A new study, titled "Chronically Ill and Uninsured: A National Study of Disease Prevalence and Access to Care in U.S. Adults," published in the Aug. 5 edition of Annals of Internal Medicine, shows that more than 11 million Americans with chronic physical illnesses aren't getting the medical care they need because of a lack of health insurance. Authors of the study say that this is the one of the first real studies that provides a national estimate of the number of uninsured adults with these potentially serious but treatable conditions.

According to the report, working-age adults with one or more chronic illnesses who reported they were uninsured were nearly four times more likely than their insured counterparts to have not seen a health professional within the past year (22% vs. 6.2%). They were also six times more likely to identify a hospital emergency room as their standard site for care when sick – which is a huge problem in itself, according to Andrew Wilper MD, the study's lead author.

Wilper, who currently teaches at the University of Washington School of Medicine (Seattle), was a fellow at Harvard University (Cambridge, Massachusetts) and the Cambridge Health Alliance when the study was carried out.

"What I fear happening is these people who are uninsured are forced to rely on the Emergency department and it's a different kind of therapy – specifically for emergencies," Wilper told Medical Device Daily. "The ideal place to get medical care is from physicians, who're familiar with your records, and your past history. That's not what the emergency room is designed to do."

Steffie Woolhandler, MD, a co-author of the study, and an associate professor of medicine at Harvard and a primary care physician in Cambridge, Massachusetts, added that "Some claim that uninsured Americans can get the care they need in emergency rooms. But emergency rooms may provide too little, too late for the millions of uninsured with chronic conditions. They need regular medical monitoring, and a steady supply of medications to control their illnesses, and a whole array of services that are out of reach for the uninsured."

Instead, what often happens is the snowball effect, and potentially manageable illness turns into a chronic illness.

"Most of the conditions are treatable, and can be well controlled," he said. "There are a lot of people that have treatable medical conditions. But they are locked out of having a quality standard of healthcare. Some plans, for example, require people to pay medical bills of $5,000 out-of-pocket before their insurance kicks in. These plans put people in the precarious state of being underinsured, which is not that much better than lacking health insurance altogether."

Of those illnesses, hypertension and high cholesterol ranked high above them both.

For a little more than a year Wilper's team analyzed data from surveys conducted by the National Center for Health Statistics. The team found that there are 11.4 million non-elderly adults with one or more chronic conditions who lack health insurance, including 1.3 million who survived a heart attack or stroke, 5.9 million with high blood pressure, 1.4 million with diabetes, and 3.5 million with asthma or emphysema.

Individuals with at least one of these conditions, or with high cholesterol or prior cancer (excluding minor skin cancers), were considered to have a chronic illness.

The 11.4 million figure represents about one-third of the total number of uninsured people in the U.S. between the ages of 18 and 64. Altogether, about 47 million Americans lacked health insurance in 2006, according to the U.S. Census Bureau.

The authors say they may have underestimated the number of chronically ill persons who lack insurance because the survey did not query participants about depression or other chronic mental illnesses, and because undiagnosed physical diseases among the uninsured may be common.

For the past year, presidential candidates have been touting healthcare plans, and the number of 46 million uninsured Americans has been etched in people's minds.

In June the Senate grappled over healthcare reform, saying that virtually any sweeping changes are likely to boost, not trim, the cost of healthcare in the U.S. in the early going (Medical Device Daily, June 17, 2008). Prior to that during a Chronic Care Congress Meeting just outside the nation's capital, panelists at a discussion called "Should Retail Clinics Manage Chronic Disease?" cited that three-fourths of all U.S. healthcare expenditures are for chronic diseases (MDD, June 4, 2008).

"We need some way of having non-profit health insurance to get everyone insured," Woolhandler told MDD. "That's what we're seeing most countries do. You can't pretend there's some cheap and easy way to mandate healthcare."

Karen Lasser, MD; Danny McCormick, MD; David Bor, MD; and David Himmelstein, MD, along with Woolhandler and Wilper were authors of the report. Annals of Internal Medicine is published by the American College of Physicians (Philadelphia).

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