EFFECT OF 3RD-PARTY REIMBURSEMENT ON USE OF SERVICES AND INDEXES OF MANAGEMENT AMONG INDIGENT DIABETIC-PATIENTS

OBJECTIVE - To determine the effect of third- party reimbursement on t he use of services and indexes of diabetes-related health management a mong inner-city diabetic patients. RESEARCH DESIGN AND METHODS- Adult diabetic patients (n = 153; 67% women, 33% men) from an inner-city dia betes clinic were categorized by level of third-party medical coverage : complete reimbursement for all services (full); partial reimbursemen t (part); and no reimbursement (none). Patients were followed for 13 m o. Use of billable medical services, diabetes clinic visits, emergency room visits, and hospital admissions were recorded. Use of a free, da y-time diabetes telephone hot line was also documented. indexes of dia betes-related health management, HbA1, blood pressure, and weight were compared from the beginning and the end of the study. Diabetes compli cations were scored and tabulated. RESULTS - Univariate analysis showe d that patients with full reimbursement were more likely to use servic es than patients without reimbursement. When the combined effects of r eimbursement status, age, sex, type of diabetes, and diabetes complica tions on use of services were analyzed together in a multivariate anal ysis, complications was the best predictor of admissions to the hospit al and whether a patient called the hot line. IDDM patients and patien ts with full reimbursement were most likely to have an emergency room visit. Age was the best predictor of diabetes clinic attendance. No di fference was noted in blood pressure or weight among the reimbursement groups at the beginning and end of study. However, the trend was towa rd (P < 0.05) an increase in HbA1 in the none group. CONCLUSIONS - Amo ng inner-city diabetic patients, multiple factors influence use of med ical services. Indigent diabetic patients without third-party reimburs ement were observed to have a rise in HbA1. These factors should be ta ken into consideration when planning strategies to prevent diabetes co mplications and the most effective allocation of health-care resources .