Many U.S. adults with chronic illness are uninsured

NEW YORK (Reuters Health) - An estimated 11.4 million Americans with at least one chronic illness have no health insurance, new research published in the Annals of Internal Medicine shows.

A doctor checks the blood pressure of a patient in Los Angeles, July 30, 2007. REUTERS/Lucy Nicholson

These people are much less likely to have a regular place to get medical care, much less likely to have seen a doctor in the past year, and much more likely to use the emergency room than chronically ill people who are insured, Dr. Andrew P. Wilper and colleagues from Cambridge Health Alliance/Harvard Medical School in Cambridge, Massachusetts, found.

“Primary care doctors know that people who don’t have access to health care due to health insurance suffer,” Wilper, who is now with the University of Washington School of Medicine in Seattle, told Reuters Health. “We wanted to study that issue and bring public attention to it.”

He and his colleagues analyzed data from the National Health and Nutritional Examination Survey for 1999-2004, which included 12,486 men and women 18 to 64 years old. Based on this nationally representative sample, they calculated that 16.1 percent of people with heart disease, 15.5 percent of those with high blood pressure, and 16.6 percent of diabetics are uninsured.

Among the uninsured, 22.6 percent had not visited a physician in the previous 12 months, compared to 16.2 percent of insured chronically ill people.

The corresponding percentages for those lacking a regular site receiving health care were 22.6 percent and 6.2 percent, and for those using the emergency room for regular care the numbers were 7.1 percent and 1.1 percent.

After the researchers adjusted for age, gender and race or ethnicity, they found that the chronically ill uninsured patients were four to six times more likely than sick patients with insurance to have these access problems.

People with chronic illnesses who don’t receive regular medical care run the risk of “catastrophic consequences,” Wilper said.

For example, individuals whose diabetes isn’t under control may wind up on dialysis for the rest of their lives, or need to have a limb amputated. Improving access to care could “prolong their life and prevent disabling complications and a lot of needless suffering,” he added.

In an editorial accompanying Wilper’s study, Dr. Marshall H. Chin of the University of Chicago writes, “Health care insurance reform is necessary for good care for chronic disease.” However, he adds, it won’t be enough until efforts are made to tackle disparities in health care.

Wilper noted that while both US presidential candidates are talking about health care reform, neither has a plan that will solve the issue of inadequate access to health care among chronically ill Americans. “Regardless of who wins the presidential election, for example, we won’t see the problem that we defined here go away.”

SOURCE: Annals of Internal Medicine, August 5, 2008.