Lack of health insurance associated with decreased use of health care services

Higher-income adults without health insurance are nearly as likely as lower-income adults without insurance to not use recommended health care services such as cancer screening, cardiovascular risk reduction and diabetes management, according to a study in the May 3 issue of JAMA.

More than 45 million Americans - nearly one-fifth of the non-Medicare population lack health insurance. Lacking health insurance has serious negative health consequences, according to background information in the article. Research has demonstrated that uninsured adults are less likely than insured adults to receive preventive services, such as screening for breast, cervical or colorectal cancer and not receiving recommended treatment for chronic illnesses, such as diabetes, arthritis or hypertension. Although the uninsured comprise a range of income levels, little attention has been directed at higher-income uninsured adults and their patterns of care.

Joseph S. Ross, M.D., of Yale University, New Haven, Conn., and colleagues examined whether an increased income weakens the association between being uninsured and using fewer recommended health care services. The researchers analyzed data from the 2002 Behavioral Risk Factor Surveillance System, a nationally representative telephone survey of households regarding medical history, health behaviors and health care use. Participants were community-dwelling adults (n = 194,943; 50 percent women) aged 18 to 64 years in 2002.

The researchers found that use varied widely across different types of recommended services. Among cancer prevention services, 51 percent of eligible adults used colorectal cancer screening while 88 percent of eligible women used cervical cancer screening. Among cardiovascular risk reduction services, 38 percent of obese adults received weight loss counseling while 81 percent of eligible adults with cardiovascular disease used aspirin regularly. Among services for diabetes management, 33 percent of

Contact: Karen Peart
JAMA and Archives Journals

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