Coverage leads to better health
Doubts about the value of health insurance coverage should disappear with the release of Care Without Coverage, a report from the Institute of Medicine’s Committee on the Consequences of Uninsurance. The report summarizes findings from 130 research studies that considered (1) health insurance status as an independent variable and (2) its effect on health-related outcomes for adults ages 18 to 64.
Health insurance emerges in the research as a key that provides access to high quality health care and consequently to better health. "It is not the only key that opens these doors, nor is access to them guaranteed if one has coverage," the report says. "But health insurance is the mechanism that most Americans rely upon to obtain the care that they want and need. The health benefits of insurance are strongest when coverage is continuous rather than sporadic."
The main findings are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late, be sicker, and die sooner, and receive poorer care when they are in the hospital even for acute situations like a motor vehicle crash.
The research studies reviewed found that people without health insurance often go without appropriate care. For example, the uninsured more often go without cancer screening tests, delaying diagnosis and leading to premature death; do not receive care recommended for chronic diseases like timely eye and foot exams to prevent blindness and amputation in persons with diabetes; lack regular access to medications to manage conditions such as hypertension or HIV infection; and receive fewer diagnostic and treatment services after a traumatic injury or heart attack, resulting in an increased risk of death even when in the hospital.
Based on the consistency among the research studies reviewed and evaluated, the committee reached these conclusions:
• Health insurance is associated with better health outcomes for adults and with their receipt of appropriate care across a range of preventive, chronic, and acute care services. Adults without health insurance experience greater declines in health status and die sooner than do adults with continuous coverage.
• Adults with chronic conditions and those in late middle age stand to benefit the most from health insurance coverage in terms of improved health outcomes because of their generally greater need for health care.
• Racial and ethnic minorities and lower-income adults would particularly benefit from increased health insurance coverage because they more often lack stable health insurance coverage and have worse health status. Increased coverage would likely reduce some of the racial and ethnic disparities in use of appropriate health care services and also may reduce disparities in morbidity and mortality.
• Health insurance that ensures adequate provider participation and that includes preventive and screening services, outpatient drugs, and specialty mental health care is more likely to facilitate receipt of appropriate care.
• Broad-based health insurance strategies across the entire uninsured population would be more likely to produce these benefits than would "rescue" programs aimed only at those who are seriously ill.
If the uninsured were provided with coverage, the report suggests, they would be likely to use more services like timely preventive care and chronic disease care that match professional guidelines. They also would be more likely to have a regular source of care. And if they were insured continuously, their health would be expected to be better and their risk of dying prematurely would be reduced.
However, the survivor benefits derived from insurance coverage can be achieved in full only when health insurance is acquired well before development of advanced disease. For example, insuring women once cancer is diagnosed will not solve the problem of later diagnosis and higher mortality among uninsured women with breast cancer.
(To download a summary of the report, go to: www.iom.org.)
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