatients with Medicaid-based insurance face significant differences in diagnosis, treatment and intensity of their diabetes as compared to their Medicare and privately insured counterparts. Medicaid patients develop diabetes at an earlier age with an increased level of severity, and face significant socioeconomic concerns. Medicaid patients also have different health information seeking preferences than their counterparts, impacted by technology use patterns and education preferences. All groups report challenges in paying for their diabetes care, though cost-sharing requirements are relatively low.ConclusionsSignificant variation in experience between Medicaid, Medicare, and privately insured patients can inform disease management and patient engagement strategies. Payers, clinicians and public health agencies can leverage these findings to design initiatives more effectively and understand how intergroup variability impacts program uptake and disease outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-015-0109-z) contains supplementary material, which is available to authorized users.

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“…Medicaid beneficiaries with diabetes generally self-report having poorer health and more comorbidities than other insured populations (29). Despite the fact that Medicaid either pays for most medications or requires a nominal copayment, out-of-pocket costs for medications and medical care are still a concern and, in some cases, may lead to insulin rationing (29,30).…”

“…Medicaid beneficiaries with diabetes generally self-report having poorer health and more comorbidities than other insured populations (29). Despite the fact that Medicaid either pays for most medications or requires a nominal copayment, out-of-pocket costs for medications and medical care are still a concern and, in some cases, may lead to insulin rationing (29,30). Medicare beneficiaries with prescription drug coverage (i.e., those enrolled in Medicare Part D or Medicare Advantage plans) and privately insured populations generally have deductibles and copayments for medications, which can lead to high out-of-pocket costs (28).…”

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“…In addition, privately insured groups have far more access to advanced treatment modalities and the newer drugs available for diabetes. They also tend to have less-severe diabetes and are younger with fewer comorbidities (33).…”

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“…Furthermore, recent research indicates that Medicaid enrollees are developing diabetes at a younger age and have increased diabetes severity. 2 This growth not only challenges the quality of life but also the ability to pay for managing this disease. The total cost of care (inpatient, outpatient, professional, and prescription) was estimated to be $245B for persons with diabetes in the United States in 2012.…”