Uninsured patients don't manage chronic illness well, UCSF study finds

Compared to insured health care consumers, uninsured people are much less effective at managing their illnesses. Specifically, they have frequent health crises, difficulty getting medication and using it correctly, poor understanding of their illness and little knowledge about self-care or risk awareness, according to Gay Becker, PhD, professor of medical anthropology in the UCSF Institute for Health and Aging. The findings appear in the July issue of Western Journal of Medicine.

While the insured reported occasional health crises, the uninsured reported an ongoing chain of health crises. This suggests that being uninsured with a chronic illness may lead to greater illness severity and premature death, Becker said. It may also account, in part, for higher death rates for certain illnesses such as hypertension and diabetes among the uninsured, she said.

"Effective illness management has a battery of components, including symptom recognition; understanding how a particular illness works; and following a daily regimen that includes regular medication use, self-care practices, and risk awareness and prevention. The uninsured are simply unable to articulate these different components," said Becker. She explained that uninsured respondents rarely had a regular physician or consistently used a specific health clinic. In addition, they constantly struggled to secure medication.

"Despite perceptions of poor, uninsured persons as inattentive, problem-ridden, and difficult to treat, the uninsured are trying to control their illnesses. Although they often have many other concerns, such as securing adequate food, shelter, finances, and caring for family members, they appreciate information about illness management and try to act on medical advice," said Becker. She added that this research attests to the critical importance of free community clinics for the uninsured.

Becker suggests that health providers can make a difference in three ways:

Contact: Maureen McInaney
University of California - San Francisco

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