Insurance Increases Diagnosis and Control of Chronic Conditions

Laura Joszt

People with insurance have significantly higher probabilities of being diagnosed for diabetes, hypercholesterolemia, and hypertension than people without insurance, according to findings published in Health Affairs.

In addition, people with insurance who were diagnosed had significantly lower hemoglobin A1c, total cholesterol, and systolic blood pressure than uninsured individuals. THe investigators analyzed data from 1999 to 2012 from the National Health and Nutrition Examination Survey to evalute the relationship between health insurance and the diagnosis and management of diabetes, hypercholesterolemia, and hypertension.

Given insurance coverage expansion under the Affordable Care Act (ACA), the authors found that the health law coul have significant effects on chronic disease identification and management.

"Evidence on expected health impacts and health services use is urgently needed by policy makers as they plan for the likely effects of the ACA's full implementation," the authors wrote.

They found that for people with insurance the probability of diagosis was 13.5% higher for diabetes and hypercholesterolemia and 8.8% higher for hypertension. The investigators determined that if the number of nonelderly Americans without health insurance was reduced by half, there would be 313,000 fewer cases of undiagnosed diabetes, 811,000 fewer cases of undiagnosed hypercholesterolemia, and 485,000 undiagnosed cases of hypertension.

If all nonelderly Americans had health insurance, there would be 3.1 million more people diagnosed with one of these 3 chronic conditions, and 1.3 million fewer with uncontrolled cases.

"Our findings suggest that the ACA could have significant effects on the identificaiton and management of chronic disease," the authors concluded. "However, more attention is needed to the potential short-term and long-term impolications of these health changes for the demand for health care services and health care spending on chronic disease."
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