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UNINSURED SUFFER GREATER HEALTH CONSEQUENCES
David Baker's findings appear in the October 11 issue of the New England Journal of Medicine. Joining him in the study are Joseph Sudano from the Center for Health Care Research and Policy at MetroHealth Medical Center; Jeffrey Albert and Elaine Borawski from the Department of Epidemiology and Biostatistics; and Avi Dor of the Department of Economics. "There has been the perception in the United States for a long time that people who are uninsured are able to get essential medical care. It may be difficult, but they can get it," said Baker, a CWRU associate professor of medicine at MetroHealth. "That's a myth we wanted to attack. Previous studies have shown that even when the uninsured have serious medical problems, they are less likely to receive medical care. We wanted to analyze how their problems with access to care affected their health," Baker added. "The findings send a clear message that being uninsured is bad for your health." Using data from the Health and Retirement Study, researchers determined the risks of a major decline in overall health and the development of new physical problems between 1992 and 1996 for participants who were continuously uninsured, intermittently uninsured and continuously insured. The Health and Retirement Study is a national survey of adults who were 51 to 61 years old in 1992. There were 9,824 participants in the study, which was sponsored by the National Institute on Aging and conducted by the Institute for Social Research at the University of Michigan. The CWRU study focused on 7,577 of the original 1992 participants, 1,138 were lost to follow-up, 377 died, 665 were excluded because they had public insurance, and 67 had missing data. Using data from the study, CWRU researchers determined that the 717 continuously uninsured and 825 intermittently uninsured participants were 63 percent more likely than the 6,035 continuously insured participants to have a major decline in overall health. The 825 intermittently uninsured participants were 41 percent more likely to have a major decline in their overall health than the continuously uninsured. Those two groups also were more likely to have new mobility problems. Baker said that in previous studies, the overwhelming reason for a lack of health insurance is cost. "The uninsured are aware they have problems, but they can't find a doctor they can afford. Many have to go to the emergency department, and they end up getting fragmented care," he said. "It's ironic that we're talking about expanding insurance coverage for people with Medicare," Baker added. "We are concerned that people are not able to afford their medication if they are over 65. But if you're 60 and uninsured, we don't seem to be mounting the same level of concern. "When that person does get to 65, they are covered by Medicare. Then we will pay for all of the problems they developed during those years when they were uninsured." Baker said there needs to be agreement across the political spectrum that this is a problem our country needs to address. He advocates starting a national dialogue on comprehensive health insurance reform that strives to achieve universal health insurance coverage. "Piecemeal, incremental solutions to this problem are unlikely to work, and this is particularly true for adults in late middle age who don't have health insurance," Baker said. "Because they are older and are more likely to have chronic medical problems, health insurance coverage is extremely expensive. "Even if they can get coverage they could afford through voucher programs and high-risk pools, the insurance policies that are available usually have such high deductibles that they would only pay out if the person had to be hospitalized. So they wouldn't help people get the medical care they need to stay healthy." Baker said the CWRU study is unique because it used data from a nationally representative sample. Previous smaller studies have looked at the health consequences from lack of insurance, but most focused on whether uninsured patients were able to see a doctor. "This shows the problems reported in previous studies are not isolated to just a few places in the United States," Baker said. "This is a national sample, and our findings show this is a national problem." The vast majority of uninsured people, he added are working or are in a family where the head of household works full- or part-time. But they are working at places where their employer does not provide health insurance. If they do happen to work for a company that offers health insurance, many times they remain unable to pay their portion of the insurance coverage. Although there are several proposals out to expand health insurance coverage, Baker said they are unlikely to help this group because they are older, carry a high burden of chronic medical problems, and are low income. "Clearly, there needs to be a consensus that this is a major national problem we need to solve, and we have to recognize what's been done to date to address it has been ineffective," Baker said.
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