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James X. Zhang, PhD, Elbert S. Huang, MD, Melinda L. Drum, PhD, Anne C. Kirchhoff, MPH, Jennifer A. Schlichting, MA, Cynthia T. Schaefer, MS, Loretta J. Heuer, PhD and Marshall H. Chin, MD

At the time of the study, James X. Zhang, Elbert S. Huang, Anne C. Kirchhoff, Jennifer A. Schlichting, and Marshall H. Chin were with the Department of Medicine, University of Chicago, Chicago, IL. Melinda L. Drum is with the Department of Health Studies, University of Chicago, Chicago. Cynthia T. Schaefer is with the University of Evansville, Indiana. Loretta J. Heuer is with the University of North Dakota, Grand Forks.

Correspondence: Requests for reprints should be sent to James X. Zhang, Associate Professor, Department of Pharmacy, School of Pharmacy, Medical College of Virginia Campus, Virginia Commonwealth University, 209E McGuire Hall, 410 N 12th St, PO Box 980533, Richmond, VA 23298 (e-mail: xzhang3{at}vcu.edu).

Objectives. We sought to compare quality of diabetes care by insurance type in federally funded community health centers.

Method. We categorized 2018 diabetes patients, randomly selected from 27 community health centers in 17 states in 2002, into 6 mutually exclusive insurance groups. We used multivariate logistic regression analyses to compare quality of diabetes care according to 6 National Committee for Quality Assurance Health Plan Employer Data and Information Set diabetes processes of care and outcome measures.

Results. Thirty-three percent of patients had no health insurance, 24% had Medicare only, 15% had Medicaid only, 7% had both Medicare and Medicaid, 14% had private insurance, and 7% had another insurance type. Those without insurance were the least likely to meet the quality-of-care measures; those with Medicaid had a quality of care similar to those with no insurance.

Conclusions. Research is needed to identify the major mediators of differences in quality of care by insurance status among safety-net providers such as community health centers. Such research is needed for policy interventions at Medicaid benefit design and as an incentive to improve quality of care.

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