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Illness Neglected Among Adults Without Health Insurance


Adults who do not have health insurance are likely to have a chronic illness such as diabetes or high cholesterol and not even know it, according to the results of a new study conducted by a research team from Harvard Medical School and Cambridge Health Alliance. When such illnesses go undiagnosed and untreated, the uninsured are at greater risk of expensive, disabling, and deadly complications of their disease.

The researchers evaluated the data from nearly 16,000 adults ages 18 to 64 who had participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2006. None of the subjects had health insurance, and they represented 21.7 percent of the more than 41,000 people who participated in NHANES.

All of the participants in the current study were questioned about their health and financial situation and then examined by physicians, who also ordered laboratory tests. Test results detected diabetes in 46 percent of the participants and high cholesterol in 52 percent. None of these individuals had known about these conditions before the study. In comparison, among people who had health insurance, 23 percent were unaware they had diabetes and 29.9 percent did not know they had high cholesterol.

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Being aware you have an illness and getting it treated properly are two different things, and the researchers found that undertreatment of illness was high among people regardless of whether they had health insurance. Among the uninsured, 58.3 percent were undertreated for high blood pressure versus 51.4 percent among those with insurance. For people who had high cholesterol, 77.5 percent of those without health insurance were untreated compared with 60.4 percent of those who had insurance.

Having health insurance did not appear to ensure people with diabetes had it under control. The study’s authors found that even patients who had excellent medical care did not achieve low hemoglobin A1c levels (lower than 7), which is a standard measure of good diabetes control.

The complications associated with high blood pressure, high cholesterol, and diabetes are often life-altering, debilitating, and even deadly. Stroke, kidney failure, heart attack, amputations, blindness, neuropathy, and other serious medical problems can be prevented or at least significantly reduced if people undergo proper diagnostic screenings and receive adequate treatment for preventable conditions. The lack of health insurance is a major hurdle to receiving such care. Lack of health insurance has also been linked to more than 45,000 deaths per year.

In a quote from a news release from the Physicians for a National Health Program, Dr. Steffie Woolhandler, professor of medicine at Harvard and a coauthor of the study noted that “The uninsured suffer the most,” but that even among people who have health insurance, there are “shocking rates of undertreatment, in part because high co-payments and deductibles often make care and medications unaffordable.” While making health insurance available to those who do not have coverage is important, ensuring that the insurance is affordable, including copays, medications, and deductibles, is critical, or the insurance will fail to provide what it was intended to do.

Physicians for a National Health Program
Pizer SD et al. Health Affairs online, October 20, 2009
Wilper AP et al. Health Affairs online, October 20, 2009