Educational disparities in quality of diabetes care in a universal health insurance system: evidence from the 2005 Korea National Health and Nutrition Examination Survey.

OBJECTIVE: To investigate educational disparities in the care process and health outcomes among patients with diabetes in the context of South Korea's universal health insurance system.
DESIGN: Bivariate and multiple regression analyses of data from a cross-sectional health survey.
SETTING: A nationally representative and population-based survey, the 2005 Korea National Health and Nutrition Examination Survey. PARTICIPANTS: Respondents aged 40 or older who self-reported prior diagnosis with diabetes (n= 1418). MAIN OUTCOME MEASURES: Seven measures of the care process and health outcomes, namely (i) receiving medical treatment for diabetes, (ii) ever received diabetes education, (iii) received dilated eye examination in the past year, (iv) received microalbuminuria test in the past year, (v) having activity limitation due to diabetes, (vi) poor self-rated health and (vii) self-rated health on a visual analog scale.
RESULTS: Except for receiving medical care for diabetes, overall process quality was low, with only 25% having ever received diabetes education, 39% having received a dilated eye examination in the past year and 51% having received a microalbuminuria test in the past year. Lower education level was associated with both poorer care processes and poorer health outcomes, whereas lower income level was only associated with poorer health outcomes.
CONCLUSION: While South Korea's universal health insurance system may have succeeded in substantially reducing financial barriers related to diabetes care, the quality of diabetes care is low overall and varies by education level. System-level quality improvement efforts are required to address the weaknesses of the health system, thereby mitigating educational disparities in diabetes care quality.