Andrew J. Karter|Mark R. Stevens|William H. Herman|Susan L. Ettner|David G. Marrero|Monika M. Safford|Michael M. Engelgau|J. David Curb|Arleen F. Brown
Out-of-Pocket Costs and Diabetes Preventive Services
Kaiser Permanente|Diabetes Australia|University of California, Los Angeles|Pacific Health Research and Education Institute|University of California, Los Angeles
despite increased shifting health care costs consumers little known impact financial barriers health care utilization study investigated effect outofpocket expenditures utilization recommended diabetes preventive servicesthis surveybased observational study 20002001 10 managed care health plans 68 provider groups across us serving approximately 180000 patients diabetes 11922 diabetic survey respondents studied occurrence selfreported annual dilated eye exams diabetes health education among insulin users daily selfmonitoring blood glucose smbg conditional probabilities estimated outcomes level selfreported outofpocket expenditure using hierarchical logistic regression models random interceptsconditional probabilities utilization 95 ci varied expenditure dilated eye exam cost 78 7582 copay 79 7582 full price 70 6475 p 00001 diabetes health education cost 29 2336 copay 29 2336 full price 19 1425 p 00001 daily smbg cost 75 6881 copay 68 6075 full price 59 4968 p 00001 extensive adjustment patient factors discernible effect estimates significance costutilization relationships similar across income levels patient characteristicsbenefit packages structured derive greater fiscal contribution health plan membership result suboptimal use diabetes preventive services may thus lead poorer clinical outcomes greater future costs lower health plan quality ratings