Occasional lack of health insurance results in less preventive care

People with even short breaks in their health insurance coverage are less likely to seek crucial preventive care, according to a new study from researchers at the Case Western Reserve University School of Medicine and MetroHealth Medical Center. The study appears in the Dec. 30 issue of the American Journal of Public Health.

"While past research has found that patients who are uninsured for long periods are less likely to seek recommended follow-up care, care for chronic conditions and crucial preventive care, we find that even a single episode of being uninsured during a period of four years decreased the likelihood of preventive service use," says Joseph J. Sudano, Jr., Ph.D., lead author and senior instructor of medicine in the Center for Health Care Research and Policy at CWRU and MetroHealth. "Also, with higher unemployment and double digit health cost inflation, our increasingly service economy will not be able to support health insurance, increasing barriers to care for many employed folks," he says.

In a study sample of 7,300 people, ages 51 to 61, who responded to a national health survey in 1992, 1994 and 1996, researchers found that intermittent lack of insurance coverage resulted in lower use of clinical preventive services. Particularly lacking: cholesterol tests, pap tests and mammograms among women, and prostate cancer screening for men. Other studies have shown that early breast cancer screening can reduce death rates by up to 60 percent.

"Our results extend the findings of other studies showing that periods of noncoverage increase people's risk of going without needed care and increase the likelihood that they will report problems involving access to care," says Sudano.

Furthermore, Sudano says that studies focused on the effects of current insurance status may seriously underestimate the pool of individuals who are potentially vulnerable to the effects of being uninsured. "Additional policy initiatives are needed to promote stability in insurance coverage," he says.

Co-author of the study is David Baker, M.D., M.P.H., who at the time of the study was assistant professor of medicine at the CWRU School of Medicine and MetroHealth and is now at the Feinberg School of Medicine at Northwestern University. The research was partially supported by the Agency for Healthcare Research and Quality.

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