TY - JOUR
T1 - National use of safety-net clinics for primary care among adults with non-medicaid insurance in the United States
AU - Nguyen, Oanh Kieu
AU - Makam, Anil N.
AU - Halm, Ethan A.
N1 - Publisher Copyright:
© 2016 Nguyen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/3
Y1 - 2016/3
N2 - Objective: To describe the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare). Methods: Cross-sectional analysis using the 2006-2010 National Ambulatory Medical Care Surveys, annual probability samples of outpatient visits in the U.S. We estimated national prevalence of safety-net visits using weighted percentages to account for the complex survey design. We conducted bivariate and multivariate logistic regression analyses to examine characteristics associated with safety-net clinic use. Results: More than one-third (35.0%) of all primary care safety-net clinic visits were among adults with non-Medicaid primary insurance, representing 6,642,000 annual visits nationally. The strongest predictors of safety-net use among non-Medicaid insured adults were: being from a highpoverty neighborhood (AOR 9.53, 95%CI 4.65-19.53), being dually eligible for Medicare and Medicaid (AOR 2.13, 95%CI 1.38-3.30), and being black (AOR 1.97, 95%CI 1.06-3.66) or Hispanic (AOR 2.28, 95%CI 1.32-3.93). Compared to non-safety-net users, non-Medicaid insured adults who used safety-net clinics had a higher prevalence of diabetes (23.5%vs. 15.0%, p<0.001), hypertension (49.4%vs. 36.0%, p<0.001), multimorbidity (≥2 chronic conditions; 53.5%vs. 40.9%, p<0.001) and polypharmacy (≥4 medications; 48.8% vs. 34.0%, p<0.001). Nearly one-third (28.9%) of Medicare beneficiaries in the safety-net were dual eligibles, compared to only 6.8% of Medicare beneficiaries in non-safety-net clinics (p<0.001). Conclusions: Safety net clinics are important primary care delivery sites for non-Medicaid insured minority and low-income populations with a high burden of chronic illness. The critical role of safety-net clinics in care delivery is likely to persist despite expanded insurance coverage under the Affordable Care Act.
AB - Objective: To describe the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare). Methods: Cross-sectional analysis using the 2006-2010 National Ambulatory Medical Care Surveys, annual probability samples of outpatient visits in the U.S. We estimated national prevalence of safety-net visits using weighted percentages to account for the complex survey design. We conducted bivariate and multivariate logistic regression analyses to examine characteristics associated with safety-net clinic use. Results: More than one-third (35.0%) of all primary care safety-net clinic visits were among adults with non-Medicaid primary insurance, representing 6,642,000 annual visits nationally. The strongest predictors of safety-net use among non-Medicaid insured adults were: being from a highpoverty neighborhood (AOR 9.53, 95%CI 4.65-19.53), being dually eligible for Medicare and Medicaid (AOR 2.13, 95%CI 1.38-3.30), and being black (AOR 1.97, 95%CI 1.06-3.66) or Hispanic (AOR 2.28, 95%CI 1.32-3.93). Compared to non-safety-net users, non-Medicaid insured adults who used safety-net clinics had a higher prevalence of diabetes (23.5%vs. 15.0%, p<0.001), hypertension (49.4%vs. 36.0%, p<0.001), multimorbidity (≥2 chronic conditions; 53.5%vs. 40.9%, p<0.001) and polypharmacy (≥4 medications; 48.8% vs. 34.0%, p<0.001). Nearly one-third (28.9%) of Medicare beneficiaries in the safety-net were dual eligibles, compared to only 6.8% of Medicare beneficiaries in non-safety-net clinics (p<0.001). Conclusions: Safety net clinics are important primary care delivery sites for non-Medicaid insured minority and low-income populations with a high burden of chronic illness. The critical role of safety-net clinics in care delivery is likely to persist despite expanded insurance coverage under the Affordable Care Act.
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U2 - 10.1371/journal.pone.0151610
DO - 10.1371/journal.pone.0151610
M3 - Article
C2 - 27027617
AN - SCOPUS:84962743708
SN - 1932-6203
VL - 11
JO - PloS one
JF - PloS one
IS - 3
M1 - e0151610
ER -