Even a small gap in Medicaid coverage can have consequences for diabetics, new research suggests. The study looked at 3,384 diabetes patients who received medical care at 50 clinics in Oregon from 2005-2007. The care was mostly free, but some recommended diagnostic tests and other services — including cholesterol screening, HbA1c testing to determine blood-sugar control and the flu shot — required a small co-pay. Medicaid usually covered the co-pay. Researchers wanted to know whether there was some minimum amount of Medicaid coverage that could boost the odds that patients would get the necessary preventive tests and vaccines. You’d think, for example, that someone who was covered for 85% of the study period would be more likely to get necessary services than someone who was covered for 10% of the period. The study didn’t provide any evidence for that, however, explains Rachel Gold, lead author of the study and an assistant investigator with the Kaiser Permanente Center for Health Research in Portland, Ore. “Patients really needed continuous coverage” to get the recommended services, she says. More than half of patients

(52%) had that kind of continuous coverage, while 27% were continuously uninsured and 21% were partially insured. “In almost all cases, those insured for 1% to 99% of the study period received services less often than those continuously insured, with no pattern of differences in rate of receipt of care seen between quintiles of time covered,” the authors write. The study appears online in the Journal of the American Board of Family Medicine. There are health consequences to not receiving the recommended tests, including cardiovascular problems and other complications, notes Gold. The study suggests that for these low-income patients, at least, even modest co-pays can cause a delay or avoidance of preventive care. “As we roll out health-care reform, it’s important to make sure that people get covered and stay covered,” she says, both for individual health reasons and because those patients are more likely to cost the system more if they delay needed preventive care. Bonus: Study: Medicaid Coverage Makes a ‘Big Difference’ Image: iStockphoto

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Study: Continuous Insurance Required for Low-Income Diabetics