title: Usual source of care as a health insurance substitute for U.S. adults with diabetes?
abstract: OBJECTIVE
  The purpose of this study was to examine the effects of health insurance and/or a usual source of care (USC) on receipt of diabetic-specific services and health care barriers for U.S. adults with diabetes.
  
  
  METHODS
  Secondary analyses of data from 6,562 diabetic individuals aged >or=18 years from the nationally representative Medical Expenditure Panel Survey from 2002 to 2005 were performed. Outcome measures included receipt of seven diabetic services plus five barriers to care.
  
  
  RESULTS
  More than 84% of diabetic individuals in the U.S. had full-year coverage and a USC; 2.3% had neither one. In multivariate analyses, the uninsured with no USC had one-fifth the odds of receiving A1C screening (odds ratio 0.23 [95% CI 0.14-0.38]) and one-tenth the odds of a blood pressure check (0.08 [0.05-0.15]), compared with insured diabetic individuals with a USC. Similarly, being uninsured without a USC was associated with 5.5 times the likelihood of unmet medical needs (5.51 [3.49-8.70]) and three times more delayed urgent care (3.13 [1.53-6.38]) compared with being insured with a USC. Among the two groups with either insurance or a USC, diabetic individuals with only a USC had rates of diabetes-specific care more similar to those of insured individuals with a USC. In contrast, those with only insurance were closer to the reference group with fewer barriers to care.
  
  
  CONCLUSIONS
  Insured diabetic individuals with a USC were better off than those with only a USC, only insurance, or neither one. Policy reforms must target both the financing and the delivery systems to achieve increased receipt of diabetes services and decreased barriers to care.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA. devoej@ohsu.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Tillotson
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards; D003920:Diabetes Mellitus / Q000191:economics*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008913:Minority Groups / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D044469:Racial Groups; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult