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Invited Commentary
January 27, 2020

Looking Back to Improve Access to Health Care Moving Forward

Author Affiliations
  • 1Institute for Healthcare Policy and Innovation and the Division of General Medicine, University of Michigan, Ann Arbor
JAMA Intern Med. 2020;180(3):448-449. doi:10.1001/jamainternmed.2019.6764

Life must be understood backwards. But…it must be lived forwards.

Søren Kierkegaard, 1843

In October 2000, colleagues and I published a study in JAMA of unmet health needs among uninsured adults in the United States during 1997 and 1998.1 At that time, 44 million US adults aged 18 to 64 lacked health insurance. Using nationally representative data from the Behavioral Risk Factor Surveillance System (BRFSS) administered by the Centers for Disease Control and Prevention (CDC) and state health departments, we found uninsured adults aged 18 to 64 were much more likely than their insured counterparts to have gone without seeing a physician when needed because of cost, especially among those reporting fair or poor health (Figure). Uninsured adults were also more likely to lack recommended preventive services and routine check-ups for long-term health conditions. This study appeared in a JAMA theme issue on health care systems and access to care alongside invited commentaries by US presidential candidates George W. Bush and Al Gore outlining their respective policy proposals for health care during the final phases of their campaigns.

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