Acute care visits rose five-fold in time after coverage gap.
The longitudinal study including over 168,000 adults with type 1 diabetes found roughly a quarter experienced an interruption in their private insurance coverage between 2001-2015, reported Mary Rogers, PhD, MS, of the University of Michigan in Ann Arbor, and colleagues.
Following these insurance interruptions, patients experienced a five-fold increase in the use of acute care services compared to before their interruption in health coverage, the group wrote in Health Affairs. This increase in acute care visits from the 30 days prior to the interruption versus 30 days after the interruption also varied according to the gap length (P<0.001 for all):
- Gap length 31-60 days: incidence ratio ratio 5.25 (95% CI 4.14 to 6.64)
- 61-90 days: IRR 4.16 (95% CI 2.98 to 5.80)
- 91-120 days: IRR 7.19 (95% CI 4.76 to 10.85)
This increase in acute care visits was elevated after the interruption for both men and women, although was slightly higher among women.
"These acute care services are costly, and largely preventable with regular self-care guided by a primary care physician or an endocrinologist," Rogers noted in a statement.
More specifically, each individual interruption in insurance coverage was associated with a 3.6% (95% CI 1.2 to 5.9, P=0.003) relative increase in HbA1c level for these patients, increasing in a dose-response manner. Also associated with coverage interruptions were lower perceived health status by patients and a lower satisfaction with life.
"Type 1 diabetes requires intensive daily management, in order to simply remain alive, so interruptions to care and coverage of insulin and supplies can pose a major risk," explained Rogers, adding that "while we expected gaps in coverage to affect health in some way, the size of the effect and the frequency of gaps were striking."