Abstract
The purpose of this study was to estimate the prevalence of diabetes in Oregon's adult Medicaid population and to compare the level of diabetes-related preventive care with the state's general population. Responses to telephone interviews conducted in 1999 among 2,770 randomly selected adult Medicaid beneficiaries and 7,229 Oregon residents were compared. Diabetes prevalence among adult Medicaid recipients (11.1% [95% CI, 9.9% to 12.2%]) was more than twice that in the general population (4.7% [95% CI, 4.2% to 5.3%]). During the year prior to the interview, adults with diabetes in the Medicaid and general populations reported performing the following preventive care, respectively: = 2 diabetes care visits (80%, 77%); foot examination (74%, 74%); dilated eye examination (73%, 68%); infl uenza vaccine (65%, 61%); self-monitored blood glucose daily (63%, 61%); pneumococcal vaccine (51%, 47%); regular aspirin use (48%, 53%); and awareness of Hemoglobin A1c (34%, 39%). Although the reported prevalence of diabetes in Oregon's Medicaid population is high, the prevalence of diabetes preventive care activities was similar to the state's general population. Nonetheless, specific services in both populations could be improved.
Diabetes affects approximately 11 million people in the United States and is the sixth leading cause of death.1 Direct medical expenditures and indirect costs for diabetes are an estimated $98 billion each year.1 The prevalence of diabetes has increased almost 50% during the past decade 2 and is projected to increase by more than 80% in the next 50 years to more than 29 million by 2050.3 Appropriate preventive care and tighter glycemic control can prevent or delay many of the complications of diabetes.4-6 Studies measuring the provision of diabetes care to low-income populations indicate that care is frequently substandard, which places this group at great risk of developing complications.7,8
The Oregon Health Plan, an expansion of Oregon's Medicaid program, was implemented in 1994 to expand access to health care among low-income Oregonians by limiting benefits based on a priority list of health conditions. The Oregon Health Plan places an emphasis on providing preventive services and promoting the delivery of care through managed care plans. In 1999, approximately 550,000 Oregon residents, accounting for approximately 18% of the state's population, received services from Oregon's Medicaid program.
The effectiveness of Oregon's Medicaid program in improving the delivery of preventive services has not been well documented. This study was conducted to estimate the burden of diabetes in Oregon's adult Medicaid population and to compare the level of diabetes-related preventive care with the state's general population.