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January 4, 2011                                

Health Insurance Does Not Discourage Compliance with Diabetes Prevention

In Colombia, as in other parts of South America, few patients with type 2 diabetes take advantage of care that could prevent their condition from worsening.  The prevalence of type 2 diabetes is greater than 8 percent among adults in Colombia, while 46 percent are estimated to be overweight or obese, a risk factor for type 2 diabetes. An analysis led by researchers at the Johns Hopkins Bloomberg School of Public Health found that health insurance coverage did not play a role in determining compliance with diabetes prevention. Their study was published in the December 2010 edition of Health Affairs.

“We wanted to determine if health insurance coverage contributed to the low level of compliance with diabetes prevention in Colombia,” said health economist Antonio J. Trujillo, PhD, lead author of the study and assistance professor in the Bloomberg School’s Department of International Health. “Some have speculated insurance coverage may play a role because it pays for care later when the condition gets worse, or that insurers limit coverage of preventive services because they did not yield a short-term financial return. Ultimately, we found no evidence that insurance coverage reduced compliance with prevention.”

The analysis was based on a nationally representative sample of 1,400 Colombians with type 2 diabetes.  Among those patients who pay premiums into Colombia’s “contributory” insurance program, the researchers found no evidence that insurance coverage influenced those individuals to avoid preventive services.  The evidence is less clear for those participating in a different, fully subsidized insurance program. Researchers found these patients—despite having access to preventive care—were no more likely to seek preventive visits than are uninsured patients.

“Since prices and availability of insurance do not explain compliance with diabetes prevention other individual factors such cognitive and non-cognitive skills may play a larger role. Policymakers and clinicians need to be aware of these factors to nudge patients to follow prevention,” said Trujillo. “Future studies will explore the role of individual discipline, self-control, risk aversion and patience on prevention among diabetics and hypertensive.”

Authors of “Health Insurance Doesn’t Seem to Discourage Prevention Among Diabetes Patients in Colombia” include Andres Ignacio, Vecino Ortiz, Fernando Ruiz Gomez and Laura Steinhardt.

Funding for the research was provided by the Inter-American Development Bank.