title: Do persons that changed health insurance differ from those who did not? The case of diabetes.
abstract: OBJECTIVE
  We aimed to compare German adults that changed health insurance since 1996 with those who did not with special emphasis on diabetes.
  
  
  METHODS
  8 representative surveys (conducted 2005-2008) of the 'Bertelsmann Healthcare Monitor' comprising 12,362 participants aged 18-79 years were analysed. We compared participants that changed their health insurance fund with those who did not. To study if diabetes is associated with switching, we fitted logistic regression models and stepwise adjusted for age, sex, cardiovascular comorbidities, anthropometric measures and health-related factors.
  
  
  RESULTS
  About one third (32.0%) changed their health insurance fund since 1996. Compared to persons that did not change, those who did were younger, higher educated, assessed their health status better and had less cardiovascular diseases. The prevalence of diabetes was much lower in persons that changed their fund than in those who did not (3.6% vs. 8.9%; Odds Ratio [OR]: 0.38; 95% confidence interval [CI]: 0.31-0.47). Adjusting for age and sex leads to a non-significant OR of 0.81 (95% CI: 0.64-1.02), which remained in the fully adjusted model (OR: 0.88; 95% CI: 0.69-1.12).
  
  
  CONCLUSIONS
  Persons that changed their fund had a much lower prevalence of diabetes than those who did not. Most of this difference could be explained by age. We found quite similar figures for hypertension, a more prevalent disease. However, ORs were significant in all described models, probably due to a higher statistical power.
authors.affiliation: University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Bremen, Germany. hoffmann@zes.uni-bremen.de
authors.forename: F
authors.initials: F
authors.lastname: Hoffmann
authors.forename: A
authors.initials: A
authors.lastname: Icks
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D015438:Health Behavior; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult