Prevalence of diabetes and patterns of health services utilization: a comparative analysis between a private and a health reform group of insured, 1997-1998

ABSTRACT

OBJECTIVE: To compare the prevalence and health services utilization patterns of diabetes mellitus in a group of insured under the Puerto Rico Health Reform Act and the private sector of the same insurance company. METHODS: The medical claims of the public sector insured whose main diagnosis was diabetes mellitus (ICD9-250.0-9) were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: A total of 38,139 diabetic cases were identified during the study period. Overall prevalence was 6.23 (95 CI 6.17-6.29); 5.22 among males (95 CI 5.14-5.30) and 7.09 among females (95 CI 7.00-7.18). The proportion of cases was larger in persons aged 65 years or more (60.3) and females (61.6). Overall, 84.7 of insured diabetics had medical office visits, while 7.8 had emergency room services and 1.3 had hospital admissions. Female cases had more physician office visits (62) and insulin prescriptions (65) compared to males (p < 0.05). The most reported complication was cerebrovascular accident (4.4). The prevalence of diabetes was higher in the public sector (6.23) when compared to the private sector (4.73) (p < 0.01). The mean number of oral hypoglycemic (32.77 +/- 0.40) and insulin (40.99 +/- 0.54) prescriptions were higher in the public sector (p < 0.01). Emergency room utilization rate was larger among males in the younger age groups of the private sector. However, hospital admissions were larger in both sexes of the younger age group of the public sector when compared with the private sector. CONCLUSIONS: A higher prevalence of diabetes and mean service utilization was observed in the public sector. An in-depth analysis of the health care of patients with diabetes in the public sector is needed.