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Issue: June 2006
June 01, 2006
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Study places actual numbers on health care gap between the insured and uninsured

The number of uninsured Americans over age 50 increased significantly to seven million.

Issue: June 2006

A new report quantifies the well-known gap between insured and uninsured Americans in health care access and their state of health.

Across the United States, 41.1% of uninsured adults, ages 18 to 64 years, reported they were unable to see a doctor when necessary in the past 12 months because of cost concerns — compared to just 9.2% of insured adults, according to the study released by the Robert Wood Johnson Foundation.

What's more, 22.5% of uninsured adults categorized their health as “fair” or “poor,” compared to 11.6% of insured adults. And 56.8% of uninsured adults do not have a personal doctor or health care provider, compared to 15.5% of insured adults. All reported differences were significant (P<.05), the study authors wrote.

Data not surprising

Ramon Jimenez, MD, of Salinas, Calif., and an Orthopedics Today editorial board member, said these numbers are not surprising.

“The delay in diagnosis that results only compounds the cost of the total health care dollar,” he told Orthopedics Today. “It is not only the cost of the health care premium but the additive costs of deductibles and co-pays that are imposing obstacles to care, even for the insured patient.”

What may be surprising are the report’s findings that the number of uninsured Americans aged 50 to 64 years increased by 2.6 million from 1994 to 2004 — for a total of seven million or 15% of this age group. This increase was most significant in the Midwest, which accounts for more than 1.3 million uninsured in this age group.

Uninsured delaying treatment

The report also confirmed that uninsured adults are much more likely to put off preventive and regular treatments. For example, just 22.8% of uninsured women, compared to 50.8% of insured women, received a mammogram in the last two years. The reports were similar for pap smears, prostate cancer screenings, blood stool tests and colonoscopies.

Alan H. Morris, MD, of St. Louis, told Orthopedics Today he has seen uninsured diabetic patients inappropriately treat foot calluses on their own, which can lead to dire consequences.

“Because of lack of access to prompt and proper care, osteomyelitis and amputation follow,” said Morris, who is also an Orthopedics Today editorial board member. “The poor and expensive outcome is obvious.”

State-by-state reports

The report also determined the states in which uninsured patients fared the best and the worst in each category:

  • States with the most uninsured adults who were not able to see a doctor when necessary: West Virginia (57%), Oregon (56%), Kentucky (54%), Washington (48%) and Maryland (47%).
  • States with the fewest uninsured adults unable to see a doctor: North Dakota (24%), Montana (32%), Wisconsin (33%), Nebraska (33%) and Massachusetts (34%).
  • States with the most uninsured adults who report their health is “fair” or “poor": Texas, California and Nevada.
  • States with the fewest uninsured adults who reported their health is “fair” or “poor”: Vermont, Alaska, Maryland and Wisconsin.
  • States with the most uninsured adults without personal doctors or health care providers: Minnesota, Arizona, Nevada and California.
  • States with the fewestleast uninsured adults without personal doctors or providers: Maine, Pennsylvania, Vermont and Delaware.

Researchers at the State Health Access Data Assistance Center at the University of Minnesota prepared the report for the Robert Wood Johnson Foundation. They used data from the U.S. Centers for Disease Control and Prevention’s 2004 Behavioral Risk Factor Surveillance System Survey — a national telephone survey on prevention and health risks.

“This data supports the concept that insurance for all Americans should be made available and affordable in order to have a healthy population,” Morris said.

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