title: Changes over time in high out-of-pocket health care burden in U.S. adults with diabetes, 2001-2011.
abstract: OBJECTIVE
  High out-of-pocket (OOP) costs can be an obstacle to health care access and treatment compliance. This study investigated trends in high OOP health care burden in people with diabetes.
  
  
  METHODS
  Using Medical Expenditure Panel Survey 2001-2011 data, we examined trends in the proportion of people aged 18-64 years with diabetes facing a high OOP burden. We also examined whether the trend differed by insurance status (private insurance, public insurance, or no insurance) or by income level (poor and near poor, low income, middle income, or high income).
  
  
  RESULTS
  In 2011, 23% of people with diabetes faced high OOP burden. Between 2001-2002 and 2011, the proportion of people facing high OOP burden fell by 5 percentage points (P < 0.01). The proportion of those who were publicly insured decreased by 22 percentage points (P < 0.001) and of those who were uninsured by 12 percentage points (P = 0.01). Among people with diabetes who were poor and near poor and those with low income, the proportion facing high OOP burden decreased by 21 (P < 0.001) and 13 (P = 0.01) percentage points, respectively; no significant change occurred in the proportion with private insurance or middle and high incomes between 2001-2002 and 2011.
  
  
  CONCLUSIONS
  The past decade has seen a narrowing of insurance coverage and income-related disparities in high OOP burden in people with diabetes; yet, almost one-fourth of all people with diabetes still face a high OOP burden.
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA eok8@cdc.gov.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Barker
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Sundar
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: O Kenrick
authors.initials: OK
authors.lastname: Duru
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Tony
authors.initials: T
authors.lastname: Pearson-Clarke
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000191:economics* / Q000517:prevention & control; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty / Q000191:economics; D012923:Social Class; D055815:Young Adult