The study used anonymous data from the Clinformatics Data Mart database from January 2001 to mid-2015, purchased by the U-M Institute for Healthcare Policy and Innovation, of which the authors are members. It focused on adults ages 19 to 64 who had type 1 diabetes. Of the 168,612 adults studied, 40,897 had at least one interruption in their health insurance coverage of 30 days or more.
The results of the study indicated that people in their 20s and 30s with type 1 diabetes were more likely than those in their 40s, 50s and early 60s to experience a gap in coverage. In addition, those in the Midwest and South were more likely to have a gap than those in the Northeast and West.
After an interruption in insurance, adults with type 1 diabetes used more acute care services â€” from an urgent care center, emergency room, ambulance or hospital. Their use of acute care services was four to seven times higher than in the period before the interruption. After a gap of 31 to 60 days, adults with type 1 diabetes were 5.25 times more likely to use such services. After a gap of 91 to 120 days, they were 7.19 times more likely.
â€śThese acute care services are costly and largely preventable with regular self-care guided by a primary care physician or an endocrinologist â€” a specialist who treats patients with diabetes,â€ť says Rogers, who is a research associate professor in the U-M Department of Internal Medicine. â€śWhile we did not examine direct costs, each emergency visit or hospitalization can easily cost thousands of dollars.â€ť
Patients with type 1 diabetes also have to deal with the rising cost of insulin, which has more than tripled in the past two decades.
Rogers notes that the availability of individual insurance plans and Medicaid expansion plans under the Affordable Care Act has broadened the kinds of insurance available to adults who do not receive insurance through their jobs.
â€śOur study provides evidence of fragmented care for adults with type 1 diabetes in the United States,â€ť says Rogers. â€śSuch gaps in health care have been noticed for people who go in and out of Medicaid coverage, but we report that it also occurs in adults who have private health insurance. We know that providing continuity of care is important for patients with diabetes and is associated with lower mortality.â€ť
Rogers concludes, â€śThis problem is not going away. If anything, fragmented care is likely to increase with projected trends. Yet access to medical care is essential for life for people with type 1 diabetes. Providing access to medical services for people with chronic conditions is a problem that America has not yet fully resolved.â€ť
Additional contributors are senior author and general medicine associate professor Catherine Kim, M.D., MPH, pediatric endocrinology professor Joyce M. Lee, M.D., MPH, general medicine assistant professor Renuka Tipirneni, M.D., and IHPI statistician Tanima Basu, M.S.