Health needs, utilization of services and access to care among Medicaid and uninsured patients with chronic disease in health centres

摘要

Introduction Understanding the role of Medicaid for health centre patients with chronic diseases can aid policymakers in designing and improving programmes to effectively meet the needs of this vulnerable segment of the population. This study compares the number of chronic conditions, health services utilization and access to care between patients with Medicaid coverage and uninsured patients seen at US health centres. Methods We used data from the 2014 Health Center Patient Survey. Measures included number of chronic conditions, number of physician visits, number of prescription drugs used, access to a usual source of care, the receipt of a routine checkup, unmet need for care and unmet need for prescription drugs. We conducted bivariate analyses to determine differences of outcome measures between the Medicaid and uninsured patient groups. Multiple linear and logistic regression models were conducted to test associations of Medicaid and other health-related factors with outcome measures. Results Bivariate results indicated there were no differences between Medicaid and uninsured patients in number of chronic diseases, having a usual source of care and receipt of a routine checkup. Significant differences existed in health services utilization measures and unmet health needs measures. After controlling for confounding factors, the differences in these measures were still apparent. Uninsured status was linked to a reduced physician visit frequency by -3.03 (95% CI: -4.05, -2.00) as compared with Medicaid patients (p < 0.001) and was associated with a reduced frequency of prescription drugs used by -0.38 (95% CI: -0.67, -0.10, p < 0.01) after controlling for the other covariates. Conclusion Despite having comparable needs to Medicaid patients, uninsured patients with chronic conditions continue to have substantial unmet needs for health care services and limited access to the health care system. Health centres serve an important role in eliminating such disparity regardless of insurance status. In addition, Medicaid eligibility may also have a substantial and positive impact on improving health services utilization and access to care among these low-income patients.