James X. Zhang ^1*, Elbert S. Huang ², Melinda L. Drum ², Anne C. Kirchhoff ³, Jennifer A. Schlichting ², Cynthia T. Schaefer ⁴, Loretta J. Heuer ⁵, Marshall H. Chin ²

¹ Virginia Commonwealth University
² The University of Chicago
³ The University of Washington
⁴ University of Evansville
⁵ University of North Dakota

^* To whom correspondence should be addressed. E-mail: xzhang3{at}vcu.edu.

	Abstract

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.

Key Words: Diabetes, Community Health, Insurance, Health Policy, Access to Care, Quality of Care

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