title: Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico.
abstract: The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared with non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease activity (per disease activity score 28), comorbid conditions, functional status (per Health Assessment Questionnaire), and pharmacologic profile were determined. Data were examined using uni- and multivariable (logistic regression) analyses. The mean (standard deviation (SD)) age of the study population was 56.6 (13.5) years; 180 (84.1 %) were women. The mean (SD) disease duration was 10.8 (9.6) years. Sixty-seven patients were treated in the managed care setting, and 147 patients received their healthcare in fee-for-service settings. In the multivariable analyses, RA patients treated in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type 2 diabetes mellitus, cardiovascular events, fibromyalgia syndrome, and poorer functional status while having a lower exposure to biological agents than those treated in fee-for-service settings. Efforts should be undertaken to curtail the gap of health disparities among these Hispanic patients in order to improve their long-term outcomes.
authors: Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, 00936-5067 San Juan, Puerto Rico.
authors: Yesenia
authors: Y
authors: Santiago-Casas
authors: Tania
authors: T
authors: González-Rivera
authors: Lesliane
authors: L
authors: Castro-Santana
authors: Grissel
authors: G
authors: Ríos
authors: David
authors: D
authors: Martínez
authors: Vanessa
authors: V
authors: Rodríguez
authors: Rafael
authors: R
authors: González-Alcover
authors: Angel M
authors: AM
authors: Mayor
authors: Luis M
authors: LM
authors: Vilá
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000458:organization & administration*; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D011647:Puerto Rico / Q000453:epidemiology; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome