Poor socioeconomic status and inadequate insurance coverage may affect an individual’s ability to utilize healthcare services. This study was conducted to evaluate whether the type of insurance coverage is associated with missed appointments for diabetes care. Data analysis included all patients with diabetes mellitus (DM) managed at a major academic center between Jan 2015 and Dec 2020. Association between insurance coverage and proportion of missed appointments was evaluated using analysis of covariance with adjustments for demographic variables and social determinants of health. The relationship between proportion of missed appointments and glycemic control was also evaluated in multivariate analyses. The final dataset included 30,633 patients, out of which 14,064 (46%) reported commercial insurance, 13,376 (44%) reported Medicare and 3,193 (10%) reported Medicaid coverage. Medicaid group was identified to have the highest proportion of Spanish-speakers, African Americans, women, current smokers and single individuals. Proportion of missed appointments was 18.1 ± 18.1% in Medicaid covered patients as compared to 12.1 ± 15.3% among commercially insured and 10.2 ± 14.1% among Medicare covered patients (p <0.001) . Type of insurance was found to be a statistically significant predictor of the proportion of missed appointments after adjusting for age, race, preferred language, marital status, smoking, BMI, HbA1c and type of diabetes (p<0.001) . Proportion of missed appointments was associated with HbA1c with partial correlation coefficient +0.1 (p <0.001) after adjusting for age, race, gender, type of insurance, BMI and type of diabetes. We conclude that Medicaid covered patients with diabetes have higher proportion of missed clinic appointments and higher HbA1C. More research is needed to evaluate the root causes of inability to keep appointments in this population so that strategies for improved healthcare delivery can be designed.


R.Radhakrishnan: None. W.H.Cade: None. E.Bernal-mizrachi: None. R.Garg: None.

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