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Original Contribution
March 14, 2007

Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition

Author Affiliations

Author Affiliation: The Urban Institute, Washington, DC.

JAMA. 2007;297(10):1073-1084. doi:10.1001/jama.297.10.1073

Context Given the large and increasing number of uninsured US individuals, identifying the health consequences of being uninsured has assumed increased importance.

Objective To compare medical care use and short-term health changes among US uninsured individuals and insured nonelderly individuals following a health shock caused by either an unintentional injury or the onset of a chronic condition.

Design, Setting, and Participants Multivariate logistic regression analysis of longitudinal data from Medical Expenditure Panel Surveys (1997-2004) limited to nonelderly individuals whose insurance status was established for 2 months prior to 1 or more unintentional injuries (20 783 cases among 15 866 individuals) and onset of 1 or more chronic conditions (10 485 cases among 7954 individuals).

Main Outcome Measures Self-reported medical care use and change in short-term general health status following the health shock.

Results After experiencing a health shock, uninsured individuals were less likely to obtain any medical care (unintentional injury [UI] group: 78.8% uninsured vs 88.7% insured [adjusted odds ratio {AOR}, 0.47; 95% confidence interval {CI}, 0.43-0.51]; new chronic condition [NCC] group: 81.7% uninsured vs 91.5% insured [AOR, 0.45; 95% CI, 0.40-0.50]) and more likely not to have received any recommended follow-up care (UI group: 19.3% uninsured vs 9.2% insured [AOR, 2.59; 95% CI, 2.15-3.11]; NCC group: 9.4% uninsured vs 4.4% insured [AOR, 1.65; 95% CI, 1.32-2.06]). Based on the AORs, uninsured individuals with UIs had fewer outpatient visits (6.1% uninsured vs 9.0% insured; AOR, 0.71 [95% CI, 0.63-0.80]), office-based visits (41.8% uninsured vs 57.3% insured; AOR, 0.59 [95% CI, 0.56-0.62]), and prescription medicines (35.5% uninsured vs 35.6% insured; AOR, 0.71 [95% CI, 0.67-0.75]). Uninsured individuals with an NCC had fewer office-based visits (58.9% uninsured vs 68.3% insured; AOR, 0.77 [95% CI, 0.72-0.82]) and prescription medicines (52.7% uninsured vs 61.7% insured; AOR, 0.66 [95% CI, 0.57-0.76]). Higher proportions of uninsured individuals reported a decrease in health status (classified as much worse) approximately 3.5 months after the health shock (UI group: 9.8% uninsured vs 6.7% insured; AOR, 0.86 [95% CI, 0.75-0.98]; NCC group: 12.3% uninsured vs 10.1% insured; AOR, 0.74 [95% CI, 0.68-0.80]). Uninsured individuals with UIs were more likely to report not being fully recovered and no longer receiving treatment. At approximately 7 months after the health shock, uninsured individuals with NCCs still reported worse health status.

Conclusions Among individuals who experienced a health shock caused by an unintentional injury or a new chronic condition, uninsured individuals reported receiving less medical care and poorer short-term changes in health than those with insurance.