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Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet Health Needs of Uninsured Adults in the United States. JAMA. 2000;284(16):2061–2069. doi:10.1001/jama.284.16.2061
Author Affiliations: Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (Drs Ayanian and Schneider), Department of Health Care Policy, Harvard Medical School (Drs Ayanian, Weissman, and Zaslavsky), Institute for Health Policy, Massachusetts General Hospital (Dr Weissman), and Department of Health Policy and Management, Harvard School of Public Health (Dr Schneider), Boston, Mass; and the American College of Physicians-American Society of Internal Medicine (Mr Ginsburg), Washington, DC.
Context In 1998, 33 million US adults aged 18 to 64 years lacked health insurance.
Determining the unmet health needs of this population may aid efforts to improve
access to care.
Objective To compare nationally representative estimates of the unmet health needs
of uninsured and insured adults, particularly among persons with major health
Design and Setting Random household telephone survey conducted in all 50 states and the
District of Columbia through the Behavioral Risk Factor Surveillance System.
Participants A total of 105,764 adults aged 18 to 64 years in 1997 and 117,364 in
1998, classified as long-term (≥1 year) uninsured (9.7%), short-term (<1
year) uninsured (4.3%), or insured (86.0%).
Main Outcome Measures Adjusted proportions of participants who could not see a physician when
needed due to cost in the past year, had not had a routine checkup within
2 years, and had not received clinically indicated preventive services, compared
by insurance status.
Results Long-term– and short-term–uninsured adults were more likely
than insured adults to report that they could not see a physician when needed
due to cost (26.8%, 21.7%, and 8.2%, respectively), especially among those
in poor health (69.1%, 51.9%, and 21.8%) or fair health (48.8%, 42.4%, and
15.7%) (P<.001). Long-term–uninsured adults
in general were much more likely than short-term–uninsured and insured
adults not to have had a routine checkup in the last 2 years (42.8%, 22.3%,
and 17.8%, respectively) and among smokers, obese individuals, binge drinkers,
and people with hypertension, elevated cholesterol, diabetes, or human immunodeficiency
virus risk factors (P<.001). Deficits in cancer
screening, cardiovascular risk reduction, and diabetes care were most pronounced
among long-term–uninsured adults.
Conclusions In our study, long-term–uninsured adults reported much greater
unmet health needs than insured adults. Providing insurance to improve access
to care for long-term–uninsured adults, particularly those with major
health risks, could have substantial clinical benefits.
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