Clinical Rheumatology

, Volume 32, Issue 6, pp 763–769

Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico

  • Yesenia Santiago-Casas
  • Tania González-Rivera
  • Lesliane Castro-Santana
  • Grissel Ríos
  • David Martínez
  • Vanessa Rodríguez
  • Rafael González-Alcover
  • Ángel M. Mayor
  • Luis M. Vilá
Original Article


The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared with non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease activity (per disease activity score 28), comorbid conditions, functional status (per Health Assessment Questionnaire), and pharmacologic profile were determined. Data were examined using uni- and multivariable (logistic regression) analyses. The mean (standard deviation (SD)) age of the study population was 56.6 (13.5) years; 180 (84.1 %) were women. The mean (SD) disease duration was 10.8 (9.6) years. Sixty-seven patients were treated in the managed care setting, and 147 patients received their healthcare in fee-for-service settings. In the multivariable analyses, RA patients treated in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type 2 diabetes mellitus, cardiovascular events, fibromyalgia syndrome, and poorer functional status while having a lower exposure to biological agents than those treated in fee-for-service settings. Efforts should be undertaken to curtail the gap of health disparities among these Hispanic patients in order to improve their long-term outcomes.


Fee-for-service system Healthcare Hispanics Managed care system Medically indigent patients Puerto Ricans Rheumatoid arthritis 


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Copyright information

© Clinical Rheumatology 2013

Authors and Affiliations

  • Yesenia Santiago-Casas
    • 1
  • Tania González-Rivera
    • 2
  • Lesliane Castro-Santana
    • 1
  • Grissel Ríos
    • 1
  • David Martínez
    • 1
  • Vanessa Rodríguez
    • 1
  • Rafael González-Alcover
    • 1
  • Ángel M. Mayor
    • 1
  • Luis M. Vilá
    • 1
  1. 1.Division of Rheumatology, Department of MedicineUniversity of Puerto Rico Medical Sciences CampusSan JuanPuerto Rico
  2. 2.Division of Rheumatology, Department of MedicineUniversity of Michigan School of MedicineAnn ArborUSA

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