Access to Care

Access and Quality of Health Care, 2003-2006

Lack of access to care can shorten lives and influence an individual's overall quality of life.42 Women who are at high risk for diabetes need a consistent source of health care, either a person or a place, to receive ongoing patient-centered preventive care, which can delay or prevent the complications of diabetes. Several factors can impede a woman's ability to obtain access to care. Race and ethnicity, socioeconomic position, age, and other factors contribute to the lack of ongoing care for women.43 

Health Insurance

Health insurance coverage during the past year among women ages 18-64 years, by diabetes risk status, 2003-2006

Figure 21. Health insurance during the past year among women ages 18-64 years, by diabetes risk status, 2003-2006; Bar chart showing women at high risk for diabetes with various types of health insurance; Any Type, At Risk, 85.9, Not at Risk, 83; Any Private, At Risk, 71.6, Not at Risk, 72.6; Public Only, At Risk, 14.3, Not at Risk, 10.2; Uninsured All Year, At Risk, 7.5, Not at Risk, 9.5; Uninsured, Any Period, At Risk, 21, Not at Risk, 21.2.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • The types of health insurance coverage reported by women at high risk for diabetes were not significantly different from the types of coverage reported by women not at high risk for diabetes.

Women ages 18-64 years with any type of health insurance coverage during the past year, by diabetes risk status and race/ethnicity, 2003-2006

Figure 22. Women ages 18-64 years with any type of health insurance during the past year, by diabetes risk status and race/ethnicity, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with any health insurance; Non-Hispanic White, At Risk, 87.9, Not at Risk, 83.6; Non-Hispanic Black, At Risk, 78.3, Not at Risk, 76.6; Mexican-American, At Risk, 47.3, Not at Risk, 57.6.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • Mexican-American women at high risk for diabetes were significantly less likely than Mexican-American women not at high risk for diabetes to have any type of insurance during the past year.
  • Among women at high risk for diabetes, Mexican-American and non-Hispanic black women were significantly less likely than non-Hispanic white women to have any type of insurance during the past year.
  • Among women not at high risk for diabetes, Mexican Americans were significantly less likely than non-Hispanic whites to have any type of insurance during the past year.

Women ages 18-64 years with any type of health insurance coverage during the past year, by diabetes risk status and education, 2003-2006

Figure 23. Women ages 18-64 years with any type of health insurance during the past year, by diabetes risk status and education, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with any health insurance; Less Than High School, At Risk, 59.2, Not at Risk, 59.2; High School, At Risk, 79.7, Not at Risk, 72.2; More Than High School, At Risk, 88.3, Not at Risk, 87.8.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 3.

  • At all levels of education, the proportion of women at high risk for diabetes who reported having any type of health insurance was not significantly different from the proportion of women not at high risk for diabetes.
  • Regardless of diabetes risk status, women who had a high school education or less were significantly less likely than women who had higher levels of education to have any type of health insurance.

Women ages 18-64 years with any type of health insurance during the past year, by diabetes risk status and family income, 2003-2006

Figure 24. Women ages 18-64 years with any type of health insurance during the past year, by diabetes risk status and family income, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with any health insurance; Poor, At Risk, 61.5, Not at Risk, 62.2; Near Poor, At Risk, 65.6, Not at Risk, 59.3; Middle Income, At Risk, 85.5, Not at Risk, 82.3; High Income, At Risk, 96.6, Not at Risk, 95.2.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 4.

  • At all levels of family income, the proportion of women at high risk for diabetes who reported having any type of health insurance was not significantly different from the proportions of women not at high risk for diabetes.
  • Regardless of diabetes risk status, women who lived in poor, near-poor, or middle-income families were significantly less likely than women who lived in high-income families to report having any type of health insurance during the past year.

Women ages 18-64 years with any private health insurance during the year, by diabetes risk status and race/ethnicity, 2003-2006

Figure 25. Women ages 18-64 years with any private health insurance during the year, by diabetes risk status and race/ethnicity, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with any private health insurance; Non-Hispanic White, At Risk, 76.3, Not at Risk, 74.5; Non-Hispanic Black, At Risk, 53.6, Not at Risk, 53; Mexican-American, At Risk, 31.6, Not at Risk, 45.5.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • Among Mexican Americans, women at high risk for diabetes were significantly less likely than women not at high risk for diabetes to have any private health insurance during the year. No significant differences were found among non-Hispanic black or non-Hispanic white women.
  • Regardless of diabetes risk status, Mexican-American and non-Hispanic black women were significantly less likely than non-Hispanic white women to have any private health insurance during the year.

Women ages 18-64 years with any private health insurance during the year, by diabetes risk status and education, 2003-2006

Figure 26. Women ages 18-64 years with any private health insurance during the year, by diabetes risk status and education, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with any private health insurance; Less Than High School, At Risk, 37.3, Not at Risk, 32.6; High School, At Risk, 62.5, Not at Risk, 61.1; More Than High School, At Risk, 77, Not at Risk, 80.3.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 3.

  • At all levels of education, the proportions of women at high risk and not at high risk for diabetes who reported having any private health insurance during the year were not significantly different.
  • Regardless of diabetes risk status, women who had a high school education or less were significantly less likely than women with more than a high school education to have any private health insurance during the year

Women ages 18-64 years with private health insurance during the year, by diabetes risk status and family income, 2003-2006

Figure 27. Women ages 18-64 years with private health insurance during the year, by diabetes risk status and family income, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with any private health insurance; Poor At Risk, 23.9, Not at Risk, 28.9; Near Poor, At Risk, 43.9, Not at Risk, 44.7; Middle Income, At Risk, 77, Not at Risk, 74.5; High Income, At Risk, 90.6, Not at Risk, 91.8.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 4.

  • At all levels of family income, the proportions of women at high risk and not at high risk for diabetes who reported having any private health insurance during the year were not significantly different.
  • Regardless of diabetes risk status, women who lived in poor, near-poor, or middle-income families were significantly less likely than women who lived in high-income families to have private health insurance during the year.

Women ages 18-64 years with only public health insurance during the year, by diabetes risk status and race/ethnicity, 2003-2006

Figure 28. Women ages 18-64 years with only public health insurance during the year, by diabetes risk status and race/ethnicity, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with only public health insurance; Non-Hispanic White, At Risk, 11.6, Not at Risk, 9; Non-Hispanic Black, At Risk, 24.5, Not at Risk, 22.9; Mexican-American, At Risk, 15.5, Not at Risk, 12.1.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • Among non-Hispanic whites, women at high risk for diabetes were significantly more likely than women not at high risk for diabetes to have only public health insurance during the year. No significant differences were found among non-Hispanic black or Mexican-American women.
  • Regardless of diabetes risk status, non-Hispanic black women were significantly more likely than non-Hispanic white women to have only public health insurance during the year.

Women ages 18-64 years with only public health insurance coverage during the year, by diabetes risk status and education, 2003-2006

Figure 29. Women ages 18-64 years with only public health insurance during the year, by diabetes risk status and education, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with only public health insurance; Less Than High School, At Risk, 21.8, Not at Risk, 26.1; High School, At Risk, 17.2, Not at Risk, 10.6; More Than High School, At Risk, 11.2, Not at Risk, 7.2.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 3.

  • Among women with a high school education or higher, women at high risk for diabetes were significantly more likely than those not at high risk for diabetes to have only public health insurance during the year.
  • Regardless of diabetes risk status, women with a high school education or less were significantly more likely than women with more than a high school education to have only public health insurance during the year

Women ages 18-64 years with only public health insurance during the year, by diabetes risk status and family income, 2003-2006

Figure 30. Women ages 18-64 years with only public health insurance during the year, by diabetes risk status and family income, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with only public health insurance; Poor, At Risk, 37.2, Not at Risk, 31.8; Near Poor, At Risk, 21.6, Not at Risk, 14; Middle Income, At Risk, 8.5, Not at Risk, 7.9; High Income, At Risk, 6, Not at Risk, 3.5.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 4.

  • In near-poor families, women at high risk for diabetes were significantly more likely than women not at high risk for diabetes to have only public health insurance during the year. No significant differences were found at other levels of family income.
  • Regardless of diabetes risk status, women who were poor, near poor, or middle income were significantly more likely than women who were high income to have only public health insurance during the year.

Women ages 18-64 years who were uninsured all year, by diabetes risk status and race/ethnicity, 2003-2004

Figure 31. Women ages 18-64 years who were uninsured all year, by diabetes risk status and race/ethnicity, 2003-2004; Bar chart showing percentage of women at high risk and not at high risk for diabetes with no health insurance; Non-Hispanic White, At Risk, 6.5, Not at Risk, 9.2; Non-Hispanic Black, At Risk, 11.7, Not at Risk, 13; Mexican-American, At Risk, 42.9, Not at Risk, 41.7.

Source: National Health and Nutrition Examination Survey, 2003-2004. Appendix Table: Table 2.

  • In each racial/ethnic group, the proportion of women at high risk for diabetes who were uninsured all year was not significantly different from the proportion among women not at high risk for diabetes.
  • Among women at high risk for diabetes, Mexican-American and non-Hispanic black women were significantly more likely than non-Hispanic white women to be uninsured all year.
  • Among women not at high risk for diabetes, Mexican-American women were significantly more likely than non-Hispanic white women to be uninsured all year.

Women ages 18-64 years who were uninsured all year, by diabetes risk status and education, 2003-2004

Figure 32. Women ages 18-64 years who were uninsured all year, by diabetes risk status and education, 2003-2004; Bar chart showing percentage of women at high risk and not at high risk for diabetes with no health insurance; Less Than High School, At Risk, 29.5, Not at Risk, 33.5; High School, At Risk, 12.6, Not at Risk, 16.8; More Than High School, At Risk, 6.1, Not at Risk, 7.5.

Source: National Health and Nutrition Examination Survey, 2003-2004
Appendix Table: Table 3.

  • At all levels of education, the proportion of women who were uninsured all year was not significantly different between women at high risk and not at high risk for diabetes.
  • Regardless of diabetes risk status, women with a high school education or less were significantly more likely than women with more than a high school education to be uninsured all year.

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Use of Health Care Services

Women age 18 years and over reporting use of health care services, by diabetes risk status, 2003-2006

Figure 33. Women ages 18 years and over reporting use of health care services, by diabetes risk status, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes using various health care services; Specific Source of Ongoing Care, At Risk, 93.4, Not at Risk, 90.3; Clinic or Health Center, At Risk, 15.5, Not at Risk, 14.3; Office or Outpatient Visit in Past 12 Months, At Risk, 90.4, Not at Risk, 91.3.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • The percentages of women at high risk for diabetes who reported that they had a specific source of ongoing care or that the source was a clinic or health center were not significantly different from the percentages among women not at high risk for diabetes.
  • The percentage of women at high risk for diabetes who reported an office or outpatient visit in the past 12 months was not significantly different from the percentage among women not at high risk for diabetes

Women age 18 years and over who had a specific source of ongoing care, by diabetes risk status and race/ethnicity, 2003-2006

Figure 34. Women age 18 years and over who had a specific source of ongoing care, by diabetes risk status and race/ethnicity, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with a source of care; Non-Hispanic White, At Risk, 93.3, Not at Risk, 90.1; Non-Hispanic Black, At Risk, 93.8, Not at Risk, 92.2; Mexican-American, At Risk, 76.2, Not at Risk, 70.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • In all racial/ethnic groups, no significant difference was found between the percentages of women at high risk and not at high risk for diabetes who had a specific source of ongoing care.
  • Regardless of diabetes risk status, Mexican-American women were significantly less likely than non-Hispanic white women to have a specific source of ongoing care.
  • Non-Hispanic black women not at high risk for diabetes were significantly more likely than non-Hispanic white women not at high risk for diabetes to have a specific source of ongoing care.

