One in three uninsured people have a chronic illness

According to a study from The Annals of Internal Medicine, out of 36 million people without health insurance, 11 million have been diagnosed with a chronic illness. How many more suffer with chronic disease that don’t know because they haven’t even been able to get to a doctor to get diagnosed? How much more will it cost to treat these patients when they need emergency treatment rather than preventative maintenance?

Article from the NY Times below:

Millions With Chronic Disease Get Little to No Treatment

Reed Abelson, New York Times, August 5, 2008

Millions of Americans with chronic disease like diabetes or high blood pressure are not getting adequate treatment because they are among the nation’s growing ranks of uninsured.

That is the central finding of a new study to be published Tuesday in the medical journal Annals of Internal Medicine.

The study, the first detailed look at the health of the uninsured, estimates that about one of every three working-age adults without insurance in the United States has received a diagnosis of a chronic illness. Many of these people are forgoing doctors’ visits or relying on emergency rooms for their medical care, the study said.

The report, based on an analysis of government health surveys of adults ages 18 to 64 years old, estimated that about 11 million of the 36 million people without insurance in 200 the latest year of the study had received a chronic-condition diagnosis.

“These are people who, with modern therapies, can be kept out of trouble,” said Dr. Andrew P. Wilper, the study’s lead author. Therapies for someone with diabetes and hypertension “are routine and widely available, if you have insurance,” said Dr. Wilper, a medical instructor at the University of Washington in Seattle.

The most recent government estimate of the number of people in this country without health insurance is 47 million, which means that if the proportions found in the study have remained constant, there might be nearly 16 million people in this country with a chronic condition but no insurance to pay for medical care.

Nearly a quarter of the uninsured with a chronic illness who were surveyed said they had not visited a health professional within the last year. About 7 percent said they typically went to a hospital emergency room for care.

“A lot of people are suffering from a lack of health insurance,” said Dr. Steffie Woolhandler, another of the study’s authors, who is a physician and associate professor of medicine at Harvard.

People with high blood pressure, for example, are at risk for catastrophic medical events like a stroke if they are not getting the drugs they need or having a doctor monitor their disease, said Karen Davis, the president of the Commonwealth Fund. The fund, a foundation in New York that specializes in health care research, has done its own research into the lack of adequate medical care among the uninsured.

The study, being published Tuesday, may have underestimated exactly how many people who are
uninsured have a chronic illness, because it includes only those who have already received such a diagnosis, the authors said. Individuals who have not had their conditions diagnosed because they are not seeing a doctor or nurse are not included.

The study’s authors say that their findings cast doubt on the common assumption that many of the uninsured tend to be young and healthy, requiring little in the way of medical care. Because so many actually have chronic conditions that may be expensive to treat, the cost of covering the uninsured is often underestimated, said Dr. Woolhandler, who advocates a nationalized system of health care.

In Massachusetts, she said, the state’s effort to overhaul its health insurance system to cover more residents is costing much more than expected and has not led to universal coverage because policy makers assumed that more people would be healthy. “The state experiments have all failed because of cost,” she said.

The study describes harsh consequences for neglecting easily treatable diseases in so many people. “For some of the 11.4 million uninsured Americans with serious chronic conditions, access to care seems to be unobtainable; many may face early disability and death as a result,” the study’s authors said.

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Study from The Annals of Internal Medicine below:

Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, David U. Himmelstein.

A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults.

Annals of Internal Medicine. 149(3):170-176. 5 August 2008.

Background: No recent national studies have assessed chronic illness prevalence or access to care among persons without insurance in the United States.

Objective: To compare reports of chronic conditions and access to care among U.S. adults, by self-reported insurance status.

Design: Population-based survey.

Setting: National Health and Nutritional Examination Survey (1999–2004).

Participants: 12 486 patients age 18 to 64 years.

Measurements: Estimates of national rates of cardiovascular disease, hypertension, diabetes, hypercholesterolemia, active asthma or chronic obstructive pulmonary disease, previous cancer, and measures of access to care.

Results: On the basis of National Health and Nutrition Examination Survey (1999–2004) responses, an estimated 11.4 million (95% CI, 9.8 million to 13.0 million) working-age Americans with chronic conditions were uninsured, including 16.1% (CI, 12.6% to 19.6%) of the 7.8 million with cardiovascular disease, 15.5% (CI, 13.4% to 17.6%) of the 38.2 million with hypertension, and 16.6% (CI, 13.2% to 20.0%) of the 8.5 million with diabetes. After the authors controlled for age, sex, and race or ethnicity, chronically ill patients without insurance were more likely than those with coverage to have not visited a health professional (22.6% vs. 6.2%) and to not have a standard site for care (26.1% vs. 6.2%) but more likely to identify their standard site for care as an emergency department (7.1% vs. 1.1%) (P <0.001 for all comparisons).

Limitation: The study was cross-sectional and used self-reported insurance and disease status.

Conclusion: Millions of U.S. working-age adults with chronic conditions do not have insurance and have poorer access to medical care than their insured counterparts.