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Barriers to care get higher when adults are ill, uninsured

Their greater medical needs, at higher costs, have implications for the debate about health coverage expansion.

By Amy Snow Landa, amednews staff. March 11, 2002.

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Washington -- For working-age Americans with at least one chronic health condition, the lack of health insurance coverage presents a significant, even life-threatening, problem.

Those who lack coverage are three times more likely not to get the medical care they need than working-age adults with chronic conditions who have private insurance, according to research findings released last month by the Center for Studying Health System Change.

One out of two uninsured adults age 18 to 64 with chronic conditions said they either could not get needed care or delayed getting needed care at least once in the previous year, according to HSC. The findings are based on a national survey conducted in 1998-99.

Without good access to health care, people with chronic conditions such as diabetes, heart disease and hypertension are at higher risk for serious disability.

"I have treated diabetics who have postponed care for so long that they are legally blind," said Margarita Pereyda, MD, who serves as the medical director of the South Country Community Health Center in East Palo Alto, Calif.

In fact, almost 40% of uninsured adults with chronic conditions reported they were in fair or poor health -- more than twice the rate of those with private insurance.

Uninsured adults with chronic conditions also tend to have low incomes, which means the treatment they need is often unaffordable.

About 7.4 million working-age adults with chronic conditions were uninsured in 1999, according to the study. Nearly two-thirds of them had incomes below 200% of the federal poverty level, which is $17,720 a year for an individual and $30,040 for a family of three. [...]