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Cost: A Deadly Barrier to Health Care

Heart Attacks Worse for People Who Can't Pay

Ill Uninsured in 'Death Spiral' continued...

Injuries included any kind of athletic or nonathletic accident -- a sprained ankle, for example, or injuries from a car crash. Chronic illnesses were new diagnoses of chronic conditions -- heart attacks, cancer, diabetes, and so on.

After one of these "health shocks," compared with people with health insurance, people without health insurance were:

  • 53% less likely to get medical care after an accident and 55% less likely to get medical care after a newly diagnosed chronic condition.
  • 2.6 times less likely to get recommended follow-up care after an accident and 65% less likely to get recommended follow-up care after diagnosis of a new chronic condition.
  • 29% less likely to get prescription medicines.

An average 3.5 months after a health shock, those without insurance were 14% more likely to say they were much worse off after an injury and 26% more likely to say they were much worse off after diagnosis of a chronic illness.

Seven months after a health shock, uninsured people were still more likely to report much worse health.

"The uninsured are significantly less likely to say they are not fully recovered -- and not because they are still in treatment," Hadley said at the news conference. "They have ended their treatment process and still are not recovered."

For those with a chronic illness, this lack of treatment may be the beginning of the end.

"This can lead to a death spiral -- a literal death spiral," Hadley said. "If you are not treated for a chronic illness, your risk of death increases over time."

Cost of Insurance vs. Cost of Uninsurance

Hadley said his study dispels the myth that people without health insurance somehow find a way to get medical care.

The Journal of the American Medical Association Editor-in-Chief Catherine D. DeAngelis, MD, MPH, told the news conference that the U.S. spends 2 trillion dollars -- that's $2,000,000,000,000 -- on health care.

Yet 47 million Americans -- including 9 million children -- lack health insurance. And an estimated 16 million more Americans are underinsured.

"And how many millions with insurance still don't have access to health care?" she asked.

Hadley said the cost of providing health insurance to uninsured Americans is far less than the cost of having so many Americans uninsured.

"There are substantial costs to not covering the uninsured," he said. "One is the loss of health to the uninsured people. Second is their lost productivity -- that, in turn, has spillover to the rest of society. And if we don't pay for their insurance, we pay for the increased costs [to the health care system]."


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