Among individuals who experience a change in health caused by an unintentional injury or new chronic condition, those without insurance are more likely to have difficulty obtaining recommended medical care and more likely to experience larger declines in short-term health, according to a study in the March 14 issue of JAMA, a theme issue on access to care.
Jack Hadley, Ph.D., of the Urban Institute, Washington, D.C., presented the results of the study today at a JAMA media briefing on access to care at the National Press Club.
The large and increasing number of uninsured individuals in the U.S. underscores the importance of knowing the health consequences of being uninsured, according to background information in the article.
Dr. Hadley conducted a study to examine whether uninsured individuals who experienced a health shock caused by either the onset of a chronic condition or an unintentional injury received the same amount of medical care and had similar short-term health outcomes as insured individuals. He analyzed data from Medical Expenditure Panel Surveys (1997-2004), limited to nonelderly individuals whose insurance status was established for two months prior to one or more unintentional injuries (20,783 cases among 15,866 individuals) and onset of one or more chronic conditions (10,485 cases among 7,954 individuals).
Dr. Hadley found that after experiencing a health shock, uninsured individuals were less likely to obtain any medical care: those with an unintentional injury (UI), were 53 percent less likely; those with a new chronic condition (NCC), were 55 percent less likely to obtain any medical care.
Among those who received some care, the uninsured were more likely not to have received any recommended follow-up care: the UI group were 2.6 times more likely, while those with a new chronic condition were 1.7 times more likely.
Results of the research also indicated that uninsured individuals with UIs or a NCC had fewer office-based visits and prescription medicines. Higher proportions of uninsured individuals reported a decrease in health status (classified as much worse) approximately 3.5 months after the health shock. Uninsured individuals with UIs were more likely to report not being fully recovered and no longer receiving treatment. At approximately seven months after the health shock, uninsured individuals with NCCs still reported worse health status.
"The findings for uninsured individuals with a new chronic condition are of particular concern. Because chronic conditions generally require care over an extended period, the finding that the uninsured are more likely to report no longer being treated at the first follow-up interview suggests that their care may have been inadequate. Moreover, their greater dependence on emergency departments for care probably increases the likelihood that their care will be episodic and lack continuity. For individuals who require treatment for chronic conditions, a continuing relationship with a clinician and appropriate medication use may be especially important for improving or maintaining health status," Dr. Hadley writes.
"The results of this analysis imply that the failure to address the problem of no insurance for U.S. individuals will have adverse health consequences. Moreover, the fact that these consequences apply to uninsured individuals who experienced unintentional injuries or new chronic conditions runs counter to the perception that the uninsured receive care, either through the safety net or their own resources, when they really need it (e.g., when they experience a health shock from an unintentional injury or develop a new chronic condition)," he writes. "If the proportion of individuals without insurance continues to increase, more and more persons may experience preventable deteriorations in their health."
(JAMA. 2007;297:1073-1084. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The research for this article was supported by contracts from the Kaiser Family Foundation, Washington, D.C. Please see the article for additional information, including author contributions and affiliations, financial disclosures, etc.
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