This study compares the quality of diabetes care by insurance type in federally funded community health centers. The authors categorized 2,018 diabetes patients, randomly selected from 27 community health centers in 17 states in 2002, into six mutually exclusive insurance groups. Multivariate logistic regression analyses were used to compare quality of diabetes care according to six National Committee for Quality Assurance Health Plan Employer Data and Information Set diabetes processes of care and outcome measures.
Thirty-three percent of patients had no health insurance, 24 percent had Medicare only, 15 percent had Medicaid only, 7 percent had both Medicare and Medicaid, 14 percent had private insurance, and 7 percent had another insurance type. Those without insurance were the least likely to meet the quality-of-care measures; those with Medicaid had a quality of care similar to those with no insurance. The authors concluded that research is needed to identify the major mediators of differences in quality of care by insurance status among safety-net providers such as community health centers. Such research is needed for policy interventions at Medicaid benefit design and as an incentive to improve quality of care.