Millions of Americans with chronic diseases, such as diabetes or high blood pressure, are not getting adequate treatment because they are among the nation's growing ranks of uninsured.
That is the central finding of a new study to be published today in the medical journal Annals of Internal Medicine.
The study, the first detailed look at the health of the uninsured, estimates that about one of every three working-age adults without insurance in the United States has received a diagnosis of a chronic illness. Many of these people are forgoing doctors' visits or relying on emergency rooms for their medical care, the study said.
The report, based on an analysis of government health surveys of adults ages 18 to 64 years old, estimated that about 11 million of the 36 million people without insurance in 2004 – the latest year of the study – had received a chronic-condition diagnosis.
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“These are people who, with modern therapies, can be kept out of trouble,” said Dr. Andrew Wilper, the study's lead author. Therapies for someone with diabetes and hypertension “are routine and widely available, if you have insurance,” said Wilper, a medical instructor at the University of Washington in Seattle.
The most recent government estimate of the number of people in this country without health insurance is 47 million, which means that if the proportions found in the study have remained constant, there might be nearly 16 million with a chronic condition but no insurance to pay for medical care.
Nearly a quarter of the uninsured with a chronic illness who were surveyed said they had not visited a health professional within the last year. About 7 percent said they typically went to a hospital emergency room for care.
“A lot of people are suffering from a lack of health insurance,” said Dr. Steffie Woolhandler, another of the study's authors, who is a physician and associate professor of medicine at Harvard.
People with high blood pressure, for example, are at risk for catastrophic medical events like a stroke if they are not getting the drugs they need or having a doctor monitor their disease, said Karen Davis, president of the Commonwealth Fund. The fund, a foundation in New York that specializes in health care research, has done its own research into the lack of adequate medical care among the uninsured.
The study may have underestimated exactly how many people who are uninsured have a chronic illness, because it includes only those who have already received such a diagnosis, the authors said. Individuals who have not had their conditions diagnosed because they are not seeing a doctor or nurse are not included.
The study's authors say that their findings cast doubt on the common assumption that many of the uninsured tend to be young and healthy, requiring little in the way of medical care. Because so many actually have chronic conditions that may be expensive to treat, the cost of covering the uninsured is often underestimated, said Woolhandler, who advocates a nationalized system of health care.
In Massachusetts, she said, the state's effort to overhaul its health insurance system to cover more residents is costing much more than expected and has not led to universal coverage because policy makers assumed that more people would be healthy.
“The state experiments have all failed because of cost,” Woolhandler said.
The study describes harsh consequences for neglecting easily treatable diseases in so many people.
“For some of the 11.4 million uninsured Americans with serious chronic conditions, access to care seems to be unobtainable; many may face early disability and death as a result,” the study's authors said.