title: Inequitable access to health services for older adults with diabetes: potential solutions on a state level.
abstract: Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states.
authors.affiliation: a Professor, Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Faul
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Yankeelov
authors.forename: Laneshia R
authors.initials: LR
authors.lastname: McCord
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control / Q000628:therapy; D015438:Health Behavior; D018166:Health Care Reform / Q000191:economics; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D017057:Medically Uninsured; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D013219:State Government
keywords: diabetes; health care reform; inequitable access to care; multilevel modeling; older adults