Although suboptimal insurance status has been linked to an increased risk of diabetes-related amputation, it is unclear how better health insurance coverage improves the care and outcomes of patients with diabetic foot ulcerations (DFUs). The purpose of the present study was to evaluate the outcomes of Medicaid beneficiaries with DFUs who had transitioned to commercial insurance.
The Pearl Diver all-payor insurance claims database was used to identify adult patients (>18 years) with a new DFU from 2010 to 2019. The study cohort included 8814 Medicaid beneficiaries with ≥3 years of continuous enrollment after the diagnosis of DFUs. The patients were stratified according to whether they had experienced an improvement in insurance coverage from Medicaid to commercial insurance. Patients who had transitioned from Medicaid to Medicare and other government-sponsored insurance during follow-up were excluded. We used logistic regression and Kaplan-Meier estimates to examine the association of insurance change (Medicaid to commercial insurance) and lower extremity amputation. An adjusted analysis was performed using propensity score matching (1:1 ratio).
Among the 8814 Medicaid beneficiaries with DFUs, 5809 (66%) had transitioned to commercial insurance coverage during follow-up. The overall major amputation rate was 3.1% (transition to commercial, 2.6%; Medicaid, 3.2%; P < .05). Medicaid beneficiaries who had transitioned to commercial insurance had had a 27% lower risk of major amputation (odds ratio, 0.75; 95% confidence interval, 0.56-0.97; P = .03) compared with those with continuous Medicaid coverage. In the propensity-matched cohort, adjusted for age, Charlson comorbidities index, gender, chronic pulmonary disease, coronary artery disease, hypertension, depression, peripheral artery disease, renal failure, and smoking, Medicaid beneficiaries who had transitioned to commercial insurance had had a significantly lower risk of major amputation (odds ratio, 0.65; 95% confidence interval, 0.22-0.55; P = .01).
Among Medicaid beneficiaries with DFUs, improvement in health insurance status from Medicaid to commercial health insurance was associated with a reduced risk of diabetes-related amputations.