More Americans With Insurance Means More Are Getting Diagnosed And Treated For Chronic Conditions
Americans with health insurance are more likely than the uninsured to have their diabetes, high cholesterol and high blood pressure diagnosed— and to have these chronic conditions under control—according to a study published in the September issue of Health Affairs. The researchers used their findings and other data to estimate that 1.5 million Americans will be newly diagnosed -with diabetes, high blood pressure and high cholesterol as a result of getting insured for the first time under the Affordable Care Act. They also estimate 659,000 new people will be able to control these conditions as a result of expanded insurance coverage.
“These effects constitute a major positive outcome from the ACA,” says senior author Joshua Salomon, professor of global health at the Harvard T.H. Chan School of Public Health. “Our study suggests that insurance expansion is likely to have a large and meaningful effect on diagnosis and management of some of the most important chronic illnesses affecting the U.S. population.”
To reach these conclusions, the researchers analyzed data from over 28,000 Americans aged 20-64, collected as part of the National Health and Nutrition Examination Survey between 1999 and 2012. Participants were asked whether a doctor had ever told them that they had diabetes, high blood cholesterol levels, or high blood pressure. They were also asked whether or not they had health insurance. On the same day, researchers tested each participant for indications of the three conditions.
The results were encouraging, says Daniel Hogan, who led the research team at Harvard’s T.H. Chan School of Public Health. People with insurance were 13.5 percent more likely to get diagnosed with diabetes and high cholesterol than those without. For hypertension, the insured were nearly 9 percent more likely to get a diagnosis.
And, they did better when it came to controlling those conditions. Diabetics with insurance were 10 percent more likely to have achieved control over their disease, with smaller gains for hypertension and high cholesterol.
To improve the accuracy of their results, the research team wanted to account for any factors that might skew the data. “For example, there really aren't a lot of wealthy uninsured people in the U.S.,” explains Hogan.
So, the researchers compared each insured person with someone from the uninsured group who was similar in many ways: sex, age, race, income, marital status, smoking status, and body mass.
“I think the thing that was pretty remarkable was just how consistent the effects were,” Hogan says. The group found similar results when they conducted an analysis comparing the uninsured group with individuals on public insurance. Hogan says that was interesting because it might be reasonable to "expect that people with private insurance may have better outcomes than public insurance. But we didn't see that.”
To extrapolate these findings to the effects of expanded coverage under the Affordable Care Act, the team referred to the Congressional Budget Office’s projection that the law will result in halving the number of uninsured non-elderly Americans by 2017. The researchers calculated that 1.5 million more people will be diagnosed with one or more of the three chronic conditions and 659,000 new people will be able to control their disease as a result of expanded insurance coverage. They couldn't predict the amount of time these new diagnoses will take to materialize, but Hogan says the change is likely to be gradual.
So what will this mean for the American healthcare system? Hogan says that rules of healthcare might have to be adjusted to provide care for so many new patients.
“One option may be changing scope of care practices. Maybe nurse practitioners should be allowed to operate a bit more independently in some settings,” he says.
The report authors write that many of the models currently used to forecast healthcare spending don’t take these diagnoses into account. While Americans might balk at spending yet more dollars on health, Hogan says we should be less concerned with the amount we spend, and more with the value we get from that spending.
“I think expecting to find interventions that save money and improve health at the same time isn't necessarily the right aim," he says. "In the short term expenditures could go up due to these new diagnoses. But it may offer cost savings in the future, because people then get into care earlier and they see reduced long-term complications."