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Jack Hadley, PhD

JAMA. 2007;297:1073-1084.

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.

Author Affiliation: The Urban Institute, Washington, DC.

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