Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured

• Published in: American journal of public health (1971) Vol. 106; no. 1; pp. 63 - 69
• Main Authors: Christopher, Andrea S, McCormick, Danny, Woolhandler, Steffie, Himmelstein, David U, Bor, David H, Wilper, Andrew P
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01-01-2016
• Subjects: Access to Care; Adolescent; Adult; AJPH Policy; Ambulatory Care - economics; Ambulatory Care - statistics & numerical data; Blood pressure; Chronic Disease; Chronic Disease - economics; Chronic illnesses; Clinical outcomes; Diabetes; Disability; Disease; Female; Health care access; Health insurance; Health Policy; Health Reform; Health Service Delivery; Health Services Accessibility - economics; Health Services Accessibility - statistics & numerical data; Hispanic people; Humans; Hypertension; Indigent care; Insurance coverage; Laboratories; Male; Medicaid; Medicaid - economics; Medicaid - statistics & numerical data; Medically Uninsured - statistics & numerical data; Middle Aged; Nutrition Surveys; Patients; Polls & surveys; Poverty; Public health; Response rates; Sensitivity analysis; Uninsured people; United States; Young Adult; United States; United States > US
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2015.302925

We sought to determine the association between Medicaid coverage and the receipt of appropriate clinical care.
Using the 1999 to 2012 National Health and Nutritional Examination Surveys, we identified adults aged 18 to 64 years with incomes below the federal poverty level, and compared outpatient visit frequency, awareness, and control of chronic diseases between the uninsured (n = 2975) and those who had Medicaid (n = 1485).
Respondents with Medicaid were more likely than the uninsured to have at least 1 outpatient physician visit annually, after we controlled for patient characteristics (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 3.8, 6.6). Among poor persons with evidence of hypertension, Medicaid coverage was associated with greater awareness (OR = 1.83; 95% CI = 1.26, 2.66) and control (OR = 1.69; 95% CI = 1.32, 2.27) of their condition. Medicaid coverage was also associated with awareness of being overweight (OR = 1.30; 95% CI = 1.02, 1.67), but not with awareness or control of diabetes or hypercholesterolemia.
Among poor adults nationally, Medicaid coverage appears to facilitate outpatient physician care and to improve blood pressure control.