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From
the January 2000 ACP-ASIM Observer, copyright © 1999 by the
American College of Physicians-American Society of Internal Medicine.
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"No Health Insurance? It's Enough to Make You Sick" challenges the myth that those who need medical attention—but lack health insurance—have other resources readily available to them such as clinics that provide free care. The report, which is part of the College's "Decision 2000" campaign to make access to health care a key issue in this election year, was praised by several presidential candidates and many health care groups.
"These kinds of dangerous myths have frustrated universal health coverage in this country," ACP-ASIM President Whitney W. Addington, FACP, said at a Nov. 30 Washington news conference where the report was released. "There is no doubt in my mind that if the majority of Americans knew about the dangers of being uninsured, they would demand immediate attention."
Currently, more than 44 million Americans, or 16% of the population, lack health insurance, a number that is growing by 100,000 people per month. To examine the health of these people, the College report analyzed 100 studies that document the dangers of living without health insurance.
"The evidence shows that uninsured people are more likely to delay getting needed care," Dr. Addington said at the press conference. "They are more likely to forego life-saving tests such as mammograms, let prescriptions go unfilled and neglect follow-up care needed to effectively treat illnesses. In short, the care the uninsured receive is fragmented and is often for conditions that could have been prevented in the first place by an earlier visit."
The report points out that the uninsured may be three times more likely than the insured to experience adverse outcomes. This is partly because uninsured individuals are less likely to have a regular source of care or to have visited a physician recently. They are also less likely to use preventive services.
The report also states that uninsured individuals are more likely to delay seeking care or to report that they have not received needed care. In the long run, this missed or delayed care "may result in unnecessary sickness, greater severity of illness or even premature death," said Dr. Addington.
The report finds that compared with insured individuals, those without health insurance are four times more likely to require potentially avoidable hospitalizations and emergency hospital care for conditions such as asthma, diabetes, congestive heart failure, hypertension or ulcers. The report also states that the uninsured are 3.2 times more likely to die in the hospital.
"In short, uninsured Americans tend to live sicker and die earlier than insured Americans," Dr. Addington said. "We hope this report serves as a wake-up call for the American public that something has to be done to reduce the number of uninsured in this country."
Several presidential candidates immediately responded to the report's findings. Democratic presidential candidate Al Gore applauded the College for releasing the report. "I believe this report can and should help to reinvigorate the debate about how to address this national challenge and help lead us to the day when every American has access to affordable health care coverage," he said in a statement.
Democratic candidate Bill Bradley congratulated the College for this "important scientific research," and said in a statement that he hopes "an unstoppable consensus will develop around the goal to help all Americans have access to quality health care."
Sen. John McCain, a Republican presidential candidate, complimented ACP-ASIM on its "efforts to bring America's rising uninsured population to the forefront of issues which must be confronted by the next president."
The report also has received support from 18 primary and specialty physician organizations, hospital groups, consumer groups and other medical organizations.
A transcript of Dr. Addington's speech can be found in the "Where We Stand" section of ACP-ASIM Online under "Access to Care."
The College's new report finds that people without health insurance face serious health risks. Here are the report's key findings:
Uninsured Americans have been found to be up to four times as likely as insured patients to require avoidable hospitalizations and emergency hospital care.
Uninsured children are up to 40% less likely to receive medical attention for a serious injury.
Uninsured women with breast cancer have a 49% higher adjusted risk of death.
Uninsured Americans are up to 3.2 times more likely to die in the hospital.
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