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Cost: A Deadly Barrier to Health Care

Heart Attacks Worse for People Who Can't Pay
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Ill Uninsured in 'Death Spiral'

The Krumholz study showed that health insurance doesn't guarantee proper health care. But when you suffer a health shock, it's a lot better than no health insurance, finds Jack Hadley, PhD, an economist at the nonprofit Urban Institute in Washington, D.C.

Hadley analyzed data from the Medical Expenditure Panel Surveys. The surveys consist of in-person interviews with a national sample of nonelderly Americans, spaced four or five months apart. Nearly 16,000 U.S. residents answered questions about unintentional injuries and nearly 8,000 provided information on the onset of chronic illnesses.

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."

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