Abstract
BackgroundThe commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. However, disparities in health care are well-documented. The objectives were to explore disparities in diabetes prevalence, care and control among diabetic patients. The study was conducted by Maccabi Healthcare Services (MHS), an Israeli HMO (health care plan).MethodsRetrospective study. The dependent variables were diabetes prevalence, uptake of follow-up examinations, and disease control. The independent variables were socio-economic rank (SER), ethnicity (Arab vs non Arab), supplementary voluntary health insurance (SVHI), and immigration from Former Soviet Union (FSU) countries. Chi Square and Logistic Regression Models were estimated.ResultsWe analyzed 74,953 diabetes patients. Diabetes was more prevalent in males, lower SER patients, Arabs, immigrants and owners of SVHI. Optimal follow up was more frequent among females, lower SERs patients, non Arabs, immigrants and SVHI owners. Patients who were female, had higher SERs, non Arabs, immigrants and SVHI owners achieved better control of the disease. The multivariate analysis revealed significant associations between optimal follow up and age, gender (males), SER (Ranks 1-10), Arabs and SVHI (OR 1.02, 0.95, 1.15, 0.85 and 1.31, respectively); poor diabetes control (HbA1C > 9 gr%) was significantly associated with age, gender (males), Arabs, immigrants, SER (Ranks1-10) and SVHI (OR 0.96, 1.26, 1.38, 0.72, 1.37 and 0.57, respectively); significant associations with LDL control (< 100 gr%) were revealed for age, gender (males) and SVHI (OR 1.02, 1.30 and 1.44, respectively).ConclusionDisparities in diabetes prevalence, care and control were revealed according to population sub-group. MHS has recently established a comprehensive strategy and action plan, aimed to reduce disparities among members of low socioeconomic rank and Arab ethnicity, sub-groups identified in our study as being at risk for less favorable health outcomes.
Highlights
The commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health
Diabetes Prevalence Diabetes was more prevalent in males when compared to females, members with a lower socio-economic rank (SER) (1-10) when compared to a higher SERs (11-20), Arabs as opposed to non Arabs, immigrants from Former Soviet Union (FSU) countries when compared with veteran residents, and supplementary voluntary health insurance (SVHI) owners when compared to non owners
Low socio-economic status and belonging to an ethnic minority are associated with less favorable diabetes care and control
Summary
The commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. The study was conducted by Maccabi Healthcare Services (MHS), an Israeli HMO (health care plan). The commitment to promoting equity in health care is derived from the notion that all human beings have the right to the best attainable health [1]. In 2001, the American Institute of Medicine (IOM) suggested six dimensions to define quality of care. Disparities in health care have been well-documented over the years [7,8,9,10,11]. Each nonprofit plan is required to provide its members with a basic benefits package that includes physician services, hospitalization and outpatient care. Enrollment in one of the health plans is by free choice; plan denial of enrollment is prohibited
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