Women age 18 years and over who had a specific source of ongoing care, by diabetes risk status and education, 2003-2006

Figure 35. Women age 18 years and over who had a specific source of ongoing care, by diabetes risk status and education, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with a source of care; Less Than High School, At Risk, 87, Not at Risk, 88.6; High School, At Risk, 90.1, Not at Risk, 82.5; More Than High School, At Risk, 93.9, Not at Risk, 89.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 3.

  • Among women with a high school education or more, women at high risk for diabetes were significantly more likely than those not at high risk to have a specific source of ongoing care.
  • Women at high risk for diabetes who had less than a high school education or a high school education were significantly less likely than women at high risk for diabetes who had more than a high school education to have a specific source of ongoing care.
  • Women not at high risk for diabetes who had a high school education were significantly less likely than those with more than a high school education to have a specific source of ongoing care.

Women age 18 years and over who had a specific source of ongoing care, by diabetes risk status and family income, 2003-2006

Figure 36. Women age 18 years and over who had a specific source of ongoing care, by diabetes risk status and family income, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with a source of care; Poor, At Risk, 85.3, Not at Risk, 82.5; Near Poor, At Risk, 89.3, Not at Risk, 79.7; Middle Income, At Risk, 92.6, Not at Risk, 89.2; High Income, At Risk, 95.1, Not at Risk, 93.3.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 4.

  • Women at high risk for diabetes who lived in near-poor families were significantly more likely that those not at high risk for diabetes to have a specific source of ongoing care. We found no significant differences by diabetes risk status in the other family income groups.
  • Among women at high risk for diabetes, those who lived in poor or near-poor families were significantly less likely than those who lived in high-income families to have a specific source of ongoing care. No significant difference was found for women in middle-income families.
  • Women not at high risk for diabetes who were poor, near poor, or middle income were significantly less likely than those with high income to have a specific source of ongoing care.

Women age 18 years and over whose source of ongoing care is a clinic or health center, by diabetes risk status and race/ethnicity, 2003-2006

Figure 37. Women age 18 years and over whose source of ongoing care is a clinic or health center, by diabetes status and race/ethnicity, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with a clinic or health center as their ongoing source of care; Non-Hispanic White, At Risk, 15, Not At Risk, 13.5; Non-Hispanic Black, At Risk, 20.5, Not At Risk, 22.5; Mexican-American, At Risk, 43.3, Not At Risk, 32.8.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • Mexican-American women at high risk for diabetes were significantly more likely than those not at high risk for diabetes to use a clinic or health center as their ongoing source of care. No significant difference was found in other racial/ethnic groups.
  • Regardless of diabetes risk status, Mexican-American women were significantly more likely than non-Hispanic white women to use a clinic or health center as their ongoing source of care. No significant difference was found between non-Hispanic black and non-Hispanic white women.

Women age 18 years and over whose source of ongoing care is a clinic or health center, by diabetes risk status and education, 2003-2006

Figure 38. Women age 18 years and over whose source of ongoing care is a clinic or health center, by diabetes status and education, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with a clinic or health center as their ongoing source of care; Less Than High School, At Risk, 32.1, Not At Risk, 28.4; High School, At Risk, 16.8, Not At Risk, 18.7; More Than High School, At Risk, 14.9, Not At Risk, 13.1.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 3.

  • At all levels of education, no significant difference was found between women at high risk for diabetes and women not at high risk for diabetes in the percentages reporting a clinic or health center as their ongoing source of care.
  • Regardless of diabetes risk status, women who had less than a high school education were significantly more likely than women who had more than a high school education to have a clinic or health center as their ongoing source of care. No significant difference was found for women with a high school education.

