• Karin M Nelson, Michael K Chapko, Gayle Reiber, and Edward J Boyko.
• Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, 1660 South Columbian Way, S-111-GIMC, Seattle, WA 98107, USA.
• Health Serv Res. 2005 Apr 1;40(2):361-72.

ObjectiveTo describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States.Data SourceThe 2000 Behavioral Risk Factor Surveillance System.Study DesignOur 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.Principal FindingsMost 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.ConclusionsUninsured 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.

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