Abstract

While Medicaid coverage improves access to care, access disparities remain between youth with Medicaid and private insurance. The purpose of this study was to evaluate whether having Medicaid versus private insurance impacts access to care for youth with type 2 diabetes, an emerging health concern with long-term patient and health system implications.

A secondary database analysis of youth age 5–19 with type 2 diabetes was undertaken in a national electronic medical record (EMR) database. Patients had at least 90 days of EMR activity after their first indication of type 2 diabetes, and all had Medicaid or private insurance. Descriptive statistics and multivariate regression analyses were used to test the hypotheses that (1) youth with Medicaid have less access to physician care the year prior to their first indication of type 2 diabetes in the EMR; and (2) that Medicaid influences access to diabetes-related care in terms being less likely to receive prescription drugs but more likely to receive tests to monitor blood glucose control.

A total of 2496 youth were included including 400 (16%) with Medicaid coverage. Over 60% were female with a age of 14.5 years, and over two thirds were obese. The study found that youth with Medicaid were not less likely to have access to physician care prior to their first indication of type 2 diabetes in the EMR. However, by study design, all youth in the study had overcome basic access barriers in entering the EMR system. Similarly, youth with Medicaid did not have reduced access to prescription drugs relative to private insurance. They were more likely to have their blood glucose control tested at baseline, as predicted, but not during a one year follow-up period.

This study suggests that if barriers to accessing physician care can be reduced for youth with Medicaid, they may not receive a lower level of diabetes care than youth with private insurance. Thus, health policy measures to ensure that Medicaid physician networks provide adequate and accommodating coverage in low-income areas may help to reduce diabetes-related care access barriers that Medicaid youth with type 2 diabetes may disproportionately face.