The relationship between insurance and health outcomes of diabetes mellitus patients in Maryland: a retrospective archival record study

Abstract

Background Past studies examining the health outcomes of diabetes mellitus (DM) patients found that social determinants of health disparities were associated with variabilities in health outcomes. However, improving access to healthcare, such as health insurance, should mitigate negative health outcomes. The aim of the study was to explore the association between four types of health insurance, namely, Medicare Fee-For-Service (FFS), Medicare Managed Care (MC), Private FFS, and Private MC plans, and the health outcomes of DM patients, controlling for patients’ social determinants of health. Methods This is a retrospective cross-sectional archival record study to explore the relationships between types of health insurance and health outcomes of DM patients who were at least 65 years old, or the elderly. Data was drawn from the 2012 Maryland Clinical Public Use Data and received an exempt status from our Institutional Review Board. Elderly Maryland residents with chronic DM were included in the study, resulting in a sample size of 43,519 individuals. Predictor variables were four types of insurance and health outcome variables were length of hospital stay (LOS), 30-day readmission, and end-stage renal disease (ESRD). Control variables included hospital characteristics, patient characteristics, and social determinants of health. Student’s t-tests determined the statistical differences for the control variables between the types of insurance. Multiple hierarchical regression analysis was applied to test the association between insurance plans and LOS, while logistic regression analyses were applied to test the association between insurance plans with 30-day readmission and ESRD. Statistical significance was set at p < 0.05. Results t-test results indicated minimal statistical differences between the health statuses of patients enrolled in different insurance plans. After factoring out the control variables, regression analyses indicated that Medicare FFS patients had the worst outcome for LOS, 30-day readmission, and ESRD rates. Although patients on Medicare MC plans had lower LOS, 30-day readmission, and ESRD rates compared to those on Medicare FFS, patients enrolled in Private MC plans had the lowest odds of a 30-day readmission and patients enrolled in Private FFS had the lowest odds of an ESRD. Conclusions The data suggests that insurance plans were related to the health outcomes of elderly DM patients after considering their social determinants of health. Specifically, DM patients enrolled in managed care and private insurance plans had better health outcomes compared to those on Medicare FFS plans.

Phenolic compounds in mango fruit: a review

“…Diabetes mellitus is a common chronic disease in modern society, causing severe health and economic problems [137]. Decreasing postprandial hyperglycemia by delaying glucose absorption by inhibiting α-amylase and α-glucosidase in the digestive tract, is one of the therapeutic approaches to treating diabetes [138].…”

Impact of a Standardized, Pharmacist-Initiated “Test-Claim” Workflow for Anticipating Barriers to Accessing Discharge Antimicrobials

“…Such disparity is consistent with the literature that public insurance may be associated with barriers to timely and necessary care. 22,23 Individuals of non-Caucasian race were more likely to have public insurance and poor outcomes as well. 24 -26…”

“…Such disparity is consistent with the literature that public insurance may be associated with barriers to timely and necessary care. 22,23 Individuals of non-Caucasian race were more likely to have public insurance and poor outcomes as well. [24][25][26] Alternative approaches to DMCI have largely focused on dealing with pre-identified medications with high likelihood of requiring PA. 19 However, if an insurance's formulary list and PA criteria are frequently updated and not easily accessible, this approach can have limited impact.…”

The impact of insurance status on in‐hospital mortality in patients with hyperglycaemic crisis: A propensity score matching analysis

“…Based on the multivariate logistic regression analysis, the insured status, shock, mechanical ventilation, hypertension, and stroke were independent predictors of in‐hospital mortality among the study cohort. The evidence from Lee et al suggests that insurance plans were related to the health outcomes of elderly patients with DM 16 . Furthermore, Gold et al have shown that insurance coverage is related to improving the diagnosis and management of DM 14 .…”

“…There is a paucity of data describing the association between insurance status and in-hospital mortality of patients with hyperglycaemic crisis. Studies 16,17 only reported the association between insurance and health outcomes, such as length of stay and 30-day readmission, among patients with DM. We hypothesised that insurance status can influence in-hospital mortality of patients with hyperglycaemic crisis.…”