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Background: In 2003, a county hospital system in the Midwest implemented policies that increased patient cost sharing via increased co-payments for services. The purpose of this study was to measure the impact of those changes for vulnerable patients with diabetes mellitus in subsequent years.. Methods: A state-of-the art electronic medical record system recorded quality and utilization measures for two years before and two years after the operational changes. Data from 2,394 patients with both diabetes mellitus and reliable utilization and quality of care data were included in the study. The associations between the quality of care, health care costs, healthcare utilization, patients’ third party pay or status, and the policy implementation were examined using Linear Mixed-Effects and Generalized Estimating Equations (GEE) models. Results: Compared to before the policy change, the quality of care measures significantly improved for patients with Medicare and indigent care pay or status. Healthcare costs, emergency department visits, and hospitalizations significantly increased after the policy change for patients with Medicare and indigent care insurance. Visits to primary care clinics decreased after the policy change for patients with Medicaid, Medicare, and self pay where as patients on the indigent care program had higher primary care visits. Conclusion: The policy implementation impacted patients in the Indigent Care program, as intended, but also impacted Medicare patients more negatively, in financial and utilization aspects, than expected by the policy. More costly utilization patterns, after increasing cost-sharing policy changes in public hospitals, may lead to higher medical costs for the system in the long-term.

international journal of community and family medicine

Is the Safety Net Leaking?: Measuring Changes in Quality of Care and Healthcare Utilization for Patients with Diabetes Mellitus before and after Implementation of Cost-Sharing at a Public Hospital