Study: Coverage lapses tied to a 5-fold spike in acute care services for patients with Type 1 diabetes

When patients with chronic conditions lose insurance coverage, the consequences can be severe and costly. A new study offers a glimpse of the costs of coverage disruptions to patients and the healthcare system, as well as a sobering look at the potential scope of the problem.

The results of a new longitudinal study of health outcomes in adults with Type 1 diabetes published in Health Affairs show a five-fold increase in utilization of acute-care services following an interruption in care. The study looked at data from nearly 170,000 adults between the ages of 19 and 64 covered by private insurance.

According to the Bureau of Labor Statistics, the average worker holds a dozen jobs between the ages of 18 and 50. Given the heavy correlation between health insurance coverage and employment, that suggests strong potential for transitions on and off of coverage.

Add a patient population heavily dependent on daily maintenance in the form of insulin and the results aren't surprising.

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Historically, it hasn't been easy to obtain or parse data quantifying patient populations that fall through the cracks of a fragmented healthcare system, said Mary Rogers, Ph.D., a research associate professor of internal medicine at the University of Michigan in Ann Arbor and lead author on the study.

Information on Medicare patients has produced studies of older patients, but data covering working-age individuals on private plans have only become more available recently through the release of large data sets from health insurers.

Those data sets aren’t perfect, but they’re a start, noted Rogers.

“They cost a lot of money to buy, and they’re large databases, so you have to know how to deal with large relational databases," she said. "They do contain information regarding people who are younger than 65, but they don’t include their entire adulthood because people go in and out of different things."

Other variables can also limit their utility. For example, the Health Affairs study lacked mortality data, which means the results exclude patients who died as a result of gaps in their care.

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Like its results, the study’s policy ramifications appear more obvious than they actually are. The simplest solution, such as providing Medicare coverage for maintenance care prior to age 65, seems sensible since, as Rogers pointed out, patients with poorly controlled Type 1 diabetes frequently wind up with kidney failure, making them eligible down the road for Medicare coverage for individuals with end-stage renal disease.

On the other hand, she said, unless groups of young people with chronic conditions band together to lobby for action, it’s hard to get much traction, particularly in a political environment that seems uncertain even for coverage of pre-existing conditions.

The fragmented nature of the American health system that makes it so difficult to quantify patient populations who fall through the coverage cracks also makes it difficult to figure out who should pay and under what circumstances when presented with such data. From that perspective, the true scope of the problem is likely much bigger and more consequential given the number of transitions American adults make in and out of insurance plans and the number of people with chronic conditions who would potentially benefit from greater continuity of care.

“I suspect that what we observed is only the tip of the iceberg,” Rogers said.