2015 APHA Annual Meeting & Expo

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Online Program

332013
Outpatient Visit Utilization and Chronic Disease Control Among Medicaid-insured and Uninsured Individuals: A National Perspective


Monday, November 2, 2015 : 12:30 p.m. - 12:50 p.m.

Andrea Christopher, MD, Fellowship in General Medicine & Primary Care, Department of Medicine, Harvard Medical School , Cambridge Health Alliance, Cambridge, MA
Danny McCormick, MD, MPH, Department of Medicine, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA
Steffie Woolhandler, MD, MPH, Hunter College - School of Public Health, Department of Medicine, City University of New York, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA

David Himmelstein, MD, Hunter College - School of Public Health, Department of Medicine, City University of New York, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
David Bor, MD, Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
Andrew Wilper, MD MPH, Boise Veterans Affairs Medical Center, University of Washington, Boise, ID
Audio (mp3) recording Recorded Presentation (mp4)
Background: Among people with low-incomes nationally, the impact of having Medicaid on outpatient physician visit utilization and chronic disease outcomes is uncertain.

Methods: We analyzed data from the 1999-2012 National Health and Nutritional Examination Surveys, which annually collected questionnaire, physical exam and laboratory data in a nationally representative sample. We included adults aged 18 to 64 with incomes below the federal poverty level who were uninsured (n=2,975) or had Medicaid (n=1,485). We used logistic regression to examine the association between having Medicaid and the number of outpatient visits (2 or more versus 1 or less), controlling for demographic and clinical characteristics. We also estimated the effect of having Medicaid on the likelihood that persons with chronic diseases knew of their condition, and whether their condition was controlled.

Results: Medicaid coverage was associated with having two or more outpatient visits annually (OR 3.54, 95% CI, 2.91-4.32). Among persons with objective evidence of hypertension, Medicaid was associated with being aware of the condition (OR 1.83; 95% CI, 1.26-2.66) and blood pressure control (OR 1.69; 95% CI, 1.32-2.27). Medicaid was also associated with awareness of being overweight/obese (OR 1.30; 95% CI, 1.02-1.67) but was not associated with awareness of or control of diabetes or hyperlipidemia.

Conclusions: Among adults with low incomes nationally, Medicaid coverage is associated with more outpatient visits, awareness of hypertension and overweight/obesity, and hypertension control.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe outpatient healthcare utilization between Medicaid-insured and uninsured low-income, US adults Compare differences in diagnosis and control of chronic conditions between Medicaid-insured and uninsured low income, US adults

Keyword(s): Health Disparities/Inequities, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a first year research fellow at the Harvard Medical School Fellowship in General Medicine and Primary Care and the Cambridge Health Alliance. I am focused on health services research using large database to study disparities in access to healthcare for vulnerable populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3273.0: Medicaid and the ACA