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ACP-ASIM Pressroom

Uninsured Americans Not Receiving Necessary Care According to Newly Released JAMA Study

Researchers from Harvard, ACP-ASIM, Massachusetts General Hospital Find More Uninsured Are Forgoing Care and Putting Their Health in Jeopardy

High proportions of uninsured adults are not getting needed medical care despite the growing perception to the contrary according to a new study in the Oct. 25 issue of the Journal of the American Medical Association titled "Unmet Health Needs of Uninsured Adults in America."

The study examined 1997 and 1998 survey data for more than 220,00 adults between the ages of 18 and 64 from the Centers for Disease Control and Prevention's Behavioral Task Force. About 14 percent of the respondents lacked health insurance and 10 percent had gone without health insurance for an entire year, mirroring the national average of the 163 million adults living in households with telephones in the United States.

"Studies such as this one prove that living without insurance is a serious health risk that needs to be treated with the same sense of urgency as not wearing seatbelts or drunken driving," says Sandra Adamson Fryhofer, president of the American College of Physicians-American Society of Internal Medicine, the group that funded the study. "This evidence proves that preventive care is crucial to the health and well-being of the patient. Unfortunately, those without insurance often cannot get treatment for diseases such as diabetes, and consequently undergo unnecessary hospitalizations and more costly treatments."

Nearly 70 percent of the respondents who reported being in poor health and 50 percent who reported being in fair health said they could not see a physician when needed in the past year due to cost.

For highly recommended preventive services, long-term uninsured adults (those that were without health insurance for more than one year) were three and a half times less likely to receive cardiovascular risk reduction services such as hypertension and cholesterol screening; 25 percent less likely to have had a mammogram; and three to four times less likely to have had a screening for breast cancer.

"Many uninsured adults are going without proper medical attention," says the study's lead author, John Ayanian, MD, MPP, FACP associate professor of medicine and of health care policy at Harvard Medical School and Brigham and Women's Hospital. "Thirty-two percent of women without health insurance for over a year report not getting a mammogram in the past two years. Twenty-six percent of the long-term uninsured with hypertension or diabetes say they haven't had a check-up with a doctor in two years. From a public health perspective, these numbers are very concerning."

The findings dispute the views of recent national surveys that show a growing proportion of the country's population - 43 percent in 1993 and 57 percent in 1999 - believe that uninsured Americans are able to get the care they need from physicians and hospitals. Furthermore, failing to monitor or effectively treat chronic illnesses such as hypertension or diabetes in uninsured adults can result in increases in morbidity and health care costs.

The instrument used to conduct this study, the Behavioral Risk Factor Surveillance System (BRFSS), was created in 1984 and initially launched in 15 states. The BRFSS has collected data annually through telephone interviews of adults aged 18 years or older residing in households. Since 1994, all 50 states and the District of Columbia have administered the survey and submitted data to the Centers for Disease Control and Prevention. This study included adults aged 18 to 64 years from all 50 states and the District of Columbia who completed the 1997 and 1998 survey, including 105,764 respondents in 1997 and 117,634 in 1998. Respondents who reported having health insurance from any private or public source (including Medicare, Medicaid, and military or veterans' coverage) were classified as insured. Adults older than 64 were excluded because almost all are eligible for Medicare insurance.

Dr. Ayanian and the study's co-authors, Joel Weissman, PhD, Massachusetts General Hospital assistant professor of medicine, Eric Schneider, MD, MSc, Harvard School of Public Health instructor in medicine and health policy and management, Jack Ginsburg, MPE, American College of Physicians-American Society of Internal Medicine, and Alan Zaslavsky, PhD, Harvard Medical School associate professor of statistics, were funded by a grant from the American College of Physicians-American Society of Internal Medicine.

ACP-ASIM funded the study as part of its million-dollar Decision 200 campaign to raise awareness about the struggles the 43 million uninsured Americans face everyday.

ACP-ASIM is the nation's largest medical specialty organization and the second largest physician group. Membership comprises more than 115,000 internal medicine physicians and medical students. Internists are the major providers of medical care to adults in America and treat more Medicare patients than any other medical specialists.


David Edelson, ACP-ASIM Washington Office, 202 261-4575
Jack E. Pope, ACP-ASIM Washington Office, 202-261-4556
Page updated: 11-03-03

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