July 10, 2014
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High out-of-pocket cost presents diabetes treatment barriers for one-fourth of US adult patients

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Out-of-pocket health care costs continue to impact nearly one quarter of the adult population with diabetes in the United States, despite more insurance coverage and less income-related disparities, according to research published in Diabetes Care.

High out-of-pocket (OOP) burden still disproportionately affects those of low socioeconomic status with 35% of people in the poor and near-poor groups and 34% of those in the low-income group shouldering a high OOP burden, as compared to 10% of those in the high-income group, according to the study.

“Because high OOP burden could be a barrier to treatment compliance and needed health-care services and people with diabetes who do not receive adequate medical care are at substantial risk for costly and debilitating complications, policies that reduce this burden should be considered,” the researchers wrote.

Rui Li, PhD, of Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga., and colleagues evaluated the proportion of people aged 18 to 64 years with diabetes facing a high OOP burden through data from the Medical Expenditure Panel Survey between 2001 and 2011.

The investigators examined whether insurance status (private insurance, public insurance or no insurance) or income based on the federal poverty level (poor and near poor, low income, middle income or high income) played a role in the trend.

In the last year of study data, 23% of people with diabetes faced high OOP burden; this represented a proportion decrease of five percentage points (P<.01) from the earliest years.

The proportion of people with diabetes who were publicly insured dropped 22 percentage points (P<.001) and uninsured 12 percentage points (P=.01). High OOP burden decreased among those categorized as poor and near poor by 21 percentage points (P<.001) and among those with low income by 13 percentage points (P=.01).

No significant change was seen in the proportion of people with diabetes with private insurance or middle and high incomes from the earliest years of data to the end.

“Future studies could examine whether this reduced disparity in high OOP burden has indeed reduced disparity in access to health care and in health outcomes across the diabetic subgroups of the overall population over age 65,” the researchers wrote.

Disclosures: The researchers report no relevant disclosures.