Having Health Insurance Improves Control of Cardiovascular Disease and Diabetes

It would seem obvious that having health insurance helps to provide better access to doctors and provide better treatments for serious illnesses. However, since many patients without health insurance can access urgent care clinics, emergency rooms, attend health clinics, and obtain primary care for cash, it is important to look at the impact of health insurance on control of important illness, and the relative impact of health insurance on different races and ethnicity.

In a recent analysis, Dr. J. M. McWilliams and his co-workers from Harvard Medical School (Annals of Internal Medicine, Volume 150, Page 505-515, 2009) looked at the control of blood pressure, high cholesterol and diabetes in patients with and without medical insurance from 1999 to 2006. In their study, the authors evaluated the results of the National Health and Nutrition Examination Survey which was conducted yearly between 1999 and 2006. This survey, called NHANES, was a nationally representative study given to individuals through interviews, physical examination, and clinical testing. Between 1999 and 2006, over 41,000 people were evaluated, of which over 12,000 were between the ages of 40 and 85 years. The authors then looked at how often blood pressure was normalized to under 140/90 and how often the hemoglobin level was normal (the hemoglobin A1C under 7.0), and how often cholesterol was controlled to a normal level of under 200.

The quality of care of all of these people improved significantly over the seven years for all of the measures that they were evaluating. These trends showed an improvement regardless of race, with the exception that Latino patients showed little improvement in diabetes care. For example the control of hypertension improved from 46% to 56%. The control of diabetes improved from 38% to 59%. The cholesterol level improved from 43% control to 63% control. Importantly, improvements were seen in each of the races, and improvements were seen in all socioeconomic categories. However, at the end of the treatment period, racial differences which had existed before were still present, although they were less pronounced. Black and Hispanic patients still had inferior control rates for diabetes, blood pressure and cholesterol.