Women age 18 years and over whose source of ongoing care is a clinic or health center, by diabetes risk status and family income, 2003-2006

Figure 39. Women age 18 years and over whose source of ongoing care is a clinic or health center, by diabetes status and family income, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with a clinic or health center as their ongoing source of care; Poor, At Risk, 33.4, Not at Risk, 34.4; Near Poor, At Risk, 24.1, Not at Risk, 20.3; Middle Income, At Risk, 15, Not at Risk, 16.4; High Income, At Risk, 12, Not at Risk, 9.9.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 4.

  • No significant difference by income was found between the percentages of women at high risk and not at high risk for diabetes who had a clinic or health center as their ongoing source of care.
  • Women at high risk for diabetes who were poor or near poor were significantly more likely than women at high risk for diabetes with high income to have a clinic or health center as their ongoing source of care.
  • Women not at high risk for diabetes who were poor, near poor, or middle income were significantly more likely than women not at high risk for diabetes with high income to have a clinic or health center as their ongoing source of care.

Women age 18 years and over who reported an office or outpatient visit in the past 12 months, by diabetes risk status and race/ethnicity, 2003-2006

Figure 40. Women age 18 years and over who reported an office or outpatient visit in the past 12 months, by diabetes status and race/ethnicity, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with an office or outpatient visit; Non-Hispanic White, At Risk, 92.4, Not At Risk, 91.5; Non-Hispanic Black, At Risk, 89.7, Not At Risk, 89.6; Mexican-American, At Risk, 76.5, Not At Risk, 81.4.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 2.

  • In each racial/ethnic group, the proportions of women at high risk and not at high risk for diabetes who reported making an office or outpatient visit in the past 12 months were not significantly different.
  • Regardless of diabetes risk status, Mexican-American women were significantly less likely than non-Hispanic white women to have reported an office or outpatient visit in the past 12 months. No significant differences were found between non-Hispanic black and non-Hispanic white women.

Women age 18 years and over who reported an office or outpatient visit in the past 12 months, by diabetes risk status and education, 2003-2006

Figure 41. Women age 18 years and over who reported an office or outpatient visit in the past 12 months, by diabetes status and education, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with an office or outpatient visit; Less Than High School, At Risk, 86.4, Not at Risk, 85.2; High School, At Risk, 92, Not at Risk, 88.2; More Than High School, At Risk, 91.6, Not at Risk, 90.7.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 3.

  • At all levels of education, no significant difference was found between the percentages of women at high risk and not at high risk for diabetes who reported an office or outpatient visit in the past 12 months.
  • Regardless of diabetes risk status, women with less than a high school education were less likely than women with more than a high school education to report an office or outpatient visit in the past 12 months.

Women age 18 years and over who reported an office or outpatient visit in the past 12 months, by diabetes risk status and family income, 2003-2006

Figure 42. Women age 18 years and over who reported an office or outpatient visit in the past 12 months, by diabetes status and family income, 2003-2006; Bar chart showing percentage of women at high risk and not at high risk for diabetes with an office or outpatient visit; Poor, At Risk, 85.9, Not At Risk, 84; Near Poor, At Risk, 85.8, Not At Risk, 85.3; Middle Income, At Risk, 93.5, Not At Risk, 87.3; High Income, At Risk, 93.5, Not At Risk, 94.7.

Source: National Health and Nutrition Examination Survey, 2003-2006. Appendix Table: Table 4.

  • At any level of family income, the proportions of women at high risk or not at high risk for diabetes who reported an office visit or outpatient visit were not significantly different.
  • Women at high risk for diabetes who lived in poor or near-poor families were significantly less likely than women at high risk for diabetes who lived in high-income families to report an office or outpatient visit in the past 12 months.
  • Women not at high risk for diabetes who lived in poor, near poor, or middle-income families were significantly less likely than women not at high risk for diabetes who lived in high-income families to report an office or outpatient visit in the past 12 months.
Page last reviewed January 2011
Internet Citation: Access to Care: Access and Quality of Health Care, 2003-2006. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/final-reports/women-and-diabetes-2003-2006/wmhrdiab5.html