title: Quality of diabetes care and health insurance coverage: a retrospective study in an outpatient academic public hospital in Switzerland.
abstract: Socioeconomic disadvantage is associated with an increased risk of adverse diabetes outcomes. In Switzerland, a country with theoretical universal healthcare coverage, people without health insurance face barriers in accessing to and in receiving standard quality care. The Geneva University Hospitals (HUG) have implemented policies aiming at reducing these gaps. We compared quality of diabetes care and ambulatory healthcare services utilization among insured and uninsured diabetic patients.
  
  
  
  This retrospective study linked health and administrative data of type 2 diabetic outpatients with at least one HbA1c test performed in 2012-2013 at HUG. Quality of care evaluation relied on processes (annual serum HbA1c, cholesterol and microalbuminuria tesing) and outcomes (HbA1c) assessment. Healthcare utilization was assessed by the number of ambulatory clinical and laboratory visits. Results were stratified by disease course (newly diagnosed versus prevalent diabetes).
  
  
  
  Of the 198 patients included, 80 (40.4 %) were uninsured. Both groups underwent annual testing of HbA1c, cholesterol, kidney function and microalbuminuria at comparably high rates and numbers of ambulatory visits did not significantly differ. After adjustments for age and sex, there were no significant differences in serum HbA1c between groups both in those with prevalent or with newly diagnosed diabetes. Initial medical intervention entailed comparable glycaemic improvement after 6 months in incident diabetes among insured and uninsured patients.
  
  
  
  This study did not find any difference in quality of diabetes care between insured and uninsured patients in a public hospital enforcing health-equity policies for access to and for delivery of standard diabetes care. It highlights the frontline role of public hospitals in contributing to care delivery equity even in countries with theoretical universal healthcare coverage.
authors.affiliation: Division of primary care medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals, Geneva, Switzerland. yves.jackson@hcuge.ch.|Global health institute, University of Geneva, Geneva, Switzerland. yves.jackson@hcuge.ch.
authors.forename: Yves
authors.initials: Y
authors.lastname: Jackson
authors.affiliation: Division of primary care medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Lozano Becerra
authors.affiliation: Division of clinical epidemiology, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Carpentier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D016640:Diabetes, Gestational / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D011247:Pregnancy; D011787:Quality of Health Care; D012189:Retrospective Studies; D013557:Switzerland; D019472:Universal Health Insurance / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin
keywords: Coverage; Diabetes; Equity; Health insurance; Hospital; Quality of care