Comparing Health Care Utilization among Persons with Diabetes between Medicaid and Private Insurance

Abstract

Introduction and Objective: Compare healthcare utilization between Medicaid and privately insured individuals with type 1 diabetes (T1D), type 2 diabetes (T2D) and without diabetes.

Methods: Using a propensity score quasi-randomization technique, we matched persons with T1D, T2D, and without diabetes. Between 2014 and 2018, we determined healthcare utilization specific to diabetes related medications and supplies, outpatient providers visits, inpatient hospitalizations, and emergency department (ED) visits, stratified by diabetes status, age (0-20, 21-40 and 41-60 years), and insurance type (Medicaid vs. Private).

Results: In 2018, compared to privately insured individuals, those covered by Medicaid had increased utilization of ED visits for T1D (0.38-0.43% vs. 0.06-0.2%) and T2D (0.32 - 0.42% vs. 0.08 - 0.2%). Inpatient hospitalizations were similar for both groups (T1D: 0.2 - 0.25% vs. 0.18 -0.21%, T2D: 0.08 - 0.22% vs. 0.13 - 0.19%). Medication utilization and overall visits to provider were lower in Medicaid. While difference in primary care provider visits were narrowing (T1D: 1.46 - 2.58 % vs. 2.24 - 2.97%, T2D: 1.45 - 2.75% vs. 2.02 - 3.33%), visits with specialists such as endocrinologists and cardiologists were lower in Medicaid.

Conclusion: Medicaid patients have higher ED utilization without concomitant increases in hospitalizations, which may indicate suboptimal outpatient access in this population. Despite lower out of pocket costs compared to private insurance, medication and provider utilization in Medicaid is lower. While gaps in provider utilization are narrowing, Medicaid patients have lower specialist utilization. Further studies are needed to determine the effects of these differences on patient outcomes.

Document Type

Meeting Abstract

Publication Date

6-20-2025

Publication Title

Diabetes

First Page

1051-P

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