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One-Third of Uninsured Are Chronically Ill

And that can mean missed care, fading health, earlier death, experts say

MONDAY, Aug. 4, 2008 (HealthDay News) -- One out of every three working-age, uninsured Americans suffers from a chronic illness and isn't getting the medical care they need, a new report shows.

Although the study didn't specifically look at the health consequences of lack of insurance and lack of access to medical care, it's reasonable to assume that these factors would lead to various medical complications, said the authors of a study published in the Aug. 5 issue of the Annals of Internal Medicine.

"This is something that is very true in my clinical experience," said Dr. Andrew Wilper, instructor in medicine at the University of Washington in Seattle. "The uninsured can't get in to see the doctor, they miss medications, their blood pressure is out of control and, really, you see devastating consequences." Wilper was a fellow in general internal medicine at Harvard Medical School while conducting the study.

Another expert agreed that a lack of insurance along with chronic illness can be a potentially lethal combination.

"These people are going to end up with complications of their illnesses prematurely. They will be disabled early. They will probably die younger. It is a major public health disaster," said Dr. Oliver Fein, president-elect of Physicians for a National Health Program and professor of clinical medicine and public health at Weill Cornell Medical College of Cornell University in New York City. "Longer-term, there will be expensive admissions to hospitals, usually through the emergency department, due to diabetes out of control and congestive heart failure because of hypertension."

Information on the number of Americans without health insurance (about 47 million in 2006, up from 31 million in 1987) is plentiful. Less clear has been how many of these individuals suffer from chronic medical conditions, although some, including policymakers, have suggested that many are healthy.

Using data from interviews with almost 12,500 people aged 18 to 64 who had participated in the National Health and Nutritional Examination Survey (NHANES), the authors conclude that an estimated 11.4 million working-age Americans with at least one of seven chronic medical conditions do not have health insurance.

This included 16.1 percent of the 7.8 million people with cardiovascular disease, 15.5 percent of the 38.2 million people with hypertension and 16.6 percent of the 8.5 million people with diabetes.

Other conditions examined were asthma, high cholesterol, chronic obstructive pulmonary disease or a previous diagnosis of cancer.

"We found some pretty striking differences when we compared uninsured individuals with one of these seven conditions with insured individuals with one of the conditions," Wilper said.

About 26 percent of uninsured people reported no standard site of care, versus only 6.2 percent of those who had insurance. More than 22 percent of uninsured individuals reported no visits to a health professional in the past year compared to 6.2 percent of insured people, and 7.1 percent of uninsured people with a chronic condition reported that the emergency room was their standard site of medical care, versus 1.1 percent of those carrying insurance.

"These are conditions that we take care of in the clinic. We know that we can prevent disabling complications or catastrophe if we are able to manage these conditions," Wilper said.

"None of it is surprising," said Greg Scandlen, founder and director of Consumers for Health Care Choices, a nonprofit advocacy group for health-care consumers. "It is interesting that chronic conditions are more common among people with insurance than without. But that isn't surprising either. People with a chronic condition are likely to place a higher value on their coverage and work harder to get and keep it," he said.

"But having insurance is not likely to prove to be a panacea for these folks," Scandlen added. "People with chronic conditions who are insured are not doing so well, either. We do not do a very good job of delivering chronic care in this country for anyone."

The new findings corroborate those from a study published July 22 in Health Affairs, which concluded that access to care among uninsured, nonelderly U.S. adults with chronic conditions actually got worse between 1997 and 2006.

More information

There's more on the uninsured at the Kaiser Family Foundation.

SOURCES: Andrew P. Wilper, M.D., instructor in medicine, University of Washington, Seattle; Oliver Fein, M.D., president-elect, Physicians for a National Health Program, and professor, clinical medicine and public health, Weill Cornell Medical College of Cornell University, New York City; Greg Scandlen, Senior Fellow and Director, Consumers for Health Care Choices, Heartland Institute, Hagerstown, Md.; Aug. 5, 2008, Annals of Internal Medicine; July 22, 2008, Health Affairs